Operating Radiology As an Individual Business Unit

Both hospitals and imaging centers are struggling with economic and political pressures that are straining their relationships with staff; finance (administration/owners); radiologists; vendors (IT providers, equipment manufacturers, suppliers, and consultants); referring physicians; and the community (your patients). Collectively, we will call them your partners. The struggle stems from a disconnect between the initial expectations set forth in each relationship and the forces that have challenged the centers/department to act differently from these expectations. While you may have the best intentions, radiology and health care are changing rapidly. You may feel that your intentions are great and those of your partners are not. It is likely that your partners (staff, finance, radiologists, vendors, referring physicians, and the community) are dealing with similar pressures and may think the same way about you. If the expectations of your partners are not met, the pressure from them increases, leaving you in a state of panic or desperation. The evolution of radiology will continue at a rapid pace, and the pressure will only increase as people become more dependent on radiology. If you do not feel the pressure, make sure that you have the proper processes in place; otherwise, you will soon feel what your colleagues are feeling. You are the quarterback and you need to take charge; otherwise, you will lose. Run a Winning Business Whether it’s a hospital radiology department or an imaging center, are you treating your operation as its own business unit? What are you doing to maximize profitability and show that you are providing high-quality patient care? The following steps describes the process through which you can begin to transform your approach to the business of radiology.

• Make the adjustment. Decide that you will run radiology as its own business unit.
• Create transparency. Communicate with your team, partners, and owners that you want to create an open dialogue and will look for help, and expect to help them in return.
• Raise your visibility. Decide what information you need so that you will be in a position to act and get help.
• Team up and plan. Work with your owners/partners/administration to establish where you want to be. Map out this progression.
• Implement accountability. Assign roles and responsibilities with specific consequences (good and bad) for meeting or failing to meet objectives.
• Evaluate results. Decide whether you are on track.

Design and Execution As you can see, in order to act, you must gain visibility first. The best way to get there is to understand how you are doing thoroughly. Table 1 provides examples of the different functions within an imaging center or radiology department.
Table 1. Catergorization of Key Business Functions in a Radiology Operation Implement and Measure When identifying and isolating the different functions, you need to determine what information is worth tracking. If you are serious about operating your department or imaging center as an individual business unit, then consider tracking and reporting on the specific key metrics in Table 2.
Table 2. Key Metrics for Tracking Operational Success Information and Accountability Once you have the data, we suggest that you share the information with your partners, including staff, owners, radiologists, and vendors. This information will enable you to assess the true health of the organization in order to work with your partners to map a destination. Without this information, you will lose market share to those who know where they are going. Furthermore, your partners will lose faith in their relationships with you, resulting in lost opportunities. By accepting this challenge and the position that you are in, you will have more clarity to act. By following a similar methodology, you will also be able to engage your partners in a more powerful way and work together to survive, improve your situation, and provide excellent service. You may be thinking to yourself that you see the value in this process, but are uncertain how to proceed. First, assess what expertise you have in house and where you need help. Where you are deficient? Get help if necessary. Second, understand which functions can be held outside of your imaging center or hospital department (for example, auditing finances, billing, capital procurement, and marketing). Outsourcing specific functions allows you to maintain overall control and leverage expert knowledge at a lower cost. Third, communicate this plan to your partners. Have the difficult conversations and develop a baseline from which to begin. You all are thinking the same thing; just put it out on the table now. New thinking can help take you from uncertainty to stability. We hope that these ideas are helpful in fostering conversations, thinking, and action among you and your partners. You must act to maintain competitiveness or your edge; otherwise, you will fall further behind, and it will be even more difficult to catch up later. Can you afford this consequence? Can your partners afford it?