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Building Awareness of the Changing Radiology Landscape


Understanding the radiology group practice environment is essential before planning or executing any operational plan. Here’s how to build that awareness.

The industry is facing a call to arms for radiologists to prepare themselves for the changes that are coming. We must adapt to the changes already present and prepare for those still to come. In this series, we are discussing how to transform a radiology group to create and drive a new culture of activism.

In our first article, we explored some of the issues facing radiologists and the importance of a strong culture binding a radiology group. In the second segment, we discussed how a new, energetic culture is the most valuable change-agent to ensure success now, and the future. In this installment, we begin discussing the specifics of our transformative model, AICI.


In evaluating how organizations successfully react and adapt to their environment, we have proposed a model using cultural dynamics as a change-agent for both tactical and strategic organizational policy initiatives. Our model is defined by four elements - AICI:

• Awareness
• Involvement
• Commitment
• Incentives

Let’s start with awareness.

The first step towards change is awareness. Within the AICI model, awareness has two main components. First, the leadership of the radiology group needs to evaluate the total environment in which the group practices. Second, the culture of AICI requires collaboration and consensus, not command and control. To create a setting of collaboration and consensus, the group leadership needs to engage all the stakeholders in an understanding of that environment.

The Business Environment

Environment and the concept of becoming aware of an organization's environment are the basic business building blocks for success. Environment is more than just the organization's setting. An organization has two business environments, internal and external. We’ll discuss the internal environment in future articles.

The external or business environment includes all those factors which are typically beyond its direct control. Business environments are constantly changing, modifying and adapting to new problems and opportunities as they arise. These changes will have a significant impact on organizations operating within the environment; and organizations, reacting to these changes, will in turn, have an impact on the overall environment. To be successful, an awareness of these interacting dynamics is of absolute necessity.

In a landmark article, Theodore Levitt first discussed the concept of "marketing myopia," the idea that with time, a business's growth stalls or fails due to a failure by the leadership to maintain a broad view of the niche their companies fill, opting instead for a narrow, constricted view of product rather than service. A myopic culture, developed over time by the leadership, ceases to evaluate cues in the environment that lead to improved client satisfaction by addressing their concerns and requirements, favoring instead a more introspective or insular view of growth through increased production and efficiency within the organization.

A myopic culture within radiology focuses on increasing technology and efficiency. Clinician, administration and patient needs and issues take a back seat.

To avoid this trap, radiology leaders must take the broad view of the service radiology provides and the role of imaging in patient care. To do this, we must accurately evaluate and understand the business environment in which radiology and radiology groups function. From the point of view of a radiology group, the business environment includes:

• Hospital administration, both local and system wide.
• Health plans and local, regional and national third party payers.
• Referring clinicians in both cooperating and competing medical groups.
• Patients.
• Local and regional cooperating and competing radiology groups.
• Local, regional and national medical-political issues.
• Local, state and national governmental and legal issues.

The Microenvironment

To begin an assessment of the group’s environment, it is easiest to begin with the microenvironment, that which is encountered every day. Radiology is a service industry and that service is judged solely on how well it fits into the care of the patient from the standpoint of the clinician.

The clinicians you encounter every day are an excellent place to start your evaluation. While there are a number of ways to gauge how your service stacks up, direct interaction with your clinician colleagues is the best, most direct and inexpensive way to begin. It also has the secondary benefit of beginning a dialogue with your most important clients, the clinicians who use and value you most.

From a business sense, a radiologist not only has medical colleagues but also business colleagues. In a hospital, those business colleagues are the supervisors, directors, hospital administrators and executives of the hospital and/or hospital system. Too many times we look at these people not as colleagues working towards a common goal, but as adversaries and obstructions to the way we want to practice medicine. Unfortunately, thinking of them this way tends to make them exactly what we anticipate. Opening a dialogue with these business colleagues is as important as opening a dialogue with your medical colleagues. Working with your administrative resources, as team members, will significantly improve the outcomes of any projects you jointly enter.

Next, your group needs to understand the competition. Look at those medical groups in competition for turf. We believe that radiological turf includes any radiological CPT code. If you are unfamiliar with CPT codes, now is a great time to become familiar with them.

We also believe radiology and radiologists should never give up diagnostic or interventional radiology segments to any competing nonradiological group. Saying that is the easy part. However, enforcing it is much more difficult. Holding onto what you have during a turf-battle will require significant interaction and trust with both your business and clinical colleagues. A myopic fortress mentality, all too often seen in radiology, only leads to we/they and win/lose types of scenarios. Alienating your colleagues and supporters only promotes ceding the battleground to your opponents.

A final and crucial area of the microenvironment you need to evaluate is the group itself. This includes all members of the group regardless of station or status. Becoming aware of what the radiologists within the group think and what they need is important as a concept of mission for the group takes shape. For example, are there areas where additional training is needed or where new radiologists will be required to complete the stated mission or obtain agreed upon goals?

Similarly, the opinions, feelings and outlook of the employees of the group should be considered. These are the individuals who will be integral to changing the culture, obtaining goals or executing any strategy. Direct interaction from the leadership with everyone in the organization is imperative. Employee surveys with open-ended questions are an important tool and promote further direct interaction and communication.

The Macroenvironment

Next, evaluate local, regional and state radiology groups that may be in competition with your own local contract(s) and/or may soon be in competition with more statewide or regional contracts. Look at them as if your group were going to consider merging. This was discussed in our original article and is repeated here:

• Evaluate the concept of mission within each group,
• Evaluate the adaptability or level of aversion to risk/entrepreneurial activity,
• Evaluate the involvement of physicians and team members in the organization as well as within the environment in which they practice,
• Evaluate the consistency within the organization, which includes the ability to follow through on a course of action.

Evaluating each of these areas will help determine whether these groups have the ability, resources and entrepreneurial spirit required to carry through with plans for expansion and to potentially become adversary. Alternatively, it will help to determine which groups may become good partners as your group begins plans for the future.

As with your clinical and business colleagues, getting to know the radiologists in other local and regional groups is important. This can be done at or through state radiological society meetings. Dinners, presentation of research or other conferences are also great ways of beginning relationships that can defuse potential problems before they occur. Working with other local and regional groups towards a common goal may prove beneficial from the standpoint of joint operations or full mergers.

Finally, from the perspective of the regional, state and national macroenvironments, it’s important to get involved in industry organizations important including the Radiology Business Management Association, state radiological societies, the Radiological Society of North America and the American College of Radiology. These organizations are frequently looking for volunteers, and opportunities to get involved are easy to find. Becoming involved pays huge dividends and provides access to academic, business and governmental leaders on a regional and national level that would otherwise not be readily available.

The Second Step

The second step of awareness requires the leadership of the group to bring all of the information found back to every level of the organization. As we have previously noted, all stakeholders - not just the leaders and managers - need to be "read in" to the issues and opportunities the group is facing. This cannot be done in one setting and should be planned with several different presentations concentrating on specific areas over several different meetings.

The money used to bring everyone together will be well spent if everyone in the organization works as a team. Input from team members is only relevant if each team member understands not only the big picture but also the nuances of potential problems or opportunities. Working on a solution to a problem that does not exist or developing an opportunity or goal that is not reachable or not in the mission plan only wastes time and resources and is frequently the result of an inadequate information base.

Awareness Is Empowering

Once team members are apprised of the micro- and macroenvironmental realities, the next step is developing reachable goals for capitalizing on opportunities and devising workable solutions to existing and upcoming problems. The team can create creative, entrepreneurial and out-of-the-box plans and goals . They can then generate logical, stepwise and focused operational plans using collaboration and consensus. Creating matrices are an excellent management tool that can be used to help the team better envision opportunities/issues, assess requirements and develop appropriate specific tactical and strategic strategies.

Throughout this process, the role of the leadership is as steward and guide, stepping in directly only when absolutely necessary. Hands-on direction or micromanagement frequently stifles the process and leads to unimaginative and potentially myopic outcomes.

Leadership, like governing, is by the consent of those being lead. Being the "boss," in whatever form that may take, does not make you a leader. A well run, aggressive, focused and thriving organization needs leaders. "Leaders lead," is a well-worn catch phrase, however many leaders forget the critical importance of their followers. Simply put, a leader is someone others want to follow. Every discussion and every meeting where information is relayed from team leaders to the team is an opportunity to demonstrate the importance of each individual to the organization. And, it is at these meetings leaders demonstrate their leadership not by sermonizing or lecturing, but by involving the entire team in the process.

Bringing it All Together

Awareness is the critical first step in the AICI process. Understanding the environment in which the group practices is a key essential before planning, staging or executing any operational plan. Awareness of the microenvironment in which the group practices and the macroenvironment in which the specialty of radiology is only a part, needs to be considered when creating an objective.

Bringing all of this information together gives the group leadership an opportunity to demonstrate its leadership to the organization by discussing issues, challenges and opportunities with the group and beginning the process of empowering every individual. The leadership needs to consider managing from the street level, not the rooftop i.e. management from the bottom up, not the top down. Finally, generating collaboration and consensus will create the greatest opportunity for the success of the group in any undertaking.

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