Partnerships between emergency radiology and emergency medicine are critical to proper patient care.

In a session during the American Society of Emergency Radiology (ASER) 2020 annual meeting, Summer Kaplan, M.D., a pediatric radiologist at the Children's Hospital of Philadelphia, discussed methods and strategies emergency radiologists can implement to launch quality improvement projects.

And, in outlining the overall importance of quality improvement partnerships between emergency medicine and emergency radiology, Kaplan also discussed some challenges that providers should keep in mind. 

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Dr. Summer Kaplan discusses strategies to design quality improvements projects in emergency radiology and the challenges that exist to proper implementation. She shared her insights during the American Society of Emergency Radiology 2020 annual meeting.

Creating Quality Improvement in Emergency Radiology

Over the past decade radiation dose exposure has fallen precipitously. But, when you are asked to make split-second decisions in the emergency room, it can sometimes still be challenging to make the choices that will limit exposures.

In his presentation during the American Society of Emergency Radiology 2020 annual meeting, Mahadevappa Mahesh, M.S., Ph.D., chief physicist at The Johns Hopkins Hospital and professor of radiology and radiological sciences at Johns Hopkins Medicine, outlined several steps emergency radiologists can take to ensure you are controlling dose for your patients.

“We want to make sure that the people who are ordering the imaging understand the risks and benefits of imaging,” he told 

For more coverage of the ASER 2020 Annual Meeting, click

Since 2010, Mahesh said, CT dose exposure has fallen by nearly 20 percent. The use of more advanced medical imaging technologies and greater dose awareness campaigns can largely be credited for this success, as can provider education around optimizing imaging protocols. These are all critical achievements, he said, because in the emergency room, imaging should never be declined or denied with the clinical appropriateness is very high.

“One should not hesitate to do medical imaging, such as CT, X-ray, or fluoroscopy because they bring a lot of value,” he said. “But, in the emergency room, there is always a concern when we are ordering large imaging studies.”

Consequently, Mahesh shared several tips you can use to ensure that you are controlling exposure and optimizing protocols.

 For those “in-the-moment” decisions about how much radiation dose you should really use with a patient in an emergency situation, Mahesh said, you must be sure you have the right people on your team. In addition to you and your colleagues, but sure to include two other individuals – a medical physicist and a technologist who reviews the protocols on an annual basis to ensure you’re using the right protocols. This team should also adapt all dose optimization strategies on the protocol. This is especially important with CT, he said, as they must pay attention to using modulation techniques.

 As much as possible, keep tabs on the scans you are conducting. Monitor whether you are performing too many scans or repeating scans. Doing so will help you control utilization when – and if – it is necessary, he said.

 Although using a lead apron with patients has long been considered a protective strategy against radiation exposure, that paradigm is shifting, Mahesh said, particularly with gonad shielding in CT and X-ray. Foregoing their use can help you avoid duplicate studies.

“We are now advocating to stay away from placing the shield on the during imaging,” he said. “The American Association of Physicists in Medicine came up with a position statement that it is now advocating that it is not necessary to use the lead shielding – in fact, it may even be contraindicated. It can actually obscure objects in the path of the beam.”

In addition, he said, the lead apron can get shifted around, potentially interfering with the image quality, forcing you to repeat an image.

Overall, Mahesh said, you as the radiologists should concentrate efforts on being sure you and your colleagues are the providers who convey information to patients about radiation dose.

“The radiation risks should be explained or communicated by people who are knowledgeable about both the benefits and the risks of the imaging,” he explained.

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Articles

Three tips to help you limit dose exposure and optimize imaging protocols.

Controlling Dose in the Emergency Department

It is impossible to know when a major incident -- a multi-car crash, a subway attack, or even a major pandemic  -- is going to strike. But, not knowing that it is coming does not mean radiology departments cannot be prepared.

In her session during the American Society of Emergency Radiology 2020 annual meeting, Dr. Susan Cross from Barts Health NHS Trust in London shared the experiences she and her emergency radiology colleagues have had in caring for patients impacted by multiple mass casualty events.

 and shared not only some lessons learned, but some details about modality-specific planning for these events, as well as what obstacles may exist.

Dr. Susan Cross from Barts Health NHS Trust discusses the experiences of her institution with multiple mass casualty events during the American Society of Emergency Radiology 2020 annual meeting.

Mass Casualty Planning: Lessons Learned from Emergency Radiology

Across the United States, approximately 1.4 million adults are living with congenital heart disease, and for many, a trip to the emergency department is inevitable. Consequently, it is critical that emergency radiologists know the signs of – and potential problems associated with – this condition on imaging scans.

That’s the message that M. Zak Rajput, M.D., an emergency and abdominal radiologist with Washington University Physicians, shared during his presentation Oct. 2 at the American Society of Emergency Radiology (ASER) 2020 annual meeting.

“Imaging can play a critical role as many patients who had operations as infants and children have grown up and they are now living with congenital heart disease in their 30s, 40s, 50s, and beyond,” he told 

 “It’s important for radiologists to be aware of what to look for in adult patients presenting to the emergency department with a history of congenital heart disease.”

Identifying congenital heart disease in patients can be complicated, he said, so he shared five pearls of wisdom that can best set emergency radiologists up for success.

It is possible, Rajput said, that the patient could have undiagnosed congenital heart disease.

“We may be the first providers to suggest this condition in patients coming through the emergency department,” he explained. “That’s certainly something to be aware of as congenital heart disease is associated with life-threatening conditions.”

For example, imaging might reveal a previously undetected bicuspid aortic valve or an atrioventricular canal defect that can put a patient at increased risk for a pulmonary embolism.

2. Clinically significant, but not life-threatening: 

Not every finding associated with this condition puts the patient’s life at risk. But, things could be clinically significant and could offer information about why he or she arrived at the emergency department to begin with.

For example, CT images could show a patient has a single left ventricle that could increase the likelihood that they will develop arteriovenous malformations or abnormal connections between their arteries and veins in their lungs, detrimentally affecting their ability to oxygenate their blood or leading to emboli. Their congenital heart disease could also prompt the formation of collateral arteries that can rupture, causing the patient to vomit blood and threatening lethality.

 Sometimes findings that look like congenital heart failure just are not so, Rajput said. In many of these cases, what the provider sees is the result of a surgical fix earlier in life.

“As emergency radiologists, we might not be aware of the appearance of some of these surgical techniques on imaging in adulthood, and they can often be confused with acute pathology that’s more serious,” he said.

For example, he added, it is possible for a surgical repair of an aorta to closely resemble an enlargement of the ascending aorta.

Capture a non-contrast scan prior to one with contrast because surgical materials show up better without contrast, he said.

“Surgical material is usually very static, and we can see it better, oftentimes, on the non-contrast scan,” he said. “It helps us get the lay of the land initially.”

Emergency radiologists should consider acquiring a delayed phase to their routine CT protocol. Five seconds after capturing an image with contrast, secure a second image.

This is helpful, he said, because oxygenated and de-oxygenated blood, as well as blood that has been opacified with the contrast agent, frequently mix in patients who have had surgical repairs that have led to reconstructed anatomy. Taking an additional image shortly after the first can help radiologists determine whether they are detecting a real pathology or a normal artifact.

Ultimately, he said, it is important for radiologists to be aware of how congenial heart disease presents because the patient population is growing.

“Radiologists are going to be encountering these patients more and more in imaging as they get CT scans,” he said. “So, it’s really important for us to recognize and understand the emergent and critical findings that we see in these patients, as well as the techniques we can use to make these diagnoses to direct patient care.”

Emergency radiologists must be familiar with how this condition presents on CT scans. 

5 Pearls to Not Miss a Beat with Congenital Heart Disease Diagnosis 

Certain concerns about radiation dose that emergency radiologists have could be getting in the way of capturing the best images possible for some patients, one expert has said.

During an Oct. 1 presentation at the American Society of Emergency Radiology (ASER) 2020 Annual Meeting, Tim Szczykutowicz, M.D., associate professor in the University of Wisconsin School of Medicine and Public Health radiology, medical physics, and biomedical engineering departments, discussed some commonly held misperceptions about radiation exposure with pregnant patients, as well as cumulative effective dose.

Overall, he said, providers should feel comfortable about ordering scans for patients – especially when forgoing imaging or dialing the dose back too much could have a deleterious effect.

“Emergency radiologists should not be afraid to order a study for a pregnant patient or not order a procedure based on a patient’s cumulative effective dose,” he told 

. “Fear of over-radiation in CT has been sensationalized by the lay press for a decade.”

In particular, Szcyzkutowicz outlined three situations where radiologists could be overly cautious about radiation dose.

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Pregnant patients with suspected pulmonary embolism (PE):

 Emergency radiologists should remember that the dose levels provided during CT scans are already low – far below levels that could be potentially harmful to a fetus – and dropping dose even further will compromise the integrity and usefulness of any diagnostic image. In those instances, he said, critical findings can be overlooked.

“You don’t want to do a lot of things that will reduce the dose and bring down that quality of imaging because then you might miss the PE,” he said. “If the mother has a pulmonary embolism that doesn’t get detected or treated, that’s going to hurt the fetus a lot more than these potential radiation risks.”

It’s also important to remember, he said, that excluding the lung bases from the scan can limit protocol robustness, as can skipping timing bolus or bolus tracking. And, if a lead shield is used – which he recommended only in cases where it eases patient anxieties – it should not be placed near the lung bases.

 In these instances, he said, radiologists should feel confident in conducting the scans without any worries of significant radiation dose reaching the fetus, Szcyzkutowicz said. In essence, because virtually no radiation reaches the unborn baby it would take more than 200 CT scans before any effect was seen.

“This should not be a worry at all,” he explained. “The only radiation getting outside the direct area of the head being scanned is a little bit of leakage that squirts out of the side.”

And, those levels of leakage are regulated by the U.S. Food & Drug Administration. The amount is so low, he added, that providers would need specialty measuring equipment for it to register.

He also advised against using lead shielding with these patients. Not only can they potentially increase anxiety, but they can also slide up with pregnant patients, potentially interfering with any head CT scans that include the neck region. In addition, they can also interfere with the bolus tracking if the scan is CT angiography.

 Radiologists should also be careful in how much weight they give to cumulative effective dose (CED) when trying to decide whether to perform an exam, he said. In some cases, denying a patient a scan because they have had multiple previous diagnostic imaging studies could actually put him or her at greater risk by missing an existing, life-threatening finding.

"There is a danger here in applying this concept in an incorrect way. If a patient comes in and is indicated for a head or chest CT and the ordering physician doesn’t order it because they see a high cumulative effective dose, that could be a problem,” he said. “We might be talking about increase someone’s baseline cancer risk from 40 percent to 40.001 percent, but if they have an undiagnosed chest pain, they could be dead within 24 hours.”

Ultimately, he said, there are no existing studies that link CED to increased cancer risks, and there is no current consensus about the time period over which it should be summed.

Concerns about CT dose levels could lead providers to overlook findings, especially in pregnant patients.

Dose Misconceptions Could Lead to Missed Findings in Emergency Department

MRI scans routinely provide critical information, but there is a great deal of preparation that goes into making sure a scan is safe for a patient. Does he or she have a metal implant or a medical device? Does that mean there will be extra steps with your scanner to provide an injury-free, diagnostic-quality scan? Or are you facing a delay or cancellation?

The presence of an implant of device does not automatically mean you will have a scheduling disaster. It is possible to successfully image these patients, said Tobias Gilk, Ph.D. senior vice president at RADIOLOGY-Planning, but it requires some forethought and planning on your part.

In a presentation during this year’s AHRA: Association of Medical Imaging Management virtual meeting, he shared insights about the cost associated with not providing timely care, as well as best practices to ensure you do so.

It is no secret that MRI scans can be time-consuming under the best of circumstances. However, if you add in the minutes needed for technologist to complete effective device screening, the process gets longer. The parameters and requirements for each scanner are different, but, on average, Gilk said, technologists devote between 6-to-8 hours per scanner per week to figuring out whether it is safe to scan patients who have devices or implants.

If you do the math, he explained, for two scanners, that can equate to 12-to-16 hours weekly that not eligible for reimbursement. In hard dollars, he said, that can potentially add up to a loss of $2,275 each week -- $118,300 in delays each year. Ultimately, he explained, it is possible that time lost to screening patients can cost your practice up to $1.2 million over the 10-year life of an MRI scanner.

Given this hefty impact, he advised, figuring out how to better scan your patient and train your technologists to feel confident in their assessments of whether they can safely clear a patient for a scan can be critical.

Q&A: Tackling the Complexity of MR Safety

To ensure your practice is providing MRI experience for your patients based on best practices, there are three tips you should follow, Gilk explained.

 As he pointed out, these days can be expensive, potentially costing you $1 million over the life of your scanner. To avoid this substantive loss, take the time to identify where these slow-downs or cancellations are occurring so you can pinpoint the spots where you might unknowingly be leaking revenue.

 Invest in making sure all of your technologists and radiologists have the same understanding of the risks associated with implants and devices, as well as how your practice chooses to address them.

“Don’t depend on the training your techs or radiologists might have had before they came to you,” he said. “If your staff and radiologists are nervous about screening patients or are unable to answer questions about specific harm to the patient or they can’t identify potential harm to the patient, they’re not acting in the interest of safety.”

This training includes providing details about the specifics on the types of magnetic fields used in MR imaging, as well as their impacts on the body, Gilk said.

 Design a protocol that can guide your staff and radiologists through the decision-making process – akin to an “if this, then that” map – for how to safely navigate the risks of any implants or devices in patients who need MRI imaging. Not only will this strategy protect your patients, but it will also help you process patients more expediently.

To be sure you can implement those best practices, he said, you will largely need to re-engineer your screening process. You’ll not only need to identify what is behind your screening hiccups, but you will also need the right tools to address the problem.

 Overall, you can organize the root cause of your delays into four categories. Knowing what problems you are facing can help you devise a strategy to address them. Evaluate your situation to determine if any of these are your setback:

 Either your technologists or your radiologists are not able to effectively identify and mitigate a potential risk with a patient. Confusion slows down the process.

 Providers generally fall into two camps, Gilk said. “Ghost” radiologists are timid and frequently elect to avoid even the slightest possibility that something could go wrong with a scan, opting instead to postpone or cancel. If a “cowboy” has not heard of a real-life problem with a particular device or implant and a scanner, he or she will forge ahead even in the face of a warning. Neither is in the best interest of safety.

 If you do not have a clear policy for how to address and provide care for a patient with a tricky device or implant, it will be difficult for your radiologists – particularly those new to the practice – to know how to proceed.

 Without clarity in your practice’s policy, your technologists will be at a loss for what to do if the scanner guidance is at odds with what your radiologist tells them. This could potentially put the technologist in the position of feeling as though he or she must make a clinical judgement call that should fall to the radiologist instead.

 Fortunately, Gilk said, implementing a decision support tool can help you navigate these murky waters.

 Developed by Emanuel Kanal, M.D., director of MRI services at the University of Pittsburgh Medical Center, this smartphone app offers robust guidance to help you decide whether to screen a patient. This tool provides information about the various types of magnetic fields and how they interact with implants and devices, as well as the major consequences of scanning. It can help you make an assessment in almost any situation, he said. But, because of this tool’s complexity, Kanal prefers to personally train anyone who wishes to use it.

 Alongside the MagnetVision™ app, the AHRA published an 

 in 2016 based on Kanal’s expertise with MR safety. The team-based method outlined in the article is designed to ensure that technologists, physicists, and physicians have the knowledge base and competency needed to provide the safest patient care.

By following these tips and using these tools – including others that can tell you when to avoid screening, when to seek additional guidance, or when to proceed – you can better streamline your MR imaging processes, Gilk said.

“If you do these things, you will improve safety because you will have people accurately identifying risks and appropriately mitigating them,” he said. “You will spend less time in screening, and you will be able to get the patient into the magnet more effectively and efficiently.”

AHRA

Knowing what causes screening delays and how to safely assess risks can streamline your MR imaging.

3 Tips to Improve MR Safety with Implants and Devices

Abbreviated MRI has comparable diagnostic performance to a full protocol MRI with breast imaging studies, new research has revealed.

In a virtual poster presented during the International Society for Magnetic Resonance in Medicine annual meeting, investigators from the University of Cambridge School of Clinical Medicine in the United Kingdom outlined the results of their study that examined the sensitivity and specificity of an MRI protocol that only used one pre-contrast and one post-contrast image.

“This is the first study to systematically compare the diagnostic performances of [abbreviated-protocol] MRI and [full-protocol] MRI through a meta-analysis,” wrote the team, led by Gabrielle Baxter, a University of Cambridge radiology doctoral student. “For patients that require adjunct MRI imaging due to a suspicious mammogram or ultrasound examination, an abbreviated protocol can provide equivalent diagnostic accuracy.”

Not only do the study results indicate the abbreviated protocol can effectively be used for diagnostic imaging, but the shortened protocol can also reduce scan time and cost, the team asserted.

Abbreviated MRI Outperforms 3D Mammography with Dense Breasts

Increasingly, MRI is being used with breast imaging as a sensitive and specific way to address suspicious findings identified on mammography or ultrasound, but widespread use has still been limited by longer scan times and high cost. Consequently, abbreviated protocols are gaining popularity due to the limited number of images needed, and previous research has already demonstrated comparable performance for full-protocol MRI.

Performance of Abbreviated and Full-Protocol Breast MRI

To make this determination, the team analyzed 13 studies published through July 2019 that had assessed abbreviated and full-protocol MRI with breast imaging. Overall, these publications – five based on a general screening population and eight on an enriched cohort – included 4,020 patients who experienced 602 cancers.

According to their literature analysis, abbreviated and full-protocol MRIs were not significantly different in sensitivity, specificity, or area under the curve, and abbreviated protocols produced equivalent diagnostic performance with the patients from the enriched cohort. These results show the abbreviated protocol is satisfactory for diagnostic imaging, they said.

Even though their study was based on a small number of publications, the team said their results support the continued use of and research around abbreviated MRI protocols.

“[Abbreviated] MRI and [full-protocol] MRI achieve comparable diagnostic accuracy in screening studies and an equivalent diagnostic accuracy in enriched cohorts,” they said, “though the number of studies to date is limited.”

ISMRM

Abbreviated MRI protocols can detect and diagnose breast cancer as well as full-protocol MRI.


Faster, Cheaper Breast MRI Performs As Well As Full-Protocol Scans

A lower-field strength MRI can provide effective cardiac imaging for patients who have suspected or known myocardial infarction, a new pilot study has demonstrated.

In a poster presentation submitted to the International Society of Magnetic Resonance in Medicine virtual annual meeting, a team of cardiology investigators from the National Institutes of Health (NIH) described their use of 0.55T MRI to acquire and interpret late gadolinium enhancement (LGE) in possible heart attack patients.

Because high-field strength MRI has been known to increase artifact in cardiac imaging, there is a push to develop low-field cardiac MRI, the team said.

“Our group has demonstrated that a lower field strength, paired with the high-performance hardware and contemporary imaging software, may be well suited to cardiac imaging,” said the team led by W. Patricia Bandettini, M.D., associate research physician at the NIH. “Our pilot investigation demonstrates that demanding imaging techniques, such as late gadolinium enhancement imaging, are feasible at 0.55T.”

Successful implementation of this approach could not only reduce costs, the team said, but it could also increase accessibility to cardiac MR imaging.

To determine the comparative difference between both types of imaging strengths, the team assessed 13 patients for known or suspected myocardial infarction with both 0.55T and 1.5T MRI. The investigators intravenously administered gadobutrol and performed LGE imaging after 10 minutes.

For imaging analysis, LGE sequences selected and optimized for each field strength on a 17-segment model. They used the identification of abnormal LGE consistent with myocardial infarction, as well as additional grading of the coronary distribution – whether the myocardial infarction was less than or more than 50 percent transmural extent – for scoring. 

According to their evaluations, the number of segments identified between each field strength was comparable. The 0.55T scanner identified 59 segments with myocardial infarction (50 subendocardial and nine transmural), and the 1.5T scanner detected 63 segments with myocardial infarction (53 subendocardial and 10 transmural). In addition, the team said, epicardial coronary artery distribution matched exactly between the two field strengths.

The team plans to expand their work with future studies that include free-breathing acquisition methods.

Performance of 0.55T MRI is comparable to 1.5T MRI in acquiring and interpreting late gadolinium enhancement in patients suspected of myocardial infarction, research shows. 

High-Performance, Low-Field MRI Provides Diagnostic Quality in Heart Attack Patients

GE Healthcare is showcasing three new technologies during this year’s International Society of Magnetic Resonance in Medicine virtual annual meeting. These new tools are dedicated to enhancing neurological research with Alzheimer’s disease and traumatic brain injury.

According to a company statement, GE is highlighting these new tools:

 This 510(k)-pending technology, the company said, has approximately five times more power than most clinical systems and is designed to pick up subtle clinically- and research-relevant structures It features a 60-cm bore system and is outfitted with UltraG gradient technology, GE’s most powerful, whole-body gradient coil.

With Precision RF transmit-and-receive architecture, it can facilitate improved image quality and research flexibility, company officials said. Additionally, clinicians will be able to use the existing SIGNAWorks applications platform to access deep learning-based platform tools, such as AIR x brain and Silent MR imaging.

 Similar in some ways to the SIGNA 7.0T, this investigational device is a whole-body 3T system that can scan all clinical anatomies, and, according to a company press release, it is designed for research and can provide improved visualization of microstructure changes associated with Alzheimer’s and Parkinson’s. Its lower field strength – and, therefore, lower cost – makes the research gains from its UltraG gradient technology, RF architecture, and SIGNAWorks features accessible to more institutions, company officials said.

 GE is also revealing its experimental high-performance Microstructure Anatomy Gradient for Neuroimaging with Ultrafast Scanning (MAGNUS). According to company data, the U.S. Department of Defense-funded technology will be installed in a U.S. military treatment facility to study new imaging biomarkers that can be used to diagnose mild traumatic brain injury.

MAGNUS will have a different gradient strength and slew rate for brain imaging than conventional MRI scanners, the company said, operating in the 500-700T/m/s and 200-300 mT/m range rather than 200T/m/s and 50-80 mT/m. The goal, said Jie Xue, president and CEO of GE Healthcare MR, is to potentially establish the first objective measures for diagnosing mild traumatic brain injury cases, as well as Alzheimer’s, Post-Traumatic Stress Disorder, Attention Deficit Disorder, and mild cognitive impairment.

Products focus on Alzheimer’s disease, traumatic brain injury, and accelerating clinical translation.

GE Unveils Three New MRI Technologies at ISMRM

Maybe you pursued a leadership role in your practice. Maybe you stumbled into one by accident or out of necessity. How you came into the position is less important than how well you execute it – but not everyone innately knows how to be effective as the person in charge.

To put you on the path for being a better leader, Mary Kelly, Ph.D., CSP, retired U.S. Navy Commander, offered seven tips during an Aug. 5 Radiology Business Management Association (

) PaRADigm Shift 2020 virtual meeting session that can strengthen your leadership skills and put your practice and your staff and colleagues on a road to greater productivity.

“People want to do a good job for you, but sometimes the processes aren’t in place to make that happen. So, it’s a struggle,” she said. “Your physicians, staff, and patients are looking to you for solutions.”

 Mission statements are great, she said, but you need a vision for your practice. Where do you want your practice to be, and what do you want for your colleagues?

“Employees need a leader to have a clear, forward-thinking vision,” Kelly explained.

Identifying your vision is not difficult, but there are several things to consider. Take the time to think about what your practice currently does and what major changes might be coming your way. Outline your service goals for the next five, 10, and 20 years, and craft the legacy you would like to leave. Consider what you would do with your practice if you had no constraints, and use these thoughts to fashion your vision.

 According to Kelly, 58 percent of most employees have reported they would trust a complete stranger before they would trust their boss. You can avoid falling into this category by being truthful, providing information, and respecting your employees’ time. Avoid creating uncertainty and only set attainable goals. Do not gossip, name call, or make your employees and peers feel you are disloyal.

“Small things can lead to big problems,” she said. “But, with your words and with your behaviors – the more attention you give and the more you show that your employees’ opinions matter – the more they will trust you.”

 Try to eliminate any confusion in your staff about priorities by providing clear guidance toward goals, and remove any protocols or processes that might impede progress. Help you employees stay focused by checking in with them more frequently, and give them smaller goals so they can see more accomplishments.

 Actively show people that their presence and their contributions matter to you and your practice, Kelly advised.

“Your job is to care about the people who give you their time,” she said. “If you don’t show you care, they will quickly stop caring.”

One of the best ways you can demonstrate that you care is to streamline policies that can help you employees re-claim some of their time during the day, showing them you value their time and allowing them to be more productive. And, take the time to acknowledge their work.

 Even if you are not unfair with your employees, Kelly explained, it is possible they can misconstrue your actions as being that way. But, you can side-step this problem. When you make decisions or announce changes, share your reasons for doing so, and work to equally distribute responsibility throughout the office. Be sure you are not focusing too much on the staff you consider to be your “go-to” employees – as for input or volunteers when new projects or initaitives arise, and hold everyone accountable for their own work and productivity.

 While energizing your colleagues around a common goal, do not forget to capitalize on their unique characteristics and skills, Kelly said.

“Look at your employees and find the magic – embrace their differences because that is what makes them special,” she said. “This is also where you can show them their value, and it will lead to better ideas and fresher perspectives.”

As the leader, it is your job to support everyone within your organization from your direct reports to the patients you serve, and if you show everyone their contributions to the team are appreciated, the group overall will become more tightly knit and effective.

 Focus on the solutions, not the blame when things do not work quite right. This type of mentality will encourage your employees to take risks and think creatively.

“If you blame people, they will probably stagnate,” she said. “And, you need your employees to be innovative so they can better support your patients.”

Above all else, Kelly advised, lead with confidence – not arrogance – and your employees will be motivated to do their best for you.

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RBMA

From fashioning a vision to creating a cohesive team to fixing problems, these leadership strategies can strengthen your practice and improve productivity.

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