Business Guru Weighs in on Radiology Leadership Issues

In an extensive interview to be featured in the April issue of Imaging Economics, Jim Collins, researcher, business guru, and author of the best-selling Good to Great, shed perspective on radiology’s current harsh climate and offered a glimpse of the focus of his next book, based on five years of researching companies that have prevailed in environments characterized by turbulent disruption. An avid rock climber, Collins used the mountain as metaphor in characterizing the swiftly changing climate buffeting imaging providers, as the following excerpt describes. Imaging Economics: You quote Eisenhower when you discuss how great companies strategize: “Planning is invaluable, plans are useless.” You differentiate the goods from the greats by describing their planning processes as “vigorous debate infused with brutal facts seeking insight from which comes iterative series of decisions that add up over time. What are the implications of this for medical practices operating in a completely volatile regulatory and reimbursement environment? Collins: We’ve been studying for the last five years the question of what separates those who prevail in environments characterized by turbulent disruption. So I like to think of it this way. You wake up at base camp in the security of your tent below Mount Everest and if a storm comes in, you can hunker down in your tent and you’re going to be OK. But if you wake up at 27,000 feet as a small, vulnerable little speck high on the side of Everest where the storms are bigger and faster moving, and everything is more unpredictable and the environment is so much more severe and just relentless, and a storm comes in, and you are caught unprepared, you might just die. In this research we are studying those that have prevailed at what I would describe as 27,000-foot environments, industries like semiconductors and biotechnology and airlines, your really brutally disruptive environments—medical devices—and in comparing those to ones that didn’t do as well in those same kind of disruptive environments. My general belief is that most people feel they are moving higher on the mountain. That the world is becoming characterized by bigger forces that are out of their control that are moving really fast that are inherently at some level really unpredictable and they can really hurt them. What you have just described to me is that radiology practices are moving higher on that mountain, they are not in a 7,000-foot environment, they are maybe in a 19,000-foot environment, and they are vulnerable to those big forces out of their control. So, if that is true, as we study this question of why do some prevail amidst turbulent disruption and others do not, the Eisenhower quote comes back even more important in two ways. First of all, if you look at those that have done well and let’s step outside of even business for a moment, you look at people who have done well climbing mountains, climbing big rocks in environments that are full of these situations, the ones who prevail best over time, they plan like utter fanatics. I have a friend who has done Everest multiple times and he has a binder that is six inches thick of all the contingency plans, A, B, and C, for everything that can go wrong on the mountain. The guy is a complete paranoid neurotic. But that’s part of why he is still alive. And yet at the same, once you are on the mountain, you have to be willing to adapt to what the mountain throws at you that you cannot expect. So, that sense of Eisenhower preparing for D-Day, that was fanatically planned, but then they landed on Omaha Beach and no one expected the degree of fire they had, so they had to adapt. Plan now, but when the battle starts, plans have to adapt to reality. And so I eventually came to see it this way: The really key thing is preparation and its preparation for what you cannot predict. You can’t predict what the world is going to throw at you. You can’t predict what is going to happen with health care reform, you cannot predict what the next administration is going to be, you can’t predict what is going to happen with managed care and reimbursement, you can’t predict these things. So, since you can’t predict them, the one thing you have to do is be prepared for what you can’t predict, which means you have slack in the system and people who can adapt to whatever is thrown at them.