Ineffective Leadership

Radiology leaders can have a profound impact on the success and working environment of a radiology department, promoting core values and inspiring staff members to achieve the organization’s mission. On the other hand, ineffective leaders can have a devastating effect on a radiology department by impairing communication among members, undermining staff commitment to the organization’s success, and stifling the development of other staff members and leaders in the organization. One of the most important investments a radiology department can make is in identifying, cultivating, and promoting new leaders. The authors describe 13 habits and characteristics of new leaders that lead these individuals to address situations in both ineffective and counterproductive ways, impeding the performance of a radiology department and its capacity to play a meaningful role in shaping the future of radiology. New leaders must continually learn and improve their leadership skills if they are to avoid the destructive habits of ineffective leaders and successfully overcome the challenges facing radiology today. Senior leaders may also benefit from understanding the pitfalls that make leaders ineffective and should strive to continually improve their leadership skills given the critical role of leadership in the success of radiology departments.     

Process reengineering for the filmless environment.

Facilities that are converting to filmless operations can learn from the University of Kentucky Chandler Medical Center's (UKMC) experience: that dramatic reengineering processes must take place before radiologists' productivity can increase. To convert a radiology department to soft copy interpretation, a piece-by-piece implementation of new systems or upgrades is customary. The first step may be to link each modality that is already digital into modality-specific mini-PACS, then to link the mini-PACS. Bringing other modalities on-line as new equipment is purchased and expanding the image information system (IIS) to the remainder of the healthcare facility rounds out the transition and may take several years. The downside of this kind of evolutionary approach is that the radiology department temporarily operates in two environments, the traditional film and the new filmless environments. To make the move from film to filmless, an administrator and the radiology staff must reengineer nearly every departmental process. Total quality management (TQM) techniques offer tools that are ideal for the task. Other recommendations include using a multidisciplinary team of staff members who are familiar with film-handling to create flow charts of all departmental processes. Each step should be validated to show its value to the overall process, the department or the institution. Next, flow charts of the expanded or new processes should be developed with input from the IIS manager, referring physicians and key IS personnel. Follow with estimates of staffing requirements that meet the needs of the completed flow charts and, finally, train staff members for the implementation of the new processes.     

Radiology integration in a multi-hospital system.

In 1989, Salt Lake City's Intermountain Health Care (IHC) began a process to reduce costs and streamline processes. Divided into four geographic regions, IHC consists of 24 hospitals and 100 clinics, a 400-member practitioner-physician group, and a staff of 23,000. IHC determined that three Salt Lake Valley hospitals, part of its Urban Central Region, must become one entity with shared management and a reduced staff to cover operations at all three hospitals. Management of the three radiology departments were charged with creating an integration process for the three hospitals. Two directors were selected to manage radiology and meet the outlined goals. Difficulty arose when one director needed to make changes in a facility managed by the other. The directors found that structuring by modality allowed them to plan for all three facilities, standardize equipment purchases and create integrated rather than departmental programs. As consolidation was taking place in top management, employees worried what the resulting changes meant for their jobs. Many were unfamiliar with the concepts of team structure and continuous quality improvement. Various courses and meetings were held to educate staff members and bring them up to new standards. Most successful were the meetings that allowed staff from different facilities to come together and share ideas. Although travel was an issue, these meetings quickly helped move the integration processes forward as peer relationships were developed. Employees were recruited for cross-training and new staff worked wherever needed. As they began to share data, the three hospitals identified best-practice and internal benchmarks. IHC is now ready to hire a single director to manage the radiology departments at the three Salt Lake Valley hospitals.     

Managing a multicultural radiology staff

Opportunities for minorities in healthcare increased with the Civil Rights movement in the 1960s. More recently, funds from the U.S. Public Health Service have been targeted toward disadvantaged minorities. The workforce in healthcare, and in business in general, has become increasingly multicultural. Much of the literature in healthcare management lacks practical guidelines for managing a diverse workforce. Communication, both verbal and nonverbal, and culture are closely intertwined. Managers, as they develop multicultural teams, will need to understand how culture influences communication in their organizations. Space, spatial behavior, and cultural attitudes influence people's behavior. This is a particularly important consideration for a radiology staff, which must often work in close quarters. For some cultural groups, the family as an organization has more significance than even personal, work-related or national causes. People's orientation to time, whether for the past, present or future, is usually related to the culture in which they grew up. Again, this may become an important issue for a radiology administrator whose organization must run punctually and time-efficiently. How patients feel about their environment, whether they believe they are in control or believe in an external locus of control, is of particular interest to those who attempt therapeutic changes in a patient's healthcare. Does the patient believe that illness is divine will or that suffering is intrinsic to the human condition? There is increasing research in the United States to show that people do differ biologically according to race. Such differences exist among patients as well as among staff members. It has been popular to assume that differences among races do not exist. Unfortunately such an attitude does not allow for different attributes and responses of individuals. Managing a multicultural staff presents a challenge to administrators who must be skilled in working with culturally diverse people and must help their staff members do the same.     

The Importance of a Radiologist-Administrator Partnership to Future Health Care

Successful physician and administrator leader partnerships are a key differentiator in today’s volatile, unpredictable, ever-changing health care landscape. Whether they are leading a division, a department, or an organization, intentional and mindful physician-administrator partnerships affect success from the micro individual level to the macro organizational level. Mayo Clinic's physician and administrative leaders are leveraging a long-held tradition of partnership by elevating their own competence as effective partners to ensure organizational sustainability. Specifically, physician and administrator leaders in the department of radiology have positioned collaboration at the foundation of their leadership practice, surrounded by the institutional values of respect, excellence, stewardship, and teamwork. From this framework, team leaders are better equipped and in a more stable position to prepare themselves and their colleagues for the very complex and unknown future.     

Beyond culture and regular staff meetings.

Joining the radiology department of a New York City hospital, I learned that if I fostered employees' self-respect and self-reliance, they would do a good job. I believed the staff would achieve maximum performance levels when I understood the culture of the department and could work with staff members beyond regular staff meetings. More than anything else, understanding the department culture influenced my style of management. To keep the lines of communication open, department supervisors and attending radiologists meet biweekly with the chairman of radiology to discuss current and anticipated problems. Often, these meetings are charged with new ideas and excitement. An in-services program to educate and motivate employees on the job was another ongoing process, with radiologists and radiology administration working together. In-service presentations emphasized learning by using actual cases. Believing a seminar's effectiveness can be measured by its relevance to staff members, I gave a seminar on financial techniques and explained stocks, bonds, mutual funds, IRAs, 403B, 401K and multiple retirement options. Technical and clerical staffs are unionized so management and union delegates now meet to identify mutual concerns under the hospital-initiated labor management meetings. To meet additional goals, my department closely monitors the QI of the most important aspects of care-waiting times, turnaround times of radiology reports and satisfaction of both physicians and patients. In the creative atmosphere I brought to the hospital, I was able to teach staff members to reach for goals they had considered beyond them.     

Project planning in the diagnostic imaging department

Certain common steps in the planning process are necessary to ensure the success of any construction project in a diagnostic imaging department. Determining the need for the project, analyzing requirements for equipment, space and personnel, and budgeting for the project are necessary steps. They are followed by scheduling and designing the various aspects of the project. Engineering the construction phase and implementation with follow-up are the last steps. Determining whether a proposed project is necessary is the essential first step. Doing a cost-benefit analysis and determining if the return on the investment will be positive are important for a project's success. Good planning and communication with key staff members of the healthcare institution and the members of the design and construction team will help ensure successful implementation of any project. The role of the facility engineer is often critical in the early planning stages of a project to determine what utilities may be needed, any need for plumbing or electric work, power sources, building code requirements, the need for medical gasses and suction and so forth. Analysis of a potential project's equipment, space and personnel needs is also critical. Gathering the necessary information from various sources within the healthcare institution is essential. The steps for scheduling and designing an entire project should include finalizing the design and developing a schedule for its implementation. Keeping accurate minutes and documenting action items from all project meetings can serve to protect the budget. By following the steps outlined, budgeting time efficiently and delegating some tasks to others, the radiology administrator can continue to perform tasks involved in the day-to-day management of a radiology department.     

Step by Step: A Structured Approach for Proposing,Developing and Implementing a Radiology Peer Learning Program

Similar to the experiences of other radiology practices, our radiology staff members felt that scored peer review identified few errors/learning opportunities while undermining team collegiality. They desired a more effective way to promote team collegiality and foster lifelong learning. We describe the steps our department took to transition from a peer review system to a peer learning program.     

Changing the face of radiology: redesigning patient-focused care

Mercy Hospital began the redesign of its patient-focused care in 1991. A steering committee composed of members from multiple disciplines was asked to create a seamless, patient-focused environment that would coordinate and align hospital resources in the service of patients and families. The director of diagnostic and clinical services served on that committee and used the committee's operating goals and principles to transform Mercy's radiology department into a diagnostic center. As part of its redesign effort, the radiology department reviewed its outpatient environment. Since so many of its patients came to have at least one of three procedures (EKGs, radiology exams and phlebotomy services) and since they must all register, the department decided to concentrate first on its registration procedure. A meeting with the medical records department resulted in the reception and scheduling staffs learning the registration process. After the two staffs went through an aggressive training program of about three months, it was possible to combine the two positions into one. Training staff members to schedule all modalities in the radiology department was next. With further cross-training, staff members now perform centralized scheduling for radiology, endoscopy and osteoporosis. Physicians can schedule such exams with only one phone call. Could technologists learn to draw blood too? Members of the healthcare team accepted the challenge to become more diversified and expand their skills. The author explains how the technologists became certified phlebotomists. With that success underway, the team accepted volunteers for EKG training. The author presents the benefits of the various steps taken, and looks at possible future opportunities in cross-training at the hospital.     

A case study in developing a radiology information technology (RIT) specialist position for supporting digital imaging

Support services in providing PACS to healthcare facilities are becoming more complex. Imaginative staffing models are imperative to provide a successful PACS program to customers. Choosing the right staffing grid of support staff can be assisted by locations with like volumes or geographic areas. The RIT (radiology information technology) specialist is an excellent asset in a growing PACS environment. RITs can be the crucial liaison between the radiology department and the customer. RITs with different backgrounds can be recruited based on what type of support services your customers need. RITs are a great resource for one-on-one training from physicians to nursing staff. This mobile PACS spokesperson can take the concerns of the customers to the PACS administrator to open dialogue and communication that will win customer loyalty in this ever changing world of technology.     

Diversity in the imaging workforce

Culture is the coherent, learned, shared view a group of people has about life's concerns that ranks what is important, and instills attitudes about those things which are considered appropriate as well as prescribed behavior. It notes that some things have more significance than others. "Culture shock" is what happens when a person suddenly finds himself or herself in a place where "yes may mean "no," where a fixed price is negotiable, where to be kept in an outer office is not a cause for insult, and where laughter may signify anger Effective leaders should be able to vary their styles of management, such as leading, planning, organizing, motivating, decision making, staffing, and more importantly, communicating with groups of workers from different cultural backgrounds. Leaders need to perceive conflict as both a challenge and an opportunity. Awareness about team members' cultural similarities and differences is key to foster effective conflict resolution. Synergistic organizations transcend the distinct cultures of the team members. They use these differences as a resource in designing and developing organizational systems. Effective leaders must become a champion and capable of acting in many ways, not experts rigidly adhering to a single approach.     

Managing imaging facilities at multiple location.

In managing multiple imaging facilities, the radiology administrator must apply basic management skills to new functions and in new directions. Mr. Hunton offers some guidelines on planning programs, working with radiologists, team management, and other key issues.     

The PACS committee: the all-important human element

The PACS committee plays a crucial role in attaining successful outcomes from a PACS implementation. However, most radiology departments do not organize and manage their PACS committees well. This has resulted in poor outcomes and inability to realize projected benefits and return on investment. Ideally, there are two PACS committees: a high-level strategic committee that aligns the goals for the PACS with institutional initiatives, and an operational PACS committee that makes a hands-on approach to the project and manages the entire PACS program. The chairman of radiology, an assigned radiologist or the radiology administrator heads both PACS committees. The strategic PACS committee consists of senior people from information systems, strategic and operational planning, radiology, physicians, nursing, critical care, and other related departments in the hospital. The operational PACS committee consists of people directly involved in radiology operations including the chief of radiology, radiology administrator, technologists, file room manager and other personnel whose daily routines will be affected by the PACS implementation. The operational PACS committee manages the PACS program from initial planning through the post-installation period. Committee tasks include: developing an implementation plan, establishing goals and objectives, conducting a cost/benefits analysis, developing functional specifications, generating an RFP, managing vendor selection and contracting, preparing the site for installation, performing project management functions, conducting acceptance testing, overseeing training, and evolving the PACS operations to meet predicted outcomes.     

Facility wide benefits of radiology vascular access teams

Many PICC lines are inserted in the radiology department and, at the rate they are inserted, can have serious financial implications for a facility. These costs combined with the increase in the number of line placements performed annually have imaging leadership evaluating alternatives for catheter placements in their departments. Several benefits to forming an in-house vascular access team include increased patient satisfaction, improved care, decreased length of stay, optimizing DRG reimbursement, and increased revenue. Considerations prior to initiating a vascular access team include: staff members involved, location of insertions, and up front funds available.     

Staff training: a critical step in computerization.

Many computer-based information management systems designed for radiology departments are increasing productivity, lowering costs and even improving employee morale. But these results do not just happen. An effective training and implementation program, conducted before the system is installed, is crucial if staff members are to become comfortable with, and not overwhelmed by, the system. The author describes the training program used at Grant Hospital in Chicago, Illinois.     

Americans with Disabilities Act: meeting the needs of hearing-impaired patients

To comply with Title III of the Americans With Disabilities Act of 1990, radiology managers must take responsibility for providing special assistance for hearing-impaired patients. That includes training staff members in techniques that can help them communicate more effectively with hearing-impaired patients. This article describes difficulties some hearing-impaired patients experience during radiology exams, and suggests measures radiologic technologists can use to assist them.     

Planning and conducting meetings effectively, part I: planning a meeting

Meetings are held by leaders for many purposes, including conveying information, raising morale, asking for opinions, brain storming, making people part of the problem-solving process, building trust, getting to a consensus, and making decisions. However, many meetings waste time, some undermine the leader's power, and some decrease morale. Part I of this series of articles gives some tips on basic planning for decision-making meetings. Part II of this series of articles analyzes selected components of decision-making meetings. Part III of this series will be on how the chairperson keeps decision-making meetings on track to make them efficient and productive.     

Comparison of face-to-face and videoconferenced multidisciplinary clinical meetings

A trial of videoconferencing of multidisciplinary breast cancer clinical meetings between three public hospitals was conducted in an attempt to increase attendance by medical staff at the meetings, and thus facilitate multidisciplinary care for breast cancer patients. The videoconferences were compared with the previously existing face-to-face clinical meetings through questionnaires, attendance, number of cases discussed and anthropological analysis. Although more people attended the videoconferences than the face-to-face meetings, most of the participants in the trial preferred the face-to-face meetings to the videoconferences. The mean number of cases discussed at the videoconferences was significantly less than the mean number of cases presented at the face-to-face clinical meetings. The face-to-face meetings were informal, spontaneous and conducive to open discussion. In contrast, the videoconferences were formal and regimented. Multidisciplinary case discussion can be facilitated by videoconferencing. Some of the negative experiences we encountered could be overcome with changes in meeting format. Our experience may help others in setting up a successful multidisciplinary team via videoconference.