DRIVING CHANGE Leadership Is for Everyone Leadership Is for Everyone

IMAGING 3.0 IN PRACTICE July 2020 | Vol. 2 | No. 2

In times of uncertainty, strong leaders are more important than ever before. To survive and thrive, every radiologist needs to ﬁ ll gaps in non-interpretive skills. That’s where the Radiology Leadership Institute® (RLI) comes in.

Built by radiologists for radiologists, the RLI teaches you the essential leadership and business skills you need to be a change agent in your organization.

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With programming for radiologists who are leading change at all levels, the RLI can help you advance your career and master the challenges ahead. Be a Leader

07.20 acr.org/rli July 2020

IMAGING 3.0 IN PRACTICE

Driving Change Leadership Is for Everyone Case Studies

Throughout medical school, residency, and fellowship, radiologists receive extensive 4 Catalyst for Growth clinical training that prepares us to deliver exceptional patient care. What’s missing A radiologist uses skills learned through in radiology education, however, are other essential skills that we also need to deliver the ACR Radiology Leadership Institute to imaging services — things like communication, negotiation, financial management, team drive measurable results and implement new building, business principles, change management, and more. In a word: leadership. service lines. In the past, many radiologists believed that, unless their goal was to become the chair of their department or an executive in their practice, they didn’t need business and leadership 7 Dedicated to Pediatric Care training. Now more than ever, it has become abundantly clear that healthcare isn’t just An interventional radiologist leads the about medicine. At all levels, it’s about leading change, driving quality improvement, and creation of a pediatric interventional radiology department at Peyton Manning implementing value-based care. Children’s Hospital. Simply put, leadership is for everyone.

In the face of today’s unprecedented health, social, and economic challenges, rapidly 10 Shaping Your Story addressing changing priorities is top of mind for many radiologists. But none of us could A radiologist in Massachusetts strives to rebrand radiology and winds up have forecasted just how fast those changes would hit. simultaneously building her own No matter what challenges you’re facing, now is the time to focus on honing your existing personal brand. leadership and business skills and learning brand-new ones to help you succeed in today’s profoundly altered healthcare landscape. 14 Behind the Curtain Ohio radiologists collaborate with a patient The Imaging 3.0 case studies in this collection demonstrate how radiologists across the advocate to implement a direct results country have applied leadership skills learned from the ACR Radiology Leadership delivery program that decreases patient Institute® to become change agents. anxiety and gives radiology a face. There’s something here for every radiologist who wants to improve their business or leadership skills. By reading these stories of leadership in action, we hope you will better 18 Changing for the Better arm yourself with new abilities and fresh perspectives to master the challenges ahead. R adiology leaders use change management strategies from the ACR Radiology Howard B. Fleishon, MD, MMM, FACR Leadership Institute to adopt previously Chair, ACR Board of Chancellors resisted technology.

Imaging 3.0 Advisers Imaging 3.0 Staff ACR Press Staff SHARE YOUR STORY Have a case study idea you’d like to share with the Geraldine B. McGinty, G. Rebecca Haines VP, ACR Press Lyndsee Cordes Director of Periodicals radiology community? To submit your idea, please MD, MBA, FACR Chris Hobson Imaging 3.0 Senior Lisa Pampillonia Art Director visit acr.org/Suggest-a-Case-Study. Communications Manager Nicole Racadag ACR Bulletin Managing Editor Marc H. Willis, DO, MMM Jenny Jones Imaging 3.0 Managing Editor Chad Hudnall ACR Bulletin Senior Writer Sabiha Raoof, MD, FACR Linda Sowers Consulting Editor Jessica Siswick Digital Content Designer QUESTIONS? COMMENTS? Lynn Riley Freelance Designer Cary Coryell Publications Specialist Contact us at [email protected]

All American College of Radiology Imaging 3.0 Case Studies are licensed under a Creative VISIT THE ARCHIVE Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. Based on works at www.acr.org/imaging 3. Permissions beyond the scope of this license may be View Imaging 3.0 in Practice online at acr.org/InPractice available at acr.org/Legal.

Imaging 3.0 in Practice n July 2020 3 Case Study Published July 2020 Catalyst for Growth A radiologist uses skills learned through the ACR Radiology Leadership Institute to drive measurable results and implement new service lines.

hawn D. Reesman, MD, FACR, was attend- Sing a peer review committee meeting KEY TAKEAWAYS when he experienced an unforeseen sense of inadequacy. As a partner with Raleigh • A radiologist participated in the ACR Radiology at the time, Reesman had joined Radiology Leadership Institute after the committee in hopes of contributing to realizing that he needed additional clinical care improvement at Raleigh General skills to advance his career toward Hospital in Beckley, West Virginia. But as improving hospital operations. his colleagues around the conference table • Leveraging communication, demonstrated a deep understanding of the negotiation, collaboration, and hospital’s daily operations, Reesman recalls other business-centered skills, feeling overwhelmed. His internal monologue the radiologist became a trusted chided, “This is beyond my skill set. I have no resource throughout the hospital, idea what I’m doing. Why am I even here?” helping to advance his radiology Reesman realized that if he wanted to group’s prominence. participate in the discussion and have a • The radiologist’s efforts led to the meaningful impact on patient care, he development of new service lines, needed additional training. In particular, he Shawn D. Reesman, MD, FACR, participated in the required the communication skills, operation- Radiology Leadership Institute to hone his interpersonal increased patient referrals, and and leadership skills for improved bridge-building higher employee satisfaction scores. al expertise, and strategic planning moxie between radiology and hospital administration as well that advancing comprehensive patient care as other specialties. requires. To obtain these skills, Reesman participated in the ACR Radiology Leadership team in today’s increasingly complex Institute® (RLI), which offers online and healthcare environment. “One of the most in-person training on topics ranging from important things that I learned from the RLI personal branding to negotiation to help is that you have to embrace change,” he says. radiologists at all career levels lead change “If you’re not helping develop the direction and enhance care within their hospitals and of the change, then you’re left at the mercy practices. “When I heard about the RLI, I of wherever the change winds up.” immediately recognized that it would provide me with the skills needed to move into the next phase of my career,” Reesman says. Getting Involved As Reesman expanded his knowledge While medical and residency training pro- base through the RLI, he took on a more grams adequately cover diagnostic skills, influential role at Raleigh General Hospital. they seldom address the business side of He served on various hospital commit- medicine. As a result, doctors rarely leave tees, collaborated with administrators on medical school with the leadership skills quality improvement initiatives, formed required for career acceleration and effective new partnerships with other physicians, and management, including interdepartmental became a trusted resource for colleagues collaboration, negotiation, communication, hospital-wide. Now a partner at Associated and problem-solving. “In medical school, the Radiologists in Charleston, West Virginia, focus is mostly on the disease, diagnosis, and Reesman continues to apply his leadership cure processes, but the business aspects of training to help solve everyday challenges building bridges between specialties and and give a stronger voice to the radiology hospital administration are often lacking,”

4 IMAGING 3.0 Reesman explains. “It’s important to develop leadership and interpersonal skills in medicine so that you can help align teams around “Once you build confidence and find direction, you are able a vision that benefits patients.” to step out and become a change agent. You become a This became increasingly apparent to Reesman as he began getting involved in sought-after resource for other stakeholders.” hospital operations in 2011. Although he had —Shawn D. Reesman, MD, FACR gained a baseline knowledge of operations from attending one-off sessions at various professional conferences, experiences like the one he’d had with the peer review essential traits that he learned along the way: Executive Committee (MEC), a governance committee made him realize that he needed integrity, intention, capability, and outcomes group that implements the hospital’s culture to deliberately hone his leadership skills if oriented. He also focused on being a good of safety, drafts and enforces bylaws and he wanted to be involved in making critical listener. “The RLI taught me to appreciate hospital policies, ensures compliance with changes. “I had a cursory understanding diversity of opinion,” Reesman says. “This was accreditation standards, and considers new of hospital operations, but I needed more a major turning point for me because before medical staff for board approval. “Once you robust training to fully engage in the type of decision-making that leadership requires,” this, I didn’t always acknowledge the signifi- build confidence and find direction, you Reesman says. cance of other people’s perspectives.” are able to step out and become a change As circumstance would have it, the ACR As Reesman applied his leadership skills agent,” Reesman says. “You become a launched the RLI in 2012 to help radiologists to committee work, he was presented with sought-after resource for other stakeholders.” at various stages of their careers further additional opportunities to get involved in As a member of the MEC, Reesman lever- their professional development. Reesman hospital operations. In 2015, for instance, aged the skills he learned through the RLI was eager to participate in the program, he was elected to Raleigh General’s Medical to open new service lines, address behavior which explores topics such as the differences between leadership and management, the value of involving diverse opinions, the secrets to active listening, and tips for developing credibility and executing follow- Make Things Happen through. He participated in the online, synchronous interactive classroom, listened to RLI podcasts, and attended several RLI Shawn D. Reesman, MD, FACR, says these leadership Leadership Summit meetings, where he networked with peers and sharpened his skills traits have been essential to his career success: to better perform in new roles that would benefit the hospital as well as radiology. • Integrity “As radiologists, we don’t have a lot of • Intention face time with patients or even colleagues • Capability because we’re reading films all day,” Reesman says. “In some cases, you are in the reading • Outcomes Oriented room for years and few people even know • Active Listener your name. You’re out of sight and out of mind. If you’re overlooked, you’re not being heard. It’s important to get engaged in hospital operations so that you can bring the radiologist’s perspective to the table.”

Building a Reputation In Reesman’s case, his reliable presence on the peer review committee positioned him as a trusted resource. He says he gained credibility in that position by demonstrating four

Imaging 3.0 in Practice n July 2020 5 and compliance issues among medical operations overall. Radiologists and the the lead interpreter and later the imaging staff, facilitate realignment of the hospi- hospital share common goals and incentives director of a freestanding OB/GYN imaging tal’s vision, and further the MEC’s role as a and are closely aligned, so their involvement center after a local physician proposed champion of change. He found the work is an appropriate fit.” that Reesman’s radiology group provide so engaging that he remained on the MEC As Reesman’s reputation as a change mammography and vascular ultrasound through the years, serving as secretary/trea- agent spread, individual physicians often services at their imaging center. “I have surer, vice president. approached him for advice and with ideas. been able to build genuine relationships Raj Patel, MD, spine surgeon and member Based on these conversations, Reesman with unlikely colleagues,” Reesman of the MEC, says that working with Reesman developed robust action plans to shepherd says. “I probably wouldn’t have had this gave him a greater appreciation for the the implementation and expansion of new opportunity if I hadn’t taken the initiative to get involved in the RLI and build skills beyond image interpretation.” Reesman also got involved in the Raleigh “The radiologist’s voice is one of the most objective voices in County Medical Society, serving on its board from 2015 through 2018. During that time, the hospital. The level of objective reasoning they have while he spearheaded the development of the society’s interactive website, allowing remote interpreting images is a valuable asset.” access to continuing medical education —Raj Patel, MD opportunities. “This all happened as a result of getting out of the reading room and taking action. The RLI taught me that while the focus of management is orderly results, leadership functions to produce change,” Reesman says. unique position that radiologists hold within and existing service lines, including MRI iron The RLI has served as a bridge for the healthcare system and the ability they quantification testing, MRI-guided breast Reesman, from one stage of his career to have to impact change across the hospital biopsies, coronary CTA interpretations, and the next, and is doing so for other radiol- for the good of patients. “The radiologist’s contrast-based liver tumor evaluation. These ogists. The importance of leadership skills voice is one of the most objective voices in leadership contributions helped generate can’t be overstated, says Reesman. “I went the hospital,” Patel says. “The level of objec- positive outcomes for the hospital, especially from feeling overwhelmed when I first tive reasoning they have while interpreting in the form of increased patient referrals joined the hospital’s peer review committee images is a valuable asset to bring to the from cardiology and hematology, which to a ranking member of the MEC to a trust- table for other types of decision-making.” helped bridge the gap between specialties. ed leader who is involved in multiple levels As the hospital’s patient referrals rose, of hospital operations. The RLI equipped me staff members came to see how their Achieving Results with the knowledge and skills to perform at contributions were impacting patient care. this new level.” Patel wasn’t the only one impressed with The results drove an increase in employee Reesman’s work with the peer review engagement, and during the 2016-2017 By Kerri Reeves committee and MEC. David Darden, MHA, year, the hospital boasted its highest-ever FACHE, former chief executive officer of physician satisfaction scores, with radiology Raleigh General Hospital, also took notice topping the list as the most satisfied depart- Next Steps and invited Reesman to join the physician ment. “Short-term gains really fire people up. • Participate in the ACR RLI leadership engagement group, which includes repre- And if you show these gains along the way, programs and attend in-person and sentatives from various hospital divisions people not only stay involved, but they also online courses to learn more about the who focus on improving both patient and go the extra mile because they have a better business side of medicine. physician satisfaction scores. understanding of the meaning behind their • Join hospital committees, and build “I’m a strong supporter of hospital-based work,” Reesman says. credibility by regularly attending meet- physicians — radiologists in particular — ings and listening to the viewpoints of being involved in leadership,” Darden says. key stakeholders. “Radiologists see almost every patient who Expanding Contributions comes into the hospital for care, so they can Reesman’s efforts inside of the hospital • Track and share results data to illustrate provide guidance to hospital administrators led to new opportunities within the the impact of change initiatives and and medical staff about patient care and community, too. For instance, he became further engage team members.

6 IMAGING 3.0 Case Study Published April 2018 Dedicated to Pediatric Care An interventional radiologist leads the creation of a pediatric interventional radiology department at Peyton Manning Children’s Hospital.

oung patients have access to more than Y40 pediatric services and subspecialties KEY TAKEAWAYS at Peyton Manning Children’s Hospital (PMCH), part of St. Vincent Hospital and • Leveraging skills learned at the Radiology Leadership Institute,, an Health System in Indianapolis. But before interventional radiologist created a 2016, when children required interventional pediatric interventional radiology radiology (IR) procedures as basic as feeding (IR) department at Peyton Manning tube replacements, a dedicated pediatric IR Children’s Hospital. department wasn’t available to treat them. Sometimes, these children went to St. • Building a pediatric IR department that Vincent’s adult vascular lab — which the met the needs of patients and referring hospital system shares with Northwest physicians required buy-in and support Radiology Network (NWR), the private from the diagnostic radiology group practice that provides the system’s diag- and hospital. nostic radiology services. Unfortunately, • In its first three months, the department though, the lab wasn’t equipped with the took on more than 80% of the hospital’s dedicated time or resources for specialized pediatric IR patients. pediatric care. “Without a dedicated workflow for all the Marc P. Underhill, MD, interventional radiologist with kids we saw, the adult lab just worked kids Northwest Radiology Network, led the creation of a in as it could,” says Marc P. Underhill, MD, an dedicated pediatric IR department at Peyton Manning interventional radiologist at NWR. “Pediatric Children’s Hospital at St. Vincent. IR is different than dealing with adults: You’re not just treating the patient, you’re also Presenting to the Board treating the parents. Reviewing treatment In December of 2015, Underhill presented plans with both the patients and parents his vision to his group’s board of directors — requires more time and flexibility than the which initially responded with “nice smiles adult lab can consistently provide.” and a bit of skepticism,” he says. They under- As the children’s hospital grew and the stood the hospital’s need for this service and volume of pediatric IR cases increased, this recognized Underhill’s passion for pediatric bottleneck became more evident. “We were care but had plenty of questions about the seeing more frequent and complex pedi- time, cost, and resources required. atric patients than the adult IR providers “One concern that always arises in any were comfortable treating,” says Richard private practice model like our group is, K. Freeman, MD, MBA, system chief medi- what are the costs associated with provid- cal officer at St. Vincent. “As a result, some ing this service?” says Matthew M. Jones, pediatric IR patients were being delayed or MD, a pediatric radiologist at NWR. “Other transferred out of our facility.” concerns include: How much dedicated For Underhill, who was studying business time is this going to take? Is there a set of and leadership through the ACR’s Radiology procedures and patients to start caring for Leadership Institute® (RLI) at the time, the immediately, or will it take a while to ramp solution was obvious: Create a dedicated up? And how will the group budget its pediatric IR department to improve the time and payroll to make it worthwhile?” patient experience and keep kids from Collaboration was the answer to many of having to seek care elsewhere. these questions.

Imaging 3.0 in Practice n July 2020 7 W. Kent Hansen, MD, PhD, president and Underhill credits the RLI, a professional chief executive officer of NWR, says, “We training program specifically designed for couldn’t promise Marc the dedicated time to radiologists, with teaching him the business do only pediatric interventional services. He savvy necessary to turn these conversations had to be willing to sacrifice his time to grow into a business plan. the pediatric department while continuing “Five years ago, I had no idea how to to provide adult care — and the group had write up a business plan or how to present to make sacrifices, too, to help him out. It was that plan to different groups to get buy-in,” critical for him to build relationships and buy- says Underhill, who wrote his RLI practicum in from the rest of the group and from the report about launching this pediatric IR hospital because he needed their support.” service. “The RLI provided me with the skills I needed to turn my vision into reality.” Rallying Support After receiving strong approval from hospital providers, Underhill secured a meeting In the weeks following his meeting with the with St. Vincent’s chief medical officer. He board, Underhill focused on building buy-in presented a list of physician-requested IR and support throughout his practice and services that the new department could the hospital. offer and laid out a proposal for delivering, Underhill had been casually bouncing the expanding, and improving those services to W. Kent Hansen, MD, PhD, president and chief executive idea of a dedicated pediatric IR department officer of Northwest Radiology Network and chairman increase referrals over time. of diagnostic medicine for St. Vincent Hospital and off other clinicians for years. Now, he began “Dr. Underhill had carefully thought Health System, says the pediatric IR department’s success depended on collaboration. asking more pointed questions to under- through the problem and the potential solu- stand how often pediatric physicians would tion and had gathered support within his use dedicated IR services and to assess how group and among his peers,” says Freeman, Leveraging the relationships and open he would manage their patients. who immediately saw the value in filling this communication lines he’d already estab- “While the initial goal of these conversations care gap. “People often bring problems to lished with referring physicians and other was to gain support, they actually informed me, but rarely do they present such a well- radiologists, Underhill exceeded his first-year how we structured the service line,” Underhill thought-out solution.” goal within three months. says. “They helped us develop a business plan With the support of his practice and During this time, Underhill attended for standardized care and determine how we St. Vincent Hospital, Underhill opened a pediatric rounds, quarterly meetings, and would schedule patients, how we would pro- dedicated pediatric IR department in shared morbidity and mortality conferences, where cess imaging orders, and who should perform space within PMCH’s radiology department he continued promoting the pediatric IR and manage which IR services.” in January of 2016. department and asking referring physicians how the department could help them. He also gave referring physicians his cell phone Building the Department number, making himself available for any IR To achieve his objective of improving the questions or requests. pediatric patient experience, Underhill built “The referring physicians really appreci- the dedicated expertise and processes to ate having Marc as a point-of-care contact,” treat children more effectively than the adult says Hansen, who’s also chairman of vascular lab. diagnostic medicine for St. Vincent. “They His initial goal was to acquire at least appreciate his accessibility and availability. 80% of the hospital’s pediatric IR cases in They have expressed that the department the first year. He thought this was a realistic is a great benefit to the hospital, referring number since referring physicians would physicians, and patients.” have to get used to sending him their pediatric patients. “Referring physicians had always ordered Improving the Patient Experience these procedures in the adult vascular lab, so Underhill attributes the successful launch of I knew there’d be a tendency to keep send- this pediatric service line in part to his accessi- ing patients there,” Underhill says. “But I was bility. He meets referring physicians and their Richard K. Freeman, MD, MBA, system chief medical officer at St. Vincent Health and Hospital System, immediately saw surprised by how quickly referring providers patients where they are — whether on another the value in establishing the pediatric IR department. adjusted to the change.” floor or even in another St. Vincent hospital.

8 IMAGING 3.0 “I have made myself as portable as abscess drains, and an increasing number of possible and tried to perform cases either sclerotherapy cases. (Read more about the in the patient’s room, when appropriate, or department’s sclerotherapy services in this at least in their hospital,” Underhill wrote in Imaging 3.0 vignette, “In the Same Vein,” at his RLI practicum report. “This has included acr.org/Imaging3-Same-Vein) performing cases in tandem with other While most ultrasound-guided procedures physicians in the operating room, so a child are done at the patient’s bedside, Underhill could be put under anesthesia once and also has access to a couple of clinic rooms in have a series of procedures done.” the radiology department and even a couple Because many of the procedures Underhill of operating rooms. performs are ultrasound guided, he can often Additionally, Underhill is building a larger in- treat patients at their bedsides. This not only ventory of kid-sized supplies, including smaller improves the patient experience, but it also feeding tubes, catheters, and IV access devices. reduced the administrative burden of estab- The department also has its own CT fluoroscopy lishing the department because Underhill scanner and access to ultrasound equipment. didn’t require dedicated space to get started. “Marc brought in the latest pediatric IR equip- “Pediatric surgeons would call me and ment to make procedures easier, faster, and say, ‘Do you have five minutes to visit this more effective for these patients,” Jones says. patient?’ So I’d run up to their clinic and see Matthew M. Jones, MD, pediatric radiologist at Northwest Radiology Network, says the dedicated IR department the patient,” Underhill says. “That saves the significantly improves pediatric care. patient time, streamlining things for a more collegial, team-based approach. It’s a more “ A strong lesson learned, cover some of his procedures, such as feeding positive experience for the patients, their tube maintenance, allowing him to focus on parents, and the referring physicians.” especially in the hospital growing the department without burning out. In his report, Underhill wrote that the ACR Imaging 3.0 initiative inspired his efforts: setting, comes directly from “Make sure other people can do your “A strong lesson learned, especially in the ACR Imaging 3.0. That is: Get job,” says Underhill, who now serves on the hospital setting, comes directly from ACR board of NWR and as president elect of the Imaging 3.0. That is: Get out of the reading out of the reading room.” Indiana Radiological Society. “You really need help from other groups to cover you room. Performing a procedure at the bedside —Marc P. Underhill, MD when it is safe to do so not only helps nursing so that you can grow.” out, but also gives you invaluable face time Hansen agrees: “Being a department of one is difficult; you have to understand that on the floor,” Underhill wrote. “Let the physi- Underhill continues to meet with hospital it requires a team approach — from both the cians see you are a physician like them. Round executives to plan the department’s growth. hospital and the radiology group. It’s critical to on your patients, take an interest in who they The next step, he says, is to formalize a achieving and maintaining continuity of care.” are and what they want. Working with your process for ordering supplies and to create a patients will always result in better outcomes, dedicated pediatric IR suite for more complex and being seen on the floors and in clinics as By Brooke Bilyj procedures. Eventually, the department may part of the treatment team buys collegiality hire additional providers to support him. and support if times ever get tough.” “Having another dedicated person here in Next Steps This method has established Underhill as the near future would be wonderful, but we • Craft a comprehensive business plan, a vital part of the care team. “Our pediatric don’t have enough pediatric business yet for a including details about the amount of providers overwhelmingly support this full-time employee,” says Underhill, who splits time and resources required to launch approach,” Freeman says. “We have seen a his time 50/50 between pediatric IR and adult and grow the service line. higher quality of care and the elimination biopsies. “The goal is to slowly grow to the of patients being delayed or transferred for • Develop and maintain relationships with point we need to hire someone else to do bi- procedures as a result.” other radiologists and with referring opsies, so I can focus exclusively on pediatrics.” physicians to identify gaps in service and Planning for Expansion build buy-in when adding new services. Two years into its existence, the pediatric Sharing Insights • Become a vital part of the treatment IR department now sees as many as seven The most valuable lesson Underhill learned team by being visible on the floor and patients a day. The most common procedures in establishing the department was that, to readily available and accessible to physi- include feeding tube changes, biopsies, succeed, he had to train other radiologists to cians and patients.

Imaging 3.0 in Practice n July 2020 9 Case Study Published July 2020 Shaping Your Story A radiologist in Massachusetts strives to rebrand radiology and winds up simultaneously building her own personal brand.

hen Carolynn M. DeBenedectis, MD, asso- Wciate professor of radiology and vice chair KEY TAKEAWAYS for education, set out to remake the perception • A radiologist at the University of of the radiology department at the University Massachusetts Medical School set of Massachusetts Medical School (UMMS), she out to change misperceptions of the didn’t realize she was simultaneously shap- specialty among medical students ing her own story. “My personal brand came and clinical colleagues. about because I wanted to rebrand the way people viewed radiology,” she says. “I didn’t see • By collaborating on a committee it as building my own ‘brand.’ Instead, I found to create a curriculum focused on something I was passionate about changing communicating with patients, she in radiology and set about doing that. Before began rebranding radiology and I knew it, my enthusiasm for patient-centered also established a personal brand for care became my own brand.” patient communications. For DeBenedectis, the initial goal was to • To expand her local brand as a reinvent how medical students and colleagues radiology changemaker, she shares saw radiologists. “I wanted people to see that her passion for patient-centered radiologists care for patients; we don’t just sit care and diversity in radiology at the in a dark reading room all day. That’s where my national level. personal brand in patient-focused care original- Carolynn M. DeBenedectis, MD, associate professor of ly started. It came out of my love for radiology, radiology and vice chair for education at the University of Massachusetts Medical School, says that building her my love of patients, and my love for wanting to personal brand started with a focus on a passion project — further the field and make it a better place,” she patient-focused communications — and being intentional says. “Rebranding radiology in your organiza- about taking steps to advance change in her organization. tion opens doors for you to establish your own brand in a strong, unique way.” (Learn more As DeBenedectis realized that she was about how DeBenedectis and her colleagues developing a personal brand, she took more at UMMS strengthened their department’s deliberate steps to become nationally recog- brand in “Rebranding Radiology” at acr.org/ nized for her commitment to patient-centered Imaging3-RebrandingRadiology.) care and, more recently, for extending her What DeBenedectis serendipitously hap- personal brand into diversity, equity, and inclu- pened upon — personal branding — is what sion in radiology. “Although my path could be many business experts have been advocat- considered to be ‘accidental branding,’ there’s ing for decades. As Tom Peters wrote in “The no doubt that my efforts to rebrand radiology Brand Called You” in 1997, “You, everything have made a tremendous impact on my career you do — and everything you choose not to trajectory. In addition to gaining national rec- do — communicates the value and character of ognition, I was also recently named vice chair [your] brand.” It’s this concept that J. Mark Carr, for education, the first female vice chair in the MBA, president of Carr Consulting Group and radiology department.” adjunct lecturer at Babson College in Wellesley, Massachusetts, lectures on for the Radiology Leadership Institute® (RLI). At a recent RLI Starting Locally Leadership Summit, he said, “Personal branding To realize the benefits of a personal brand, it’s is about taking control of one’s own image — helpful to know what constitutes as personal just like a product or company would to achieve branding. As Amazon founder Jeff Bezos once some professional or personal goal.” said, “Your brand is what other people say

10 IMAGING 3.0 about you when you’re not in the room.” And move it forward every day. Try to help people being invited to join a national committee. “A as Carr explains in his RLI Leadership Summit understand the unique value you bring to a few years ago, the ACR asked me to join the presentation: Personal branding is how oth- particular issue. Be focused: one passion, one Commission on Patient- and Family-Centered ers perceive you — a view derived from the group, then go from there.” Care (acr.org/PFCCCommission),” she notes. “A actions you take to have “a significant and key goal of our work has been to transform the differentiated presence” in your profession. Building National Recognition UMMS communications curriculum into a na- Anyone interested in developing a While DeBenedectis’ leadership in patient tional standard for training radiology residents personal brand should start with an honest communication skills started locally at her own in patient- and family-centered care.” assessment of who they are and what they institution, it wasn’t long before her brand DeBenedectis followed the same model to want to be known for, Carr says. They must started gaining national recognition. “Personal build a national reputation in another area as ask themselves: What are my values? What branding goes beyond creating a name for well: diversity, equity, and inclusion (DEI). As makes me unique? What are my skills yourself in your own organization; it’s also she focused on rebranding radiology in the and competencies? Can my colleagues about finding ways to get yourself out there medical school, she discovered a passion for clearly articulate what I do and what I’m so that people know you as an expert in the getting more women to join the specialty. “One passionate about? For DeBenedectis, those answers came easily. “I wanted our med students and hospital faculty to truly understand the “ We’re not just sitting on the sidelines reading scans; in many value that radiologists bring to patient care and the critical role we play in communicat- cases, we’re at our patients’ bedsides guiding them and their ing directly with patients and families,” she says. “We’re not just sitting on the sidelines referring physicians to get the best care possible. I wanted to reading scans; in many cases, we’re at our patients’ bedsides guiding them and their change the misconceptions that our med students and other referring physicians to get the best care care providers had about radiology.” possible. I wanted to change the misconcep- —Carolynn M. DeBenedectis, MD tions that our med students and other care providers had about radiology.” To advance her passion, DeBenedectis began taking intentional steps to ensure her field,” she explains. “Once you achieve success medical student that showed an interest in ra- colleagues recognized radiology’s contribu- locally, publish a paper about it. Let everyone diology got me into DEI. After initially showing tion to patient care. She started showing up see it. For my patient- and family-centered care interest in radiology, she decided it wasn’t for to medical student events — such as those initiative, I published a paper in the Journal of her because she didn’t see any young female focused on how to choose a specialty and the American College of Radiology about our role models in the field. After meeting me and how to apply to residency — to share her communication skills curriculum. When people other female radiologists, she changed her love for radiology and patient-centered care read the paper and think of that topic, I believe mind and decided to join the specialty after all.” with students. UMMS radiology department they will think of my name.” DeBenedectis adds, “I collaborated with chair, Max P. Rosen, MD, MPH, FACR, took After publishing about patient communica- her to develop a radiology paper about her notice of DeBenedectis’ dedication to direct tions, DeBenedectis was invited to co-author experience — “Do Interventions Intended to patient care and asked her to represent additional articles with people involved in Increase Female Medical Student Interest in radiology on a UMMS committee that was similar initiatives and research. “That builds Radiology Work?”1 — which led her to get developing a curriculum for communicat- your brand further because you’re considered even more excited about radiology, and she ing with patients. From there, her personal an expert by other people,” she adds. “From matched into the specialty. To advance my brand was born, and she has been building there, I started getting invited to speak about passion for getting more women in radiology, and evolving it ever since. patient-centered care at national conferences I then wrote a paper about the experience, To start building a personal brand, like those hosted by the Radiological Society which turned into a national presentation, DeBenedectis recommends a focused, of North America and the Association of step-by-step approach. “Start with one University Radiologists. It catches like wildfire. which led to doing more projects and more group, one goal,” she says. “I was initially If you work at it one step at a time, and it’s a papers on diversity in radiology. Based on all just trying to convince the committee that good idea, it will perpetuate itself.” these efforts, Dr. Rosen nominated me to join radiologists were key in communicating As her reputation as a leader in patient- LEAD, a women’s leadership program. Now, with patients. That’s how personal branding centered care grew, DeBenedectis discovered more people know me for my brand as a di- begins. Be intentional about one idea and another path to bolster her personal brand: versity expert than for communication skills.”

Imaging 3.0 in Practice n July 2020 11 things better — not only to advance them- “ Never, in a million years would I have thought I’d be a leader in selves but also to advance the specialty.” DeBenedectis has leveraged what she radiology. But everyone can be a leader. You’re a leader just by learned through the RLI to become an am- bassador for change in radiology. As such, wanting to change something and taking action.” she was invited to share her approach to —Carolynn M. DeBenedectis, MD personal branding at the most recent RLI Leadership Summit, where she shared her secret to success: “Your brand has to Once DeBenedectis started building her Leading Change come from the heart; it can’t be something brand, she turned to social media to amplify that’s a cerebral decision. For me, it came DeBenedectis’ personal brand story started it. “Social media is not the defining element of because I love talking to patients. I love to with her seeing opportunities for positive your brand,” she emphasizes. “Twitter opens show people how important radiologists change — and then taking action to make are to patient care and how we are with me up to a whole new world of people who them happen. She credits the RLI leadership them through some of their most vulnera- follow me and want to talk to me as an expert programs with giving her the inspiration and ble moments. And I’m equally passionate in particular subjects. But I find that all the tools to lead change locally and nationally. about getting more women into radiology. hard work of the papers, lectures at national “Change is hard, and most people don’t My journey shows how you can make a conferences, and the committees are the most want to change, so you need leadership difference by building your brand.” important vehicles to build personal branding. training to know how to go about it the All radiologists, regardless of their titles Based on my experience, social media helps right way,” she states. “They don’t teach you and positions within their practices, can you showcase your efforts to a wider audience. those skills in medical school. The RLI and follow a similar approach to make change First, you have to find your brand and then use other leadership programs are imperative in their organizations. “It is imperative to social media to perpetuate your brand.” for every radiologist who wants to make empower all radiologists to become better

LEADERSHIP ACTION PLAN Steps radiologists should take to lead change

Communicate Collaborate Lead change Understand the needs of those you serve Identify allies and get others involved Create a compelling vision and Provide clear communication Find a local champion communicate it to the group to all stakeholders Design creative, results-oriented teams Develop a clear plan for executing change Listen, listen, listen Develop relationships with administrators Get the right people involved to Get feedback and other physicians accelerate change Be open to everyone’s opinions Recognize and celebrate small wins Include diverse perspectives Create a sense of urgency for change Acquire high-quality data that supports change * This action plan is based on a survey of radiology leaders.

12 IMAGING 3.0 radiologists, we must all be at the forefront ENDNOTES of change to make things better for our 1. Yuan ED, Makris J, DeBenedectis CM. Do Interventions “The RLI and other leadership Intended to Increase Female Medical Student Interest patients and for the specialty.” in Radiology Work? Preliminary Findings. Curr Probl programs are imperative for Diagn Radiol. 2018;47(6):382‐386. doi:10.1067/j. By Linda G. Sowers cpradiol.2017.09.003 every radiologist who wants to make things better — not only Next Steps • Be intentional. Think about where to advance themselves but your passions lie and how you want to Participate in the change things for the better. Focus on ACR RLI leadership also to advance the specialty.” one idea or group, then take actionable —Carolynn M. DeBenedectis, MD steps to reach your goals. programs! • Start locally and build a reputation as an expert in a particular area within your leaders,” DeBenedectis says. “I was a junior own organization. Then expand your faculty member, one of the newest in my brand by publishing papers, speaking at department when I started taking steps conferences, and participating in nation- to rebrand radiology. Never, in a million al committees to advance your passion. years would I have thought I’d be a leader Use social media to amplify your brand. in radiology. But everyone can be a leader. • Gain leadership skills to learn how to ef- You’re a leader just by wanting to change fectively cultivate buy-in and make the something and taking action. To improve changes you want to see in your group things, you have to lead the charge. As as well as the specialty. To learn more, visit acr.org/rli.

Steps radiologists should take to lead change

Gain business skills Ensure continuous improvement Be a leader Learn what drives the business Develop new skills Lead by example Understand the institution’s financial goals Keep growing personally and professionally Focus on value Get involved with hospital operations Build on existing efforts Deliver patient-focused care Engage at the local, state, and Learn from prior mistakes Tell the truth national level in radiology Embrace failure Be patient Implement an effective and efficient Quantify performance Mentor the next leaders governance structure Engage in continuous improvement Be enthusiastic, inspirational, and visible Account for non-RVU activities

Imaging 3.0 in Practice n July 2020 13 Case Study Published September 2017 Behind the Curtain Ohio radiologists collaborate with a patient advocate to implement a direct results delivery program that decreases patient anxiety and gives radiology a face.

hen David C. Mihal, MD, diagnostic Wradiology resident at the University of KEY TAKEAWAYS Cincinnati Medical Center, began working • Cincinnati Children’s Medical Center on his practicum for the ACR Radiology has implemented a direct results Leadership Institute® (RLI) he knew he wanted delivery program that allows patients to use the opportunity to make a real dif- and families to discuss their test ference for patients and families. But before results directly with a radiologist. Mihal could improve the patient experience, he needed a better understanding of how • Providing results directly to patients patients and families perceived radiology. helps decrease patient and parent To that end, Mihal turned to Dianne Hater, anxiety while increasing their patient and family advocate in Cincinnati understanding of what radiologists do Children’s radiology department, to help and how the department operates. him focus his efforts to foster meaningful • Connecting with patients and positive change in patient and radiology reemphasizes the importance of relations. Through her research, Hater found the individual behind the image, that patients and families were often nervous about their imaging exams and, for some, un- reinvigorating radiologists’ sense David C. Mihal, MD, diagnostic radiology resident at of purpose and reducing burnout. certainty about how to obtain their imaging the University of Cincinnati Medical Center, initiated results increased their anxiety. “Patients and the department’s direct results reporting project to give families want answers, so having to wait for patients a chance to speak directly with radiologists. results creates a lot of stress,” Hater says. Recognizing an opportunity to significant- relationships at Cincinnati Children’s, and I ly improve the patient experience through wanted to make some sort of real difference better communication, Mihal initiated a direct that would directly benefit them,” Mihal says. results delivery pilot project that would allow Once on board, Hater, who became an patients and families to review their exam advocate for patients and families after results directly with a radiologist immediately navigating the healthcare system during her after image acquisition. Since its inception own daughter’s illness, began talking with the in 2015, the project has drawn praise from hospital’s frontline staff, including registration patients and families, with 92% providing personnel, patient advocates, and child-life positive feedback on surveys, and has led to specialists, about their interactions with 84% of participating radiologists and tech- patients and families who had undergone nologists reporting increased job satisfaction imaging. Many staff members reported that — leading the department to adopt it as an patients and families were often concerned ongoing initiative. about having to wait for imaging results, and they lamented having few tools available to Patient and Family Perspective help minimize patients’ and families’ anxieties. When Mihal decided to embark on a patient Hater also interviewed radiology technol- experience improvement project, he wanted ogists since they have the most interaction to ensure the change would be something with patients during image acquisition. From patients and families wanted and needed, these conversations, Hater found that many not just what he assumed they needed. That’s patients and families were noticeably nervous why his first step was to reach out to Hater during and after their imaging exams, and the for help. “I approached Dianne because she technologists often felt helpless because they was deeply entwined in patient and family were unable to share results with patients and

14 IMAGING 3.0 “Oftentimes, as radiologists, we get detached from our patients. Speaking with patients is an excellent reminder that we are diagnosing real people.” —Alexander J. Towbin, MD families. “We just did the best we could to a human face to the profession, helping ease their anxieties with the limited time we patients understand the important role that had with them,” says Erin Adkins, an imaging radiologists play in their care,” Coley says. technologist and quality improvement coach. In addition to humanizing radiology for For even greater insight into the patient- patients, the project also offered the chance and-family perspective, Hater reviewed for the department’s radiologists to connect patient feedback surveys from 2011 to 2015 with their patients and feel more fulfilled as a to see what patients and families themselves result, says Alexander J. Towbin, MD, associ- had to say about their radiology experiences. ate chief of clinical operations and radiology Dianne Hater, patient and family advocate in Cincinnati That’s when she discovered that patients and informatics and pediatric radiologist at Children’s radiology department, found that patients and families were not only anxious about their Cincinnati Children’s. “Oftentimes, as radiol- families were often nervous about their imaging exams, and for some, uncertainty about how to obtain their results, but some were also stressed because ogists, we get detached from our patients. imaging results increased their anxiety. they were unsure how to obtain their results. We are looking at pictures all day, and we see “Patients and families were saying, ‘We just the body parts and the disease, but we don’t need answers. The waiting and not knowing always see the child on the other side of the limiting the number of patients to a man- is the worst,’” Hater says. “We knew there had picture,” Towbin says. “Speaking with patients ageable sample set,” he says. to be a better way of communicating results.” is an excellent reminder that we are diagnos- During the project’s first of four phases, ing real people.” the department’s technologists vetted A Face to Radiology patients and families, identifying those they thought were most likely to benefit from a To achieve that goal, Mihal and Hater A New Beginning direct consultation with a radiologist, such conceptualized the direct results reporting With support from the department’s lead- as patients and families who were visibly project. They envisioned it as a natural ex- ership, Mihal began rolling out the project anxious or those who requested immediate tension of the department’s existing “difficult slowly and purposefully. It’s an approach results. Patients were excluded from the news” program, in which radiologists deliver he took in part to win support from his service if they were emergency patients, negative results directly to patients and colleagues, many of whom were initially inpatients, had follow-up appointments families. Only in this case, the news would concerned that they would be unable to already scheduled, were in a hurry to get to be mostly positive. “With the direct results keep up with the volume of patients opting reporting service, the results are often good, for the service. In fact, only seven of the another appointment, or preferred to receive so the radiologists are able to immediately department’s 40 radiologists volunteered to results from their referring physicians. relieve the stress that patients and families participate in the project at first. After deeming a patient eligible to receive feel, allowing them to walk away breathing a To put the radiologists at ease, Koch, who direct results, the technologist would ask the sigh of relief,” Hater says. served as a physician champion on the proj- patient and family whether they wanted to To get the program off the ground, Mihal ect, reached out and encouraged them to speak with the radiologist. If the patient and approached Brian D. Coley, MD, radiologist participate in the consultations, explaining family opted for a consultation, the technol- in chief and professor of radiology and that each one takes only about five minutes. ogist located a radiologist from the volunteer pediatrics, and Bernadette L. Koch, MD, pe- “As the program expanded and faculty pool, assigned the study to that radiologist, diatric neuroradiologist and associate chief saw how little time it actually took, it was and informed the patient that the radiologist of academic affairs, about implementing it much easier to get more radiologists in- would be in soon to discuss the results. as a pilot project. Coley and Koch were both volved,” Koch says. On top of that, Mihal and The radiologist would then read the study excited for the opportunity to reemphasize his team addressed radiologists’ workload and deliver the results directly to the patient quality patient care and to give patients a concerns by limiting the number of patients in the exam or consultation room. Wait time chance to speak directly with radiologists. who were eligible for the program. “I wanted for the patient was typically less than 10 “This program provides patients with more to identify patients who would benefit the additional minutes. After the consult, the positive experiences in radiology and puts most from this service while simultaneously patient would fill out a survey regarding the

Imaging 3.0 in Practice n July 2020 15 excluding the reference to the additional wait time, which they found exceeded the “Spending time with patients minimizes physician burnout. It actual average wait time for the service and personalizes what radiologists do and allows them to connect likely caused patients to opt out. As a result, 33% of patients opted into the service, more directly with patients.” bringing the number to approximately one —Brian D. Coley, MD patient per day. Program Feedback interaction with the radiologist and drop it While low patient participation rates were In feedback surveys, patients and families into a locked box before leaving the facility. initially discouraging, Mihal and his team were overwhelmingly satisfied with the This feedback was invaluable in helping didn’t let it derail them. Instead, they took it service and reported feeling relieved and Mihal and his team understand what was as a learning opportunity and made efforts to at ease after receiving their results from a working with the program and informed improve the program. “When you embark on radiologist. Comments included, “Made my ideas for positive change. a project like this, it’s important to measure your progress and look for areas of improve- day!” and “It immediately eased my mind and Adjustments and Growth ment,” Koch says. “You must be open to assured me everything was OK to return to changing small things to see if those changes work and school.” With only one patient per month opting into will help rather than just abandoning ship.” As a technologist, Adkins has been grate- the program, the project’s first phase did not For the project’s third phase, the team ful for the opportunity this service provides attract as much interest as Mihal had hoped, expanded the program to all imaging out- to help lessen the anxiety that patients and so he and his team expanded the inclusion patients. Patients opted into the program families often feel. “When you see patients criteria and primary screening method. In through a self-screening survey, which also and families enter the room who are visibly doing so, they began allowing administrative included information that suggested a wait nervous, you can immediately put them at staff to offer the service to any patient at time of an additional 10 to 30 minutes. ease by offering to find a radiologist to speak check-in who did not have a follow-up ap- With this approach, only 8% of patients with them,” she says. “A lot of what we do is pointment already scheduled. This doubled opted into the service — still well below so quick, and this provides some closure and the rates of patients opting for consultation the hoped-for engagement. more connection with the patients. It gives from phase one but was still not quite the In the fourth and final phase of the proj- you satisfaction in knowing that you are part volume for which Mihal had hoped. ect, the team tweaked the survey, this time of improving the patient experience.” In addition to increasing job satisfaction, most of the radiologists and technologists involved in the program report little increase in their workloads as a result. “If anything,” Coley says, “spending time with patients minimizes physician burnout. It personalizes what radiologists do and allows them to connect more directly with patients.” Towbin agrees and says radiologists owe it to their patients to put in the extra effort. “I volunteered for this program because I strongly believe that families deserve to get results as soon as possible,” he says. “Some families want the results from the pediatrician, and some families want to know whether

Alan S. Broder, MD, consults with a something is wrong immediately. young patient about a procedure. As radiologists, our job is to meet our patients’ needs.”

16 IMAGING 3.0 Plans for the Future Cincinnati Children’s radiologists were so pleased with the results of the pilot GET READING project that they have now integrat- ed it into their regular workflow as a permanent and ongoing program for outpatients undergoing radiographs. “It’s What’s on Your been wonderful to watch this initiative grow,” Towbin says. “Knowing that we are Nightstand? able to provide this service efficiently and help put a face on the radiology depart- 25 Leadership Books that Made ment is incredibly satisfying. It really has an Impact on Radiologists a positive impact on our day, and we feel like we are doing something special for patients and families. What’s more, we’re showing others that this can be done.” 1. Fish!: A Proven Way to Boost Morale and 18. Be in Charge: A Leadership Manual: How With this program as a proof of Improve Results Stephen C. Lundin, Harry Paul, To Stay on Top Alexander R. Margulis concept, Hater encourages all radiology and John Christensen 19. How to Win Friends and Influence People Dale groups to follow Cincinnati Children’s 2. First Among Equals: How to Manage a Group Carnegie lead and offer to deliver results directly to of Professionals Patrick J. McKenna 20. The Seven Habits of Highly Effective People: patients. As someone who’s been on the and David H. Maister Powerful Lessons in Personal Change receiving side of care, Hater knows how 3. Understanding A3 Thinking: A Critical Stephen R. Covey powerful such interactions can be and Component of Toyota’s PDCA Management 21. Your Brain at Work: Strategies for Overcoming how much it can mean to patients and System Durward K. Sobek II and Art Smalley Distraction, Regaining Focus, and Working families to have the answers they need, 4. Infinite Game Simon Sinek Smarter All Day Long David Rock when they need them. 5. Start With Why: How Great Leaders Inspire 22. The Power of Vulnerability: Teachings on “There’s no doubt how much patients Everyone to Take Action Simon Sinek Authenticity, Connection, and Courage and families appreciate it when they can 6. The Tyranny of Metrics Jerry Z. Muller Brené Brown get their results and have their questions 23. The Art of Strategy: A Game Theorist’s answered immediately,” she says. “It saves 7. New Power Henry Timms and Jeremy Heimans Guide to Success in Business and Life 8. The Art of Gathering: How We Meet and them from so much worry and allows them Barry J. Nalebuff and Avinash K. Dixit to move more quickly toward treatment Why It Matters Priya Parker 24. Pre-Suasion: A Revolutionary Way to Influence and healing. This kind of patient-centered 9. Good to Great: Why Some Companies Make the and Persuade Robert Cialdini care is the way of the future, and radiolo- Leap and Others Don’t Jim Collins 25. The Practice of Adaptive Leadership: Tools and gists are well positioned to lead this effort.” 10. High Output Management Andrew S. Grove Tactics for Changing Your Organization and By Chelsea Krieg 11. The 21 Irrefutable Laws of Leadership the World Ronald A. Heifetz, Marty Linsky, and John C. Maxwell Alexander Grashow Next Steps 12. Team of Rivals: The Political Genius of Abraham Lincoln Doris Kearns Goodwin • Start small. Look for manageable 13. Range: Why Generalists Triumph in a ways to provide opportunities for To make it easy for you to find these Specialized World David Epstein radiologists to interact more directly 25 favorite titles, we’ve created an RLI with patients. 14. Getting to Yes: Negotiating Agreement Without Giving In Roger Fisher and William Ury Leadership Reading List on Amazon: • Find others who are excited to bit.ly/RLIgoodreads implement patient-and-radiologist 15. First 90 Days: Proven Strategies for Getting Up to Speed Faster and Smarter interaction initiatives. Work together What leadership books have made Michael Watkins to brainstorm innovative practices the biggest impact on you? and strategies to accomplish goals. 16. Crucial Conversations: Tools for Talking Join the discussion and add your When Stakes Are High Kerry Patterson, Joseph own leadership favorites. • Don’t be afraid to tweak what you are Grenny, Ron McMillan, and Al Switzler doing if something isn’t working. Ask 17. Lincoln David Herbert Donald questions and look for ways to alter the project rather than abandoning it.

Imaging 3.0 in Practice n July 2020 17 Case Study Published July 2020 Changing for the Better Radiology leaders use change management strategies from the ACR Radiology Leadership Institute to adopt previously resisted technology.

n the value-based era, radiologists must Istep out of the reading room and take KEY TAKEAWAYS on new roles to enhance patient care. To • A newly elected president of a succeed in this new paradigm, radiologists struggling radiology practice in Little need more than interpretive expertise. They Rock, Arkansas, recognized that major also need negotiation, hospital adminis- changes were needed to get the tration, and financial know-how. However, practice back on solid footing. most medical schools don’t teach these noninterpretive skills. Without leadership • After determining that he needed to training, radiologists can find themselves learn critical business skills to guide his practice through organizational and in dire straits — with a faltering practice, technological changes, he discovered transitioning leadership, and no one to the radiology-specific leadership spearhead change. courses taught by the ACR Radiology In 2009, this was the situation in which Leadership Institute (RLI). Radiology Consultants of Little Rock (RCLR) found itself. After one of its two outpatient • Change management skills learned imaging centers shuttered due to a lack of from the RLI helped the new president profit, the group was in debt and its leaders lead a transition to voice recognition were struggling. Several radiologists left the technology and structured reporting, group while others blamed one another for Scott B. Harter, MD, FACR, used change management despite resistance from many the group’s problems. “No one wanted to be techniques gained at the Radiology Leadership Institute radiologists in the group. president,” recalls Scott B. Harter, MD, FACR. to guide his practice towards embracing new technology. “We spent a couple of months trying to figure out who was going to take charge of the dif- and his team. He also realized that the event ficult situation.” Several of Harter’s colleagues would provide an opportunity for him to approached him and asked him to take the learn from and network with the specialty’s lead. After consulting his wife and close top thought leaders and business experts. friends, Harter agreed to run for the position “The RLI offers leadership programming and was elected. tailored specifically to radiology,” Harter says. Harter spent the beginning of his presidency “I immediately recognized that I could bene- stabilizing the group. He helped integrate a fit from many of the topics presented at the new practice manager and spent time re- summit, including negotiation and business establishing relationships with administrators skills taught mostly by business school pro- at Baptist Health, the hospital RCLR serves. He fessors. It offered me a new perspective that also developed relationships with the radiol- I could leverage as my practice’s president — ogy group’s various departments, including especially since I am someone who believes accounting and billing. Things were improving all radiologists, regardless of title, should be for RCLR, but Harter worried he still didn’t have a strong enough business or administration involved in moving the practice forward.” background to succeed in the position. With the business challenges ahead of him In 2012, Harter received an invitation to as president, Harter asked his group to spon- the ACR Radiology Leadership Institute® sor him to attend the RLI Leadership Summit (RLI) Leadership Summit and discovered an in 2012. He considers it one of the most opportunity to learn the financial, commu- important steps he has taken to advance his nication, collaboration, and other leadership career and his practice’s transformation from skills he needed to strengthen his practice instability to steady ground.

18 IMAGING 3.0 Negotiating for Change the time we received the written report, we were concerned we wouldn’t know whether One of the concepts Harter learned at the something changed between the initial and RLI Summit and valued most was change final reports that could have an impact on management, a transformational process patient care.” Despite the expected benefits that follows key stages to build change over of structured reporting, many radiologists time. It was one of several skills Harter says were against that transition, too. “Initially, he has learned through the RLI that helped several people believed their own report him make specific improvements within his structures were better than standard tem- practice. One of those changes was to im- plates,” Harter recalls. plement voice recognition technology with Most departments within the hospital structured reporting into a practice that was were implementing voice recognition a late adopter of that technology. Starting in 2013, hospital administrators technology, making radiology an outlier. at Baptist Health had approached RCLR Hospital administrators became somewhat about incorporating voice recognition technology into their practice. Although the radiology group knew about the technol- “ Convincing the group to ogy, they resisted adopting it, believing it would decrease their efficiency and reduce change was smoother and productivity. Radiologists in the practice Wendall Pahls, MD, medical director of emergency services at Baptist Health, was a great supporter of the wanted to hold onto the status quo — easier because we followed radiology department’s change to voice recognition using transcriptionists, with radiologists technology and to standardized reporting. editing the reports. the change management “The radiologists had a lot of concerns,” steps, got the right people Applying Lessons Learned recalls Gerald C. Raymond, information systems manager at Baptist Health. At the together, and paid strict Harter saw an opportunity to put some time, Raymond was the PACS administrator of the change management skills he had and spearheaded the hospital’s transition attention to the details.” gained at the RLI Summit into action. He to voice recognition technology. “Some —Scott B. Harter, MD, FACR determined he would use the lessons radiologists had used voice recognition tech- learned to overcome resistance, get nology before and believed it didn’t work consistency of buy-in from his group, well.” Harter says, “Initially we thought that and plan and execute the transition. frustrated with the radiologists because they adopting the voice recognition technology Some of the change management recognized that voice recognition technolo- would decrease our productivity by forcing principles that the faculty taught at the RLI gy would save money and benefit the entire us to become transcription editors, and we Summit were first published in a Harvard hospital system. Harter worried that RCLR’s were resistant to the proposed change.” Business Review article by John Kotter, resistance made them seem unsupportive of Harter knew implementing voice PhD, business and management thought the organization as a whole. recognition technology would also be an op- leader, business entrepreneur, and Harvard In 2014, the hospital began putting more portunity to initiate structured reporting for professor. In “Leading Change: Why pressure on providers to align with other the group. Having a standardized reporting Transformation Efforts Fail,” Kotter lays out physicians and adopt voice recognition process would add value because other de- a structured design approach to making technology. Resisting change also made partments would consistently know where to change and overcoming resistance by radiology’s image more problematic, says look for sought-after information in radiology those who are holding on tightly to the reports, and physicians could immediately Harter. “Any time information is communi- status quo. receive clear, significant findings. cated verbally instead of written down, there According to Kotter, the steps to success- At the time, the radiology practice’s pro- is a concern. And by resisting change, they fully leading change are: cess of transcriptionists typing and editing weren’t addressing that,” says Pahls. the report before a written copy was sent Harter says it quickly became apparent • Establish a sense of urgency to referrers left other departments uneasy. that the group either had to take ownership • Form a powerful guiding coalition “Any time there was a significant finding, the of implementing the technology or be forced • Create a vision radiologist would give us a verbal report,” to do it. “I knew that this change was inevita- • Communicate the vision explains Wendell Pahls, MD, medical director ble and that I had to convince my colleagues • Empower others to act on the vision of emergency services at Baptist Health. “By that it was the right thing to do.” • Plan for and create short-term wins

Imaging 3.0 in Practice n July 2020 19 • Consolidate improvements and residency. And he recruited people to collab- a full year from start to finish, and we knew produce more change orate with him on the transition group. what physician training for it might look like,” • Institutionalize new approaches From that point, Harter says, establishing explains Harter. “Our goal was to make the Harter acknowledged that “change is urgency was easy. “I went to my board and change as clear as possible so that radiolo- hard, and you often see it fail more than it told them we would continually get pres- gists wouldn’t be deterred by unknowns.” succeeds.” He was determined to succeed sured to do this and that it was in our best and decided to follow Kotter’s approach to interest to be proactive about it. That way Convincing the Practice implement the voice recognition system we’d have the most influence in installing Next, Harter and the board communicated in his practice. “Convincing the group to the system that worked best for us,” he notes. their vision. In a corporate meeting in January change was smoother and easier because “Otherwise, we’d be coerced to use a system 2015, they explained their decision to the rest we followed the change management steps, we were unfamiliar with and might not like.” of the practice, as well as the timeline. “One got the right people together, and paid strict With board members receptive to the of the reasons everyone was so skeptical — attention to the details,” he says. idea, Harter took steps to further educate his guiding coalition about voice recognition and remained skeptical — was that they were technology. He arranged for board leaders to afraid of the unknown. So, it was my goal to Applying Change Management Skills attend professional conferences and site vis- help explain the technology and process as much as possible,” explains Harter. Following Kotter’s principles of change, its to learn about various voice recognition For the next year, the voice recognition Harter initially worked to understand the systems, and the group identified vendors project was placed on each agenda for every issue better. He connected with radiologists they thought would best fit the radiologists’ board meeting and corporate meeting to across the country whose practices had needs. “We spent time understanding what keep the project at the forefront of group already implemented the voice recognition different vendors were offering,” Harter members’ minds. “We talked about where technology software and solicited opinions explains. “We weighed the pros and cons, we were on the timeline and what progress about the transition process and using the and we spoke with practices who had imple- we’d made. That way, everyone knew the technology. “I heard lots of people saying mented different systems. After narrowing change was coming, and there would be no it was not as difficult as they imagined to the field, in cooperation with hospital surprises,” he says. make the transition. Those who were most administration, we had a couple of different From there, Harter engaged several successful advised committing considerable vendors do onsite demonstrations.” colleagues who were familiar with voice administrative time toward group commu- This education also helped Harter and the recognition software and understood its po- nication and to the development of voice board determine their vision for the change tential advantages to help lead the change. recognition templates.” process, the third step in successful change Harter named a point person, a radiologist Harter also talked to several people in his management. “With hospital administration, who was tech-savvy and could talk about the own practice who had used voice recognition we collectively decided which vendor to use. benefits of voice recognition software. He — including board members and younger We understood that implementing voice rec- also got section leaders within the radiology radiologists who had used the technology in ognition and structured reports would take practice involved. This powerful coalition built structured report templates, which each section leader vetted through their own areas. Harter also arranged training for a transcriptionist on John Kotter’s actions ESTABLISH a sense of urgency the voice recognition software so that she for successfully FORM a powerful guiding coalition could provide support and answer additional leading change CREATE a vision questions. “Prior to that, she was in danger of losing her job, but we found a way to em- COMMUNICATE the vision power her to find a new role in the practice,” EMPOWER others to act on the vision explains Harter. “Our internal IT company associates were also trained in the technology.” PLAN for and create short-term wins Harter and his coalition also spent time CONSOLIDATE improvements and talking to members of the practice who produce more change weren’t on board with the project. Knowing it would be more effective coming from mul- INSTITUTIONALIZE new approaches tiple sources, Harter asked several members of the practice who understood the technology and were positive about it to allay fears

20 IMAGING 3.0 in the group and convince them the new Having a quick turnaround, accurate results, learning how to lead. “Taking on a leadership technology wouldn’t hurt their practice. and standard formatting are valuable role was one of the best decisions I ever Knowing that this change process would things the radiologists can provide to speed made, but I couldn’t have been as successful take time out of everyone’s schedules, Harter patient recovery, and Dr. Harter helped without the skills I learned through the RLI,” gave his team administrative time for these introduce that here,” says Raymond. Harter says. “The fundamentals I learned activities. “They were excited about it,” Harter Despite their initial resistance, the radiol- through the RLI carried me through my notes. “It was a fine opportunity for estab- ogists were pleased with relatively how little tenure as president and allowed me to lead lished leaders to increase their stature and impact the change had. “Over time, pro- our practice back to stability. The overall for young leaders to emerge.” The approach ductivity actually improved, and we weren’t experience was a platform from which I was worked, convincing many skeptical members having to spend time after hours signing able to become a more effective leader.” of the practice that adopting voice recogni- and editing reports,” says Harter. Feedback Now Harter is focused on mentoring the tion technology was the way to go. from the other departments was also very next generation, using what he learned Structured reporting implementation positive. “The perception that we were get- through the RLI to inspire his colleagues and took a little more effort. “I had to assert the ting a more thorough read of the report was empower them to take on leadership posi- influence and power of the board — we extremely comforting,” adds Pahls. tions of their own. In recognition of the value told resisters it was a mandate, not a choice. that the RLI provides, RCLR now sponsors a In some cases, we really had to give them radiologist to attend the RLI Summit each some tough love if they refused to use the year to build leadership skills in the practice. report template. And they would have to “ Taking on a leadership role “The RLI has been a valuable investment explain to me why they believed their report in developing new leaders in the practice,” structure was better than the one the team was one of the best decisions Harter says. “The opportunity for new leaders developed,” says Harter. “Eventually, all of our I ever made, but I couldn’t to emerge is embodied by the ascendance of members adopted the templates.” the new group president Dr. Greg Baden.” have been as successful Harter believes all radiologists should Achieving Victory make leadership a priority. “I think it’s import- Due to the collective efforts of the board without the skills I learned ant for everyone to learn these skills,” Harter and the section leaders, more and more through the RLI.” says. “Radiologists must do more to demon- of the group signed on to embracing the strate that they’re willing to step out of the —Scott B. Harter, MD, FACR technology and report templates. Three reading room to lead change and enhance months before the technology went live in the care we give our patients. Acquiring com- the hospital’s radiology department, they munication, negotiation, collaboration, and installed the voice recognition software in other leadership skills will position radiolo- RCLR’s remaining outpatient office to get Says Harter: “The hospital was excited that gists for success well into the future.” all of the radiologists familiar with using we had been able to accomplish the task and the software. “We made sure every single get on board. We were seen as being part By Meghan Edwards doctor rotated through the office so that of the team, supportive of the hospital, and they could experience the technology and administration strongly supported us. We Next Steps could call on IT support if they were stuck,” received lots of positive feedback.” • Identify an issue you’d like to change Harter says. “They ended up feeling more and contact others who have success- comfortable with the technology, and this Looking to the Future fully undergone the same transition way, there wouldn’t be any surprises to to become familiar with processes, them during the hospital’s rollout.” The lessons Harter learned from the RLI don’t potential pitfalls, and opportunities. The result of all the communication and end with change management. Harter con- • Identify and empower a coalition with the practice was an overwhelming success. tinued to apply leadership skills to ongoing diverse viewpoints that will help you RCLR stuck to its timeline and switched challenges and changes within the practice. For understand and master the challenge. completely over to voice recognition soft- example, Harter leveraged the success of the Doing so gains greater buy-in and ware with no transcriptionist backup in one voice recognition process to continue making allows other individuals to learn day on Feb. 2, 2016 — moving completely changes within the practice, including adding leadership skills. over to the new technology and structured clinical decision support technology in 2017. reporting. “Radiology did amazing work. Although Harter stepped down from his • Recognize that the leadership skills By eliminating the need for transcription presidency in January of 2020 to prepare and business knowledge gained from services so quickly, they ensured patients for a move to the local teaching hospital, the RLI can help radiologists at all would get faster, more standardized results. he continues to advocate for radiologists levels lead change.

Imaging 3.0 in Practice n July 2020 21 What are the most important professional development CRITICAL SKILL SETS skills radiologists need to succeed?

Jonathan Breslau, MD, FACR Carolyn C. Meltzer, MD, FACR Chief of Sutter Imaging Professor and chair of radiology and executive associate dean for faculty academic advancement, LISTEN “Trading 90 Years of leadership, and inclusion at the Emory University Independence for School of Medicine Employment” Episode 3 LISTEN “Leading to Serve” Episode 11 Listening skills Self-reflection Humility Empathy Resilience Humility

Catherine J. Everett, MD, MBA, FACR President and managing partner of Coastal Daniel J. Mollura, MD Radiology Associates Founder and CEO of RAD-AID International

LISTEN “Leading with Authenticity” LISTEN “Leading by Serving the Episode 5 Underserved” Episode 17 Adaptability Versatility Patience Growth minded Outreach Flexibility Communication skills

Judy Yee, MD, FACR Geraldine B. McGinty, MD, MBA, FACR University chair of radiology at Montefiore and Chief strategy officer and chief contracting officer professor of radiology at Albert Einstein College for the Weill Cornell Physician Organization of Medicine

LISTEN “Leading With Mindfulness LISTEN “Populations From Coast and Inclusivity” Episode 8 to Coast” Episode 2 Curiosity Emotional intelligence Avid professional networking Negotiation Inf ormed risk taking Time management

The RLI Taking the Lead podcasts are available at acr.org/rlipodcast, iTunes, Spotify, Read the “Leading the Way” article on pages 18-19 of the ACR Bulletin to learn more about and everywhere you listen to podcasts. New episodes are released each month. the RLI Taking the Lead Podcast.

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