Health care economics, a painful lesson taught to most radiologists by experience, is now an educational mandate for radiology residents and fellows.
At a meeting for the Children’s National Health System Society of Chairs in Washington, DC, Raymond Sze, MD, recalled the group being asked who in the group had a formal business training. One person raised their hand.
“In a room full of 50 people responsible for the lives, welfare, business strategy, and revenue [of the hospital], isn’t it amazing that so few of us had formal business training?” Sze asked the audience at an RSNA 2015 session.
Like, many of his colleagues, Sze had to learn about business the hard way. Shortly after he arrived at Children’s Hospital, he noticed a significant technological gap.
“No one said, ‘you know Ray, here is a couple million dollars, why don’t you buy yourself some equipment?’ We had to fight for [new equipment],” he said. “We had to capture the net present values of [the equipment].”
Systematically, Sze, the faculty, and the leadership successfully made the case and received the resources they asked for, but it wasn’t easy.
“We had to develop a performance and zip code analysis, figure out our budget, revenue, and the impact on our main campus,” he said.
Sze mentioned other tough business lessons he learned, for example, creating a beautiful environment in a children’s outpatient imaging center to promote loyalty and branding. He also discussed the integrated practice unit, as described in Michael Porter’s 2013 Harvard Business Review article.
“[In an integrated practice unit], we need to work with our referring physicians and figure out what they want and need,” he said. “See their patients as our patients and create protocols, reports, as well as feedback mechanisms that allow you to be part of the care team and not just a consultant living in a dark room losing relevance.”
Teaching health care economics is where it gets tricky, as many of the attendings in the radiology department didn’t have this training themselves.
Sze recommended Coursera, which offers courses online from universities all over the country. For example, the first year MBA curriculum of the Wharton School of the University of Pennsylvania is available on the site, he said.
At Children’s National, they implemented a pilot health care MBA (which stands for minimal business acumen, in this case) program.
“I basically used the tactic of hiring our management team,” Sze said. “Instead of trying to recruit my attendings, some of whom are quite intimidated by this, I decided to recruit my management team.”
Management educated fellows on budget, billing, operations, profit and loss statements, revenue cycle, and more. “Suffice it to saw we created a comprehensive curriculum,” Sze said.
Another easily adaptable tactic Children’s instituted was partnering with their affiliate business school, George Washington University. This creates a win-win situation, Sze said, because the MBA students get internships in health care, a worthwhile experience, during which they can learn from the management team of the department. In return, they can educate the trainees about business.
The concept of reverse mentoring also came into play when managers, who were intimidated about public speaking and presentations, were taught by the MBA students how to craft a presentation, Sze said.
“We are pretty unsophisticated in terms of assessment,” Sze said. “We created five questions, we use the same ones pre-test and post-test to assess performance, and we specifically ask for feedback.”
They range the questions because they noticed variability in the pre- and post-test results, some were too hard or too easy. In their feedback, fellows requested some background reading prior to the lecture, so faculty started sending out reading material for students to read beforehand.
Also, Sze believes that knowledge not applied is knowledge lost, so his faculty try to create projects for fellows, driven by the management team.
“[In this instance], minimal business acumen becomes minimal business action,” he said. “As an example [of a project], we are asking fellows to identify a procedure that they are interested in, figure out the cost association with that procedure, and work with a management mentor to identify ways to decrease the cost in a standardized way.”
The Diagnostic Radiology Milestone Project from the ACGME and ABR provides tools for evaluating trainees in their development of knowledge, skills, attitudes, or attributes for the ACGME competencies.
For a reporting period, trainees will be given a level of performance (1-5) that describes their current performance level in relation to milestones. For example, in the “Systems-based Practice” milestone, a level 1 (the lowest) is someone who “describes departmental QI initiatives” and “Describes the departmental incident/occurrence reporting system.” A level 5 (the highest), “Leads a team in the design and implementation of a QI project,” and “Routinely participates in root cause analysis.”
More information about the milestones and program requirements is available on the ACGME web site for Diagnostic Radiology.