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(Not) Choosing Mediocrity


Striving to be better than average in radiology.

You don’t hear too many businesses boasting about how unimpressive their goods and services are.

At least, not directly. There are more than a few oblique ways of conveying the message. Selling in bulk, for instance, or calling attention to extra low prices made possible by nofrills packaging, little/no advertising, etc.

In some fields, that just isn’t feasible. Everyone is supposed to be providing the absolute best, to all customers, all of the time. It’s kind of a laughable concept, really; who bats a thousand? Yet, in arenas like health care, maintaining the illusion is more of a “must” because nobody wants to think that they or their loved ones will, at some point, receive less-than-the-best treatment, when life and limb are on the line.

I have encountered more than a couple of facilities and medical groups that seem determined to prove this grim reality. Naturally, they don’t come right out and say that they’re doing their minimum, although I can imagine Half-assed Healthcare’s slogan: “Why pay for the best when ‘good enough’ will do?” Or Mediocre Medical Imaging’s: “Getting the job done-barely.”

They, too, get the message across indirectly: Having equipment old enough to teeter on the brink between technology and archaeology. Maintaining staff morale at a level where they have no motivation to excel at their jobs…and just above the point at which they would take the chance of quitting without necessarily having a better job already lined up. Letting the décor go to the point of not quite falling apart before thinking about putting on a new coat of paint, filling potholes in the parking lot, etc.

I don’t think too many scrupulous professionals start out with the attitude that they are going to make a career out of doing as little as they can get away with. They don’t actively choose mediocrity; they just fail to actively opt against it. For most, it’s a slippery slope, on which it takes more than a few steps before one is willingly sliding on an accelerating downward trajectory.

Which is why it seems so important, to me, to avoid even taking those first few quality compromising steps. I’ve written a few columns about how frustratingly difficult, even seemingly impossible, it can be for an individual physician in a mediocrity-bound health care environment to stand firm and refuse to be a part of the status quo.

Left to his own devices, such an individual is all too quickly and easily worn down. Having even just one or two like-minded teammates in the medical trenches to bolster one another helps. Being in an organization that considers quality for its own sake to be a worthy pursuit is ideal; if one can’t find such an outfit to join, it’s not uncommon to dream of creating it from scratch. “We’ll do it right,” is often the rallying idea.

A quality seeking organization isn’t as easy to come by as one might hope. More often than not, businesses sporting Quality Control divisions seem more about damping down the quality than perking it up. Not too surprising, since invariably there are limited resources but an unlimited number of ways things could be better than they are, and priorities have to be determined. Sooner or later, decisions get made about how this is worthy of effort to improve, whereas that has to be shelved for some other time. Personal preferences, biases, and ulterior agendas more than occasionally skew such prioritization.

Having been on the receiving end of what I term “nonprioritization” (being told that something I deemed a worthy investment of quality improving resources was, well, less than worthy), I’ve fantasized about there being a sort of anti-mediocrity honcho. Somebody relatively low on the executive ladder, but graced with the status of “go-to guy” for anybody in the organization who feels like they have important, but ignored (or indefinitely postponed) ideas in the group’s best interest.

Call him the Quality Ombudsman, or the Anti-Mediocrity Officer. When your great idea for improving profit margins, efficiency, morale, or whatever else gets summarily shot down or interminably “considered” by the chain of command, he’s your sounding board. Unencumbered by numerous other concerns of the higher-ups, yet thoroughly familiar with the workings of the organization, he is well situated to objectively hear you out as to why you think your notion deserves more of a hearing than it’s gotten.

He might do some research to see if the idea has “legs.” If he agrees, he presents it to the decision makers as something to reconsider. Or explains to you why the idea is not getting traction (which requires the higher-ups to be honest and straightforward with him, lest lack of transparency undermine his credibility).

Maybe he gets even a little more authority than that-a modest budget and/or staff which he can allocate to initiatives he deems worthy, in the absence of “buy-in” from the execs. If his projects prove worthwhile, his recommendations up the chain of command will likely be heeded more frequently. And maybe he’s granted additional resources once he’s shown he can propagate success stories.

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