Effective leadership has never been more important in radiology. Declining reimbursements, growing competition and changing models of care all are threatening long-standing operational assumptions. More and more, hospitals view imaging as a commodity and radiologists as replaceable.
To adapt, leaders must extend their focus beyond compensation issues and zero in on the needs of their primary constituencies: Patients, referring physicians and hospital partners. Leaders also should work to align the skills of practice members with specific tasks or responsibilities, ranging from public relations to information technologies. Finally, they should establish personnel policies that support a productive, equitable and team-oriented approach to providing care.
“I see radiology executives confusing management with leadership all the time,” said Rod Farris, regional vice president for radiology at McKesson Business Performance Services (McKesson). “They get caught up in the minutia of to how maximize compensation and forget about everything else, including the fundamentals of the business. But if you take care of your key stakeholders, the compensation will take care of itself.”
While leaders obviously can’t ignore the nuts and bolts of managing, Farris said, they also need to provide vision and direction, particularly in today’s environment. As clichéd as it may sound, Farris said, leadership begins with a viable mission statement.
“You can have something as simple as: ‘Our goal is to provide high-quality care to patients and exemplary service to referring physicians and partner hospitals. Period.’ You need to give everyone something to shoot for and, preferably, the simpler the better.”
Patient-focused care is important across all medical specialties today from both a reimbursement and marketshare perspective. In radiology, patient-focused care means convenience and customer service.
“What do patients want? They want to get in and out quickly, they want a competent and accurate read and they want to know the outcome as quickly as possible,” Farris said. “So those are the areas you need focus on.”
Patient convenience is slipping in radiology, Farris said, as more imaging shifts away from stand-alone centers to the hospital setting. At one small-hospital practice, he noted, interventional radiology is performed only one day a week.
“If the radiologist falls behind and the appointment is delayed and patient hasn’t eaten to prepare for the procedure, it’s not a real pleasant experience,” he said. “So groups need to constantly look at their operations from the patient’s perspective.”
Beyond improving convenience, patient-focused care also means understanding the importance of timely information. This is especially true in areas like mammography, where the stakes couldn’t be higher.
“You have to reach an understanding with the referring physician about who is going to communicate with the patient: Should you do it or should they? It’s not easy to work it out, but those are the kinds of details that need to be addressed so that you have a system in place. The goal is to provide information to the patient as quickly as possible.”
It also is important not to overlook the impact billing problems can have on customer service. Be sure that information is conveyed clearly and that financial expectations are established from the outset. Above all, Farris said, communicate with patients in a friendly, professional and timely manner.
Because referring physicians are an imaging group’s true clients, every effort should be made to accommodate their requirements and expectations. In the Internet era, Farris said, direct communication between the radiologist and the referring doctor has declined dramatically. As a result, relationships are more tenuous and vulnerable than in years past.
Groups can alter this dynamic by seeking out referral docs on a regular basis for face-to-face meetings. Practices should solicit feedback on services provided and discuss ways to collectively improve care. For example, groups should meet with their emergency medicine department to discuss how to improve or modify standing imaging orders for injured or ill patients presenting at the emergency room, Farris said.
“In every group, there is someone who excels at interpersonal communication and relationship-building,” he said. “You need to identify that person and put them in charge of what basically amounts to client management.”
Keeping hospitals happy
Similar efforts should be employed to strengthen hospital relationships. One way to do that is to participate in a range of hospital activities, from quality assurance committees to tumor boards. Too often, Farris said, the only time radiologists interact with hospital leadership is to complain about technology or other issues.
“You’ve got to demonstrate that you’re committed to their success and willing to partner in ways that collectively strengthen both the quality of care and the viability of the organization,” he said. “Engage with other doctors; educate them. Work with others to better manage costs and outcomes. These skills will only become more critical as value-based purchasing becomes widespread.”
Although some cost reduction efforts may lead to a decline in imaging volume for the practice, groups can balance the effect by reducing group overhead.
Picking the right partners
According to Farris, major productivity differences between partners can frequently cause problems for radiology groups. A belief that some are not pulling their weight can lead to ill-will between doctors and discontent when it comes to collective goals and tasks.
Given the challenges associated with firing a doctor after they’ve made partner, it is essential to try to make sure a physician will be a good fit up front. One way to do that is to create a path to tenure that includes specific productivity benchmarks.
“I know of a group that, after the third month, looks at the new physician’s productivity, and if it is significantly lower than the norm, they let them know that either they produce at a higher rate or you’re not going to be here,” he said. “You’ve got to have an aggressive indoctrination strategy and establish the right expectations from the start.”
Whether you’re dealing with patients, physicians, hospital staff or practice members, a major part of effective leadership involves managing relationships, Farris said. “You need to do everything you can to make your organization irreplaceable. And the best way to do that is to pay very close attention to the needs and expectations of people the group depends on.”