“Dear Doctor: Three recent [radiology] reports from Dr. So and So are just plain wrong. I reviewed these studies with other radiologists in your department, and they all agree that the interpretations are overcalls. These overcalls are impacting the care my patients are receiving, have delayed surgery and are impacting my outcomes data. May I please request that Dr. So and So no longer interpret studies of my patients?”

Minus the “So and So” and plus an actual radiologist’s real name in its place, the note above is a verbatim message sent to a radiology chief at an academic medical center.

Jonathan Kruskal, MD, PhD, radiology chair at Beth Israel Deaconess Medical Center in Boston and chair of the radiology executive committee at Harvard Medical School, shared the message—and others painting similar pictures of customer dissatisfaction with radiology—in an RSNA plenary session Nov. 28.

Kruskal’s topic was how the profession can thrive in the value era. His prescription for success, beginning in the present fee-for-service phaseout stage, was straightforward: Provide value by making attentiveness to your referring physicians and, by extension, the patient, your top priority.

Fail to place all other duties somewhere below that, and you will soon enough be identified as a low-value drag on the system. Attention must be paid now, he suggested, or the price will be steep later.

“Quality, patient experience, cost, outcomes—it’s everything,” Kruskal said, emphasizing that the ongoing pursuit of excellence across those four domains, all at once, constitutes the very definition of value.

“You’re not providing value,” he said, “and your customer is telling you so.”

Don’t review later—learn now

Kruskal challenged attendees gathered in McCormick Place’s Arie Crowne Theater to consider how they might manage the Dr. So and So scenario.

“How would you talk to your poor-performing radiologist?” he said. “And how was it that his or her poor performance slipped through the peer-review process? Why are you hearing about this from your customer, a referring physician, without you even knowing about it?”

Part of the solution, Kruskal insisted, must come from replacing retrospective peer review with prospective peer learning.

“Until we embrace peer learning, some hospitals will continue to oversee our reviews. They will become our peer reviewers,” he said. “Is 95 percent accuracy OK for an airplane? I would venture to say not. Be current and be great, because good is too low a bar for what we do. We have to participate in lifelong learning. And learning organizations utilize data to achieve improvement.”

At this point a live tweet popped up on Kruskal’s slide projection. It was from David Larson, MD, of Stanford, who was seated in the audience. “Radiologists who do not actively learn from their mistakes,” Larson commented, “may be replaced by machines that do.”

‘Start walking the actual value walk’

Kruskal wound down his presentation by condensing his material into eight succinct strategies for thriving in the value era:

1. Provide appropriate and efficient care.
2. Deliver excellent service.
3. Help discharge patients sooner.
4. Be data-driven and provide data-supported care.
5. Be visible, voluble and aligned with team members.
6. Be available, accessible and affable.
7. Learn and improve continuously.
8. Provide unambiguous reports and engage your customers.

He underscored the advice offered from the same stage one year prior in the president’s address given by the late Richard Baron, MD: We as radiologists must extend our gaze beyond the constraints of the image to gain a broader perspective on the patient experience.

“It’s all about the patient experience, indirectly back through your primary customer, the referring physician,” Kruskal said. “We have to take this seriously. We’ve been talking this talk for too long. It’s real. We’ve got to start walking the actual value walk right now.”

Finally, Kruskal pointed out that radiology’s history is replete with achievements of exploration, invention and transformation.

“Next year—in fact, tomorrow—we have a unique opportunity to innovate, to reinvent and to transform ourselves into visible value-adders and serious contributors to patient care,” he said. “We’ve been saying this. It’s now way past time.”