Every radiologist seeks to excel in one’s professional duties, from lesion analysis to recommendations for further evaluation. But for radiologists to govern themselves, they must step back and see the larger contexts in which they work.

Authors Richard B. Gunderman, MD, PhD, along with Paul J. Martin, both with the Indiana University School of Medicine, make these points in an article published online Feb. 2 in Radiology.

The pair traces the life of Elinor Ostrom, the only woman and the first non-economist to receive the Nobel Prize in economics, and her theory of the eight conditions of self-governance. She developed the theory in application to the self-governance of communities, but the duo argues they are just as applicable to radiologists.

Below are the direct words of the authors on how the conditions apply to radiology:

1. Become part of a coherent group.

“Radiologists need not only be part of a group but also part of a group that stands for something—a group with a specific mission or purpose, such as excellence in patient care. Radiologists who do not know what they stand for cannot succeed at self-governance.”

2. Members must earn benefits from their investment in the group.

“This highlights a huge problem with publicly traded radiology groups, whose owners may view a physician group as just another opportunity to make money and who have no experience or personal investment in the care its members provide.

“This also highlights a large pitfall in consolidation, namely, organizations can grow so large that members can no longer see the contributions that other members are making. Such a lack of mutual understanding can sow the seeds of ignorance and distrust, causing groups to disintegrate.”

3. Members must agree on decisions and avoid power struggles.

“This highlights an important problem for radiology groups that are owned or controlled by non-radiologists, or at least non-physicians. When members believe that they are subject to the authority of someone who does not engage in or even understand the work they do, they are much likelier to feel that they are being exploited. For self-governance to work well, everyone doing the work needs to have a voice in how, when, where, by whom, and why the work is being done. Only then will colleagues feel fully engaged in their profession.”

4. The group must self-govern by disciplining disruptive or selfish conduct.

“Whenever a potentially self-governing group looks outside its own members to carry out such functions, it effectively cedes governance to another person or organization. Without doubt, handling such situations can be one of the most difficult challenges groups face, but it is a challenge to which they must rise if they are to exercise responsibility for charting their own professional course.”

5. Groups must swiftly and transparently resolve conflicts.

“Although one sign of a thriving group is a relative paucity of conflict, in diverse organizations honest disagreements should arise from time to time, and how groups respond to such tensions is more important than preventing them from arising in the first place. This means acknowledging them when they arise, making sure all parties to a conflict know that their voices have been heard, and adopting a method of resolution that the parties can agree is just, even if all are not satisfied with the outcome.”

6. Group members should not feel they are micromanaged.

“To forfeit the capacity for self-governance is to start down a path toward deprofessionalization, from which recovery can prove very difficult. But when group members know and trust one another, many decisions can be made at an individual level, without a great deal of oversight or interference. The need for an external overseer implies that the organization can no longer manage its affairs in a mutually trustful and respectful fashion, reflecting the erosion of self-governance’s foundation.”

7. Large or small, self-governing organizations operate on mutual respect.

“When organizations grow so large or so dispersed that group members no longer have any hope of knowing one another, they begin to adopt bureaucratic patterns of management that undermine reliance on personal relationships and the mutual knowledge and respect to which they can give rise. For example, a radiology practice that is so widely geographically dispersed that many of its members have never even met each other has little prospect of governing itself effectively.”