RLI Summit: Good radiology governance doesn’t just happen

All the leadership training in the world won’t make a lick of difference if good governance structures are not in place to manage cultures and implement up-to-date processes within radiology practices and departments.

That’s according to Cheri Canon, MD, who made the point—the above is a condensed paraphrase, not a direct quote—in a program on governance at the American College of Radiology’s 2016 Radiology Leadership (RLI) Summit at Babson College in Wellesley, Massachusetts, last week.

Canon, endowed chair of radiology at the University of Alabama at Birmingham and a member of the 2016 RLI Leadership Summit faculty, said governance is “way more challenging” than branding, referring to ground she and others had covered earlier.

“We see that private-practice groups are caving. They’re buckling under the strain of these democratic-led organizations,” Canon said. “Academics are having the same strain, but in a completely different structure. And it’s ironic how differently yet equally [they are experiencing] the same outcomes.”

She added that academic rad departments are “paralyzed” because, historically, they’ve been led by a “somewhat benevolent dictator. We’re too large and complex now for that to work anymore.”

Canon said she’s seen her department grow from a well-oiled machine 20-plus years ago with 25 faculty members to a complex, 75-member organization.

“It can’t be run by one person,” she said. “We need a leadership council, and we need to provide development for that council and put in rigorous processes” of the kind that the RLI group had heard about Friday afternoon from program leader Marla Capozzi, MBA, of Babson and McKinsey & Company.

Out with the outdated

Capozzi’s presentation had included a graphic showing how, circa 2016 and beyond, mindsets about decision-making need to change in six key ways:

  1. From expecting that most decisions you make will be right to assuming that many decisions will require course corrections or even be wrong.
  2. From driving toward consensus for all decisions to fostering debate and seeking multiple points of view.
  3. From making and cementing all decisions (“pencils down”) to talking about when past decisions should be revisited or newly opened.
  4. From considering poor decisions to be personal failures to seeing in poor decisions fresh opportunities to learn.
  5. From holding off on timing (“wait and see”) to getting going, testing and learning—and then pivoting.
  6. From sending all decisions through the same process to addressing each decision with the best “people, process and protocol” approach.

Capozzi elicited a knowing response from attendees when she described a scenario that is evidently all too familiar in the management and leadership of rad practices and departments.

“People say there’s consensus in the meeting,” she said. “Then they leave the meeting room, and they go back to other people and say, ‘I so didn’t agree with that. I had to go along with it in the meeting, but I really don’t agree with the decision that was made.’ That’s how you fragment your culture.”

To change such a culture, Capozzi said, group leaders need to accept that there is rarely going to be 100 percent agreement on anything involving humans.

“Governance is about people coming together,” she said. “And when people come together to do anything, it’s messy.”

She suggested approaching disagreements with the shared view that the benefit of the practice trumps the interests of any one individual. With that as a foundation, debate can be conducted in a non-personal, objective way.

“When you have the debate, have people switch sides,” Capozzi advised. “I have to argue your point of view, and you have to argue mine. This will de-personalize the debate and take the emotion out of it. The idea is to be able to debate so you can get not to your answer but to the best answer.”

Forward-looking leadership  

A readily apparent strength of the 2016 RLI Summit was that its 120 or so attendees included many of tomorrow’s leaders—i.e., today’s residents and junior-level rads—and they were encouraged to stand up and be heard.

When Capozzi asked what they might do to incorporate what they’d learned at RLI when they got back to work, Claudia Cotes, MD, of The Rose breast-imaging center in Houston took the mic.

“As a young radiologist, one of the things I took out of the conversation was probably to volunteer more, not just sit there and do your work and that’s it,” Cotes said. “Maybe if you volunteer into some project or bring up an idea in a project type of way, and test it, you might get some of the higher-level administrators to listen to you more in the future.”

“I know it’s hard to change the way things are done in certain places,” Cotes added. “But as long as you have a good idea, even if somebody else at the end brings up the idea, you planted that seed in their head. And then at the end, the idea is going to be implemented even if it wasn’t you that made it happen.”

Stated another way, in words variously attributed to Harry Truman and other famous leaders: It’s amazing how much can be accomplished if no one cares who gets the credit.

To many present, that seemed a good thought on governance to go back to work with.