Reinventing the Radiology Practice
Radiology practices must be nimble enough to reinvent themselves if they are to thrive, according to Fred Gaschen, MBA, CHE. Gaschen, executive vice president of Radiological Associates of Sacramento, Calif, presented "Reinventing Your Radiology Practice" on October 24, 2008, at the Economics of Diagnostic Imaging 2008 National Symposium in Arlington, Va. Radiology, he says, is changing rapidly, and practices that are capable of changing along with the industry will be much more likely than their more hidebound competitors to survive. 
Fred Gaschen, MBA, CHE. In 10 to 15 years, Gaschen adds, methods of radiology practice will be nearly unrecognizable, by today’s standards. Because the money, time, and staff needed to respond to the coming changes will be limited in nearly every case, it is necessary to plan the practice’s response to those changes now. By setting priorities in the present, the practice that plans ensures that it will have the necessary resources to reinvent itself as needed in the future. Strategic Planning Before undertaking change, Gaschen notes, practices must use strategic planning to determine the direction that change should take. In practices that do not conduct frequent planning sessions, it may first be necessary to determine whether the group already has a strategic plan in place, as well as whether it was developed with or without the help of an external consultant. If a plan is present, it may need to be updated to reflect changes in the practice, in its market, in radiology and its technologies, and in health care regulation and reimbursement. Gaschen recommends the use of planning retreats to improve the focus of strategic planning, adding that it may be helpful to bring in outside experts who will speak to the group and will help the attending radiologists and practice executives make their communication and planning efforts more effective. A comprehensive strategic plan covers the practice’s mission, vision, values, goals, and objectives, and it includes an assessment of the practice environment. Based on all of these, it then outlines the core strategies that will be used to position the practice for the most successful future possible. Women’s Health In planning for a market that he characterizes as showing slowed (but still strong) growth, Gaschen recommends placing emphasis on comprehensive women’s health services within the radiology practice. While mammograms are not particularly profitable, the follow-up procedures that they generate usually are. Since the percentage of screening mammograms that will call for follow-up imaging and/or biopsy is relatively high, Gaschen notes, the initial mammogram serves as a type of loss leader that prompts many patients to return, if they were favorably impressed by the facility and by the level of customer service that they received there. The women’s imaging center must offer all applicable services, Gaschen says, if it is to gain a substantial share of the market; his own practice includes radiation oncology in addition to all women’s diagnostic procedures. This sector also calls for the most pleasant environment that the practice can create, including attractive waiting and changing spaces. The goal of Radiological Associates of Sacramento, Gaschen explains, is to maintain practice spaces that look so wonderful that patients, on arrival, nearly always react by saying, “Wow.” If a space is no longer getting this reaction, employees are asked to report this to management. The practice then updates and upgrades the space until the wow reaction returns, and it spares no reasonable expense in obtaining this effect. Turnaround Times Referring physicians almost universally want more rapid access to radiology reports. Reinventing the practice to suit today’s (and tomorrow’s) requirements will call for serious, sustained attention to turnaround times; this will include every step of imaging provision, from the patient’s arrival through delivery of the report. In many practices, it may take some investigation to determine the causes of routine delays, which may be multiple. Clerical staff, technologists, transcriptionists, and radiologists may all be responsible for some types of slowdowns, but so may poor spatial layouts, obsolete patient-throughput methods, aging imaging equipment, or outdated information systems. Once the operational and personnel-based bottlenecks have been addressed, the practice can consider improving its turnaround times still further by securing more rapid access to reports for referring physicians. Using PACS for report delivery is one such method, and other technological advances can streamline and speed up various parts of the imaging process. Voice recognition can reduce transcription delays, for instance, and better workflow-management Marketing Gaschen singles out the need to market radiology services as the area that has changed most, for many practices, in recent years. It is no longer enough to rely on a practice’s good reputation and the close relationships between its radiologists and referring physicians to bring in an adequate share of the area’s imaging business. Much higher visibility in the community is now required, Gaschen says, adding that advertising is an important component of this need. Taking an active role in community events—perhaps through charity affairs, team sponsorships, and public-education campaigns—is another vital step. At Radiological Associates of Sacramento, marketing representatives maintain ongoing contact with referring physicians to ensure that their needs are being met and that they are aware of what the practice offers. Whenever the practice has a new achievement to report (such as a decrease in appointment lead times, the acquisition of new technological capabilities, or a reduction in report-turnaround times), marketing staff will contact referrers to be certain that they have heard about the practice’s accomplishment. As an important part of the practice’s marketing efforts, Gaschen recommends conducting frequent surveys of referrers and patients to maintain an up-to-date awareness of their needs. Using Surveys In conducting surveys—whether these involve referring physicians, patients, or staff—the most important step is to avoid asking about anything that the practice is unable (or unwilling) to change. As Gaschen puts it, it merely creates ill will if survey respondents bother to spend their time giving opinions, but later find that nothing has been done to correct the flaws that they pointed out to the practice. Unless the practice honestly intends to make improvements based on survey responses, it might be better off skipping the survey process entirely. Of course, Gaschen adds, the best radiology practices will conduct surveys and then use them to direct their focus in pursuing improvements. Referring physicians can provide input that is of great value in determining where the practice’s improvement resources should be invested in order to gain more of their business. After a survey of referrers, Radiological Associates of Sacramento sent practice representatives to visit each responding physician’s office. This not only told the referring physicians that the practice was genuinely interested in their input, but gave the practice representatives an opportunity to explain what changes had been made to address their concerns—and what other services were available. Patients are not in any position to judge the quality of imaging that the practice produces, but they can (and do) use customer service and appearance as surrogate indicators of quality. A practice is wise to invest in its amenities and to train its staff to provide the highest possible level of customer service, and patient surveys are important in obtaining patient opinions about both. Likewise, Gaschen says, the patient who bothers to complain (instead of simply failing to return) is providing valuable information to the practice and should be thanked, in addition to having the complaint resolved. Many (perhaps most) practices neglect the third kind of valuable survey, which asks employees what should be changed and how to change it. At Gaschen’s practice, for example, executives had been impressed with the performance of a particular manager; an employee survey, however, indicated that this person was seen by the staff members reporting to him as a terrible manager who created problems for employees and erected roadblocks in their paths. This feedback allowed the practice to get much better performance from this person through retraining, but the need for that step would never have been clear without an employee survey. In conclusion, Gaschen says that the overall goal of the reinvention process is to get the best possible results for the practice’s investment of resources. Strategic planning lets the practice put its limited time and money where it will get the most bang for the buck, he adds, calling the planning process a way of organizing the future. This is accomplished by identifying the practice’s strengths and weaknesses, determining what threats and opportunities it faces, and setting priorities for actions that can ensure its ongoing success. .
Fred Gaschen, MBA, CHE. In 10 to 15 years, Gaschen adds, methods of radiology practice will be nearly unrecognizable, by today’s standards. Because the money, time, and staff needed to respond to the coming changes will be limited in nearly every case, it is necessary to plan the practice’s response to those changes now. By setting priorities in the present, the practice that plans ensures that it will have the necessary resources to reinvent itself as needed in the future. Strategic Planning Before undertaking change, Gaschen notes, practices must use strategic planning to determine the direction that change should take. In practices that do not conduct frequent planning sessions, it may first be necessary to determine whether the group already has a strategic plan in place, as well as whether it was developed with or without the help of an external consultant. If a plan is present, it may need to be updated to reflect changes in the practice, in its market, in radiology and its technologies, and in health care regulation and reimbursement. Gaschen recommends the use of planning retreats to improve the focus of strategic planning, adding that it may be helpful to bring in outside experts who will speak to the group and will help the attending radiologists and practice executives make their communication and planning efforts more effective. A comprehensive strategic plan covers the practice’s mission, vision, values, goals, and objectives, and it includes an assessment of the practice environment. Based on all of these, it then outlines the core strategies that will be used to position the practice for the most successful future possible. Women’s Health In planning for a market that he characterizes as showing slowed (but still strong) growth, Gaschen recommends placing emphasis on comprehensive women’s health services within the radiology practice. While mammograms are not particularly profitable, the follow-up procedures that they generate usually are. Since the percentage of screening mammograms that will call for follow-up imaging and/or biopsy is relatively high, Gaschen notes, the initial mammogram serves as a type of loss leader that prompts many patients to return, if they were favorably impressed by the facility and by the level of customer service that they received there. The women’s imaging center must offer all applicable services, Gaschen says, if it is to gain a substantial share of the market; his own practice includes radiation oncology in addition to all women’s diagnostic procedures. This sector also calls for the most pleasant environment that the practice can create, including attractive waiting and changing spaces. The goal of Radiological Associates of Sacramento, Gaschen explains, is to maintain practice spaces that look so wonderful that patients, on arrival, nearly always react by saying, “Wow.” If a space is no longer getting this reaction, employees are asked to report this to management. The practice then updates and upgrades the space until the wow reaction returns, and it spares no reasonable expense in obtaining this effect. Turnaround Times Referring physicians almost universally want more rapid access to radiology reports. Reinventing the practice to suit today’s (and tomorrow’s) requirements will call for serious, sustained attention to turnaround times; this will include every step of imaging provision, from the patient’s arrival through delivery of the report. In many practices, it may take some investigation to determine the causes of routine delays, which may be multiple. Clerical staff, technologists, transcriptionists, and radiologists may all be responsible for some types of slowdowns, but so may poor spatial layouts, obsolete patient-throughput methods, aging imaging equipment, or outdated information systems. Once the operational and personnel-based bottlenecks have been addressed, the practice can consider improving its turnaround times still further by securing more rapid access to reports for referring physicians. Using PACS for report delivery is one such method, and other technological advances can streamline and speed up various parts of the imaging process. Voice recognition can reduce transcription delays, for instance, and better workflow-management Marketing Gaschen singles out the need to market radiology services as the area that has changed most, for many practices, in recent years. It is no longer enough to rely on a practice’s good reputation and the close relationships between its radiologists and referring physicians to bring in an adequate share of the area’s imaging business. Much higher visibility in the community is now required, Gaschen says, adding that advertising is an important component of this need. Taking an active role in community events—perhaps through charity affairs, team sponsorships, and public-education campaigns—is another vital step. At Radiological Associates of Sacramento, marketing representatives maintain ongoing contact with referring physicians to ensure that their needs are being met and that they are aware of what the practice offers. Whenever the practice has a new achievement to report (such as a decrease in appointment lead times, the acquisition of new technological capabilities, or a reduction in report-turnaround times), marketing staff will contact referrers to be certain that they have heard about the practice’s accomplishment. As an important part of the practice’s marketing efforts, Gaschen recommends conducting frequent surveys of referrers and patients to maintain an up-to-date awareness of their needs. Using Surveys In conducting surveys—whether these involve referring physicians, patients, or staff—the most important step is to avoid asking about anything that the practice is unable (or unwilling) to change. As Gaschen puts it, it merely creates ill will if survey respondents bother to spend their time giving opinions, but later find that nothing has been done to correct the flaws that they pointed out to the practice. Unless the practice honestly intends to make improvements based on survey responses, it might be better off skipping the survey process entirely. Of course, Gaschen adds, the best radiology practices will conduct surveys and then use them to direct their focus in pursuing improvements. Referring physicians can provide input that is of great value in determining where the practice’s improvement resources should be invested in order to gain more of their business. After a survey of referrers, Radiological Associates of Sacramento sent practice representatives to visit each responding physician’s office. This not only told the referring physicians that the practice was genuinely interested in their input, but gave the practice representatives an opportunity to explain what changes had been made to address their concerns—and what other services were available. Patients are not in any position to judge the quality of imaging that the practice produces, but they can (and do) use customer service and appearance as surrogate indicators of quality. A practice is wise to invest in its amenities and to train its staff to provide the highest possible level of customer service, and patient surveys are important in obtaining patient opinions about both. Likewise, Gaschen says, the patient who bothers to complain (instead of simply failing to return) is providing valuable information to the practice and should be thanked, in addition to having the complaint resolved. Many (perhaps most) practices neglect the third kind of valuable survey, which asks employees what should be changed and how to change it. At Gaschen’s practice, for example, executives had been impressed with the performance of a particular manager; an employee survey, however, indicated that this person was seen by the staff members reporting to him as a terrible manager who created problems for employees and erected roadblocks in their paths. This feedback allowed the practice to get much better performance from this person through retraining, but the need for that step would never have been clear without an employee survey. In conclusion, Gaschen says that the overall goal of the reinvention process is to get the best possible results for the practice’s investment of resources. Strategic planning lets the practice put its limited time and money where it will get the most bang for the buck, he adds, calling the planning process a way of organizing the future. This is accomplished by identifying the practice’s strengths and weaknesses, determining what threats and opportunities it faces, and setting priorities for actions that can ensure its ongoing success. .