We’re All Leaders Now:
Physicians as Leaders in the Changing World of Radiology
By: Patricia Kroken, FACMPE, CRA, FRBMA
Updated from version originally published in the RBMA Bulletin Nov/Dec 2015
A New Lens
We need a new lens through which to view the role of practice leadership, especially as a changing business environment introduces new demands. Radiologists have less security in their hospital professional services agreements and turf is no longer defined with geographic boundaries and protections.
In addition, we face the looming specter of payment mechanisms based on still undefined “value” measures. It’s time to take a cold hard look both at how groups have traditionally defined leadership and what it means to be a leader in today’s increasingly unforgiving world.
Group leadership is often influenced by the size and structure of the practice. In smaller groups it isn’t uncommon to find an “Alpha radiologist” at the helm in what may be an elected position (or not). The person has often been in that role for years and has a strong working relationship with hospital administration.
As groups get larger, it is necessary to become more formal in regard to elected leadership positions, although again one person may serve at the helm for a long period of time.
In both of these instances the group tends to rely on the formal leader to ensure contracts are negotiated appropriately, hospital leadership is appeased and the group is financially viable.
In every group, there are also renegades. They don’t pay attention in meetings, don’t respond to e-mails, tend to vote with the crowd and seem to think showing up for work is sufficient. They love having a strong leader so they can remain uninvolved.
Anecdotally, I’ll tell you about a couple of the latter (and I think they migrate because there seems to be at least one in every group). In one of my stints as practice administrator I kept a physician schedule next to the phone on my desk for quick reference. When I saw the hospital radiology department manager’s identification come up on my phone, I quickly checked the schedule for a hint as to whether he would be raging about a problem.
When certain people were on the schedule for a week, I could usually count on getting a complaint call. The group’s chairman eventually developed a strategy of moving them from site to site frequently so they couldn’t be in one place long enough to generate too many complaints. You know who these people are in your group too!
A common hospital complaint focuses on “service issues” and more than clinical competency, these are too often the reason a group loses its hospital professional services agreement.
How do service issues relate to quality?
And where does leadership fit into all of this?
Leadership without a title
Leadership Without a Title
Yes, we expect the elected leaders of an organization to step up and assume more responsibility—and lead.
The buck stops with them for fiduciary responsibility and very often, for the care and feeding of the hospital contract. Others in the group can make that job easier or incredibly difficult.
When auditing radiology reports (as compared to the American College of Radiology Practice Guideline for Communication of Diagnostic Imaging Findings), it is typically a small number of radiologists who chronically fail to dictate all necessary information.
Adherence to the guidelines has both clinical (risk management) and financial implications and yet, there will be members of the group who refuse to modify their dictation habits even when deficiencies are causing revenue losses.
In another case, a new hospital contract was lost after only two years due to the failure of a few members of a group to meet the administrative (service) expectations of their agreement. There are always several people in the group nobody wants to work with on weekends. Are all of these instances the responsibility of the elected leadership? In some ways, yes.
Part of the Problem: Radiologists
Part of the problem lies in the fact radiologists are not easily “led.” They are highly intelligent and trained to make their own decisions. They typically don’t like to be told what to do and in large part, feel many of the rules and regulations are an incredible nuisance.
Because of the latter, they can be quick to punish the messenger, often to the point where the messenger will yield and not again ask the same question. They also tend to feel they can get lost in the pack and their individual actions are probably not noticeable.
Who is Responsible?
The future of the entire group is as strong as its weakest members. Is it the responsibility then of the elected leaders to browbeat, wheedle, demand and beg for good behavior?
No, but that’s the position in which many of them are placed.
There are no unimportant or invisible members of a radiology practice. The entire group is being judged every day by the behavior—the “leadership” in a given situation—of each of its members.
So how do we get from the “you can’t make me do that” attitude to one in which each person is accepting leadership responsibility? Start with the fact radiologists have proven themselves to be very good students in the past.
Seeking Value—and Leadership
Value-based payments continue to lurk in our future and there continue to be active discussions about where radiology fits in the “value equation.”
There is already an expectation of accurate reads by highly qualified, board certified physicians so that alone doesn’t allow for differentiation. Granted a physician who consistently delivers substandard reads will be flagged but quality in terms of accurate interpretation is already expected. So where else does value lie?
At this point in the game, value is being defined as the service beyond the accurate read. For one, it involves collaboration. That means working with our hospitals or contracted organizations (for example independent physician organizations, large multi-specialty groups, physician networks and accountable care organizations) to help ensure their success in patient management.
At a minimum it would for example, involve ensuring the hospital is in compliance with Joint Commission requirements. Those requirements represent some of the “pestering” that comes from hospital staff and which cause rebellion, or at least resistance, from members of the group. Basically, value can begin with all of the annoying administrative, supporting tasks that on the surface, from the standpoint of the physician, seem to have nothing to do with being a “good radiologist.”
It involves engaging referral sources and sites of service, finding out their needs and priorities and then helping them make things happen—not being dragged reluctantly like a cat on a leash while complaining all the way. It means moving beyond the “darned lucky I show up to read your cases” contract-as-an-entitlement mentality to truly partnering for success.
The elected leadership alone cannot make that happen. It requires a “leader” who assumes responsibility for fulfilling expectations (even seemingly stupid ones) in every seat.
A Culture of Leadership
Few leading radiology practices profess to having a formal orientation program, where the group’s values and expectations are communicated, along with education about the practice itself, its business philosophy and the nuts and bolts of each site to be covered.
Instead, most groups do this poorly and orientation is instead limited to a briefing by the IT folks about how to sign on to the workstations and use the voice dictation system and then handing the new guy a schedule. Only later can a new recruit find out he/she isn’t meeting productivity standards, is causing problems at a particular site by being late too often or is the source of issues regarding getting reports signed on time.
Let’s Ask Ourselves
How many of us have asked the hospital department manager to outline the Joint Commission priorities they are facing and how the group fits into meeting those expectations? What are some of the priorities or key initiatives over the coming year?
How well have we done introducing a new physician to our customers (hospitals and other contracted groups)?
This goes beyond distributing a CV to maybe holding a “meet and greet” so the physician can interact with staff and they can have a better idea of who will be showing up for work next Monday.
How often do we provide that new physician with a list of who’s who at the various sites covered or in the group’s business office?
Have we formally sat down with the new physician to communicate the history of the group and factors that have made it successful?
Have we outlined expectations in terms of:
- productivity and workloads
- not dumping unfinished work on the next person at the end of a shift
- ensuring dictated reports are complete and billable
- what makes for a good weekend or call shift team
- responding to communications
- participating on committees, and
- how others are to be treated?
More often than not, those things are somehow assumed. After all, the old guard had to just pick it up along the way and the new person should be smart enough to figure things out too.
As we move into the value-based environment, it is no longer sufficient to assume the other guy will certainly “take care of that” or that everyone will instinctively figure out how to successfully represent the group in any and all situations—or that they need to do so.
Leadership in this context is ownership. Ownership of the seat for that work day, of a site as medical director, of a committee reviewing protocols, of a team making sure all reports are signed promptly.
It means owning relationships, beginning with the other folks trying to make sure the work happens each day and understanding the goals for mutual success. It means taking the initiative to learn about the regulatory requirements related to supervision and being a medical director, what it takes to earn and maintain advanced imaging accreditation or Joint Commission expectations.
It means thinking about the demands of the day and taking the extra step to not only complete the assigned work but to pick up the slack for someone else who is struggling once in a while.
Ultimately, it means thinking about how someone else could make your life easier and then doing those things for others.
In terms of a group philosophy, leadership involves identifying what it will take to make out customers successful and then allocating resources and responsibilities so the entire burden doesn’t fall only on the elected leadership. Then it means holding everyone accountable.
This can involve dealing with the “Bobby” syndrome. In a former life, I worked for a radio station and we had to write and produce our own commercials (which is how those annoying local ads happen). Most of the disc jockeys were great working with you in production—except Bobby.
Bobby was always late, bumbled through lines so everything took three times as long and made every studio hour agonizing. Eventually, nobody asked Bobby to work with them on production. He happily skipped out the door at the end of his air time shift and everyone else picked up his production workload.
Bobby was a leader—just not the kind we want.
Bobby is also in every radiology group.
Communication is KEY!
I really feel if someone in a leadership position had sat Bobby down early in the game and explained expectations, things might have worked out better for everyone who wasn’t Bobby. He had the talent and training to do what he needed to do. He just needed to hear his shenanigans were not acceptable in the success culture of the organization and everyone was onto him.
If we don’t communicate to everyone in the group the importance of their individual leadership and give examples of what that looks like, we are left letting them figure it out. Some will be better than others but there is a greater chance the mission will fail.
If we don’t communicate the demands, expectations and success measures of our various customers, we can’t expect customer satisfaction. Time spent by the elected leaders (and practice administration) on this curriculum should mean fewer problems down the line.
We can’t become a team by saying “be a team.”
We can guide, teach and reinforce regarding what is expected of each person and how they can—and must—be leaders if the practice is to survive and thrive.
Every successful athletic team—or orchestra—gets there because each person understands the assignment at hand and is ready to deliver. Each of these organizations drills the basics all the time.
The athletic team works on agility, strength, mastering plays, being in the right place at the right time and taking care of teammates. The member of the orchestra practices scales, dynamics and range, repeatedly rehearses the assigned music, responds to cues and learns the nuances of the piece to be performed.
Each organization relies upon everyone to fulfill an assigned role and it is highly evident when someone isn’t participating competently or with the end goal in mind.
Far from being comfortable and predictable, radiology is dynamic, demanding and rapidly changing. It is no longer enough to show up, read cases and make the success of the group someone else’s responsibility.
Does everyone in the group know the basics? Have we told them where they fit in and how important they are to the success of the organization? Have we effectively communicated who are customers are and what it will take to make them successful? And that the professional services relationship is earned and not an entitlement?
Think of what we could accomplish if everyone accepted the challenge of leading—no matter where they were assigned. The practices that figure this out first will be the desired partners in the value-based world. The rest will fight for the scraps.
She worked as a consultant for radiology practices, billing companies, software developers, and hospital radiology departments for 20 years before joining MSN.
She is a regular contributor to the RBMA Bulletin and a frequent speaker on topics related to radiology practice management.
Pat can be reached at firstname.lastname@example.org