RESIDENTS’ AND FELLOWS’ COLUMN

C. MATTHEW HAWKINS, MD

Lessons Learned at the Radiology Leadership InstituteeKellogg Leadership Development Program: A Resident’s Perspective Robert A. Mackey, MD, MBA, Zachary Ballenger, MD The Radiology Leadership Institute (RLI) was established to prepare leaders to take on the challenges facing health care, particularly those unique to radiology. For many years, clinical expertise has been adequate to ensure a radiologist’s success. This is no longer true, as the evolving health care system requires physicians to expand the breadth of their skills to include an understanding of concepts central to leaders in the fields of business, law, and health administration. Leaders in radiology interact with professionals from these fields on a daily basis yet receive relatively no comparable training. The RLI attempts to prepare capable health care leaders. This year’s annual event was held at Northwestern University’s Kellogg School of Management, where world-class faculty members from both the RLI and Northwestern educated radiology leaders in topics vital to business, administration, and advancing the practice of radiology. UNDERSTANDING NETWORKS AND STRATEGIC ALLIANCES

From the opening session, it was clear that this conference would be unlike any other in radiology. Dr Brian Uzzi began his lecture with the legendary tale of Paul Revere. The story was not a roundabout mnemonic to remember the difference between Monteggia and Galeazzi fractures. Rather, it was to illustrate how effective networking can transcend limitations. Everyone knows the name Paul Revere, who rode The authors received a full scholarship to attend the RLI meeting.

north from Boston to spread his famous message. Fewer people know of William Dawes, who carried the same message south. Historians have studied how Revere raised the much larger militia, despite riding a shorter distance and talking to fewer people. They found that it was because he had a much more effective network of contacts [1]. Revere’s network included a larger cross-section of diverse people. Uzzi explained how to build such networks by highlighting the importance of participation in shared activities (such as squash) and the perils of being caught in “echo chambers,” where everyone has the same ideas and falls victim to the “joys of spontaneous agreement.” The importance of networking for radiology residents is enormous. By having a strategic network, residents can more effectively create and manage alliances within our hospitals, communities, and specialty. A prime example is the lobbying effort of RADPAC and the ACR. Having access to the right people and knowing how to effectively negotiate mutually beneficial outcomes is the key to achieving meaningful results in Washington. These lessons hold true in the clinical setting and in advocating for our patients. ANALYZING OPERATIONS

As important as it is for radiology leaders to have solid relationships outside the hospital, we must also make sure our own institutions are running efficiently. Dr Jan Van Mieghem taught the principles of operations management and how they relate to radiology departments. The focus was on value-stream

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mapping, identifying value, and eliminating waste. Waste includes overproduction, waiting, transportation, overprocessing, inventory, rework, motion, (ie, due to poor ergonomics), and intellect (when not used properly). We learned how to identify the bottlenecks in an operation, and that improving the bottleneck is the best way to yield the highest returns on investment. By eliminating waste, a radiology department will function more efficiently by using its resources strictly to add value for referring physicians and patients [2]. This concept will become increasingly important in the near future, as the government will play an even greater role in the allocation of limited funds and resources. NEGOTIATIONS: A BETTER APPROACH

Before the RLI’s annual meeting, most of the residents in the audience viewed negotiating as a form of battle, resulting in a winner and a loser. Popular culture has furthered this perception. Gordon Gecko, in the classic movie Wall Street, quoted Sun Tzu’s Art of War and reminded us that “every battle is won before it is even fought.” This may be true when engaging an enemy combatant, but certainly not in business or medicine, where success should be defined as mutually beneficial outcomes. Dr Keith Murnighan orchestrated the perfect team activity to illustrate his message, combining residents with attending radiologists to simulate a prisoner’s dilemmaetype business competition. Most teams were so focused on “winning” in the short 433

434 Residents’ and Fellows’ Column

term that they were willing to sacrifice their personal reputations and trust with the other teams, ironically the very traits that would have yielded success for both teams in the long term. Dr Murnighan’s research suggests that negative tactics commonly used in negotiations can have significant consequences, which often arrive much later in a professional relationship [3]. Radiology residents will face many important negotiations throughout their careers, from first employment contracts to negotiating service contracts between groups and hospitals. The RLI’s annual meeting illustrated many common and completely avoidable mistakes and how to successfully navigate the misunderstood art of negotiation. HOW TO MANAGE TEAMS

Imagine trying to survive a plane crash in the desert with a handful of senior radiology partners, the chair of your department, members of the ACR Board of Chancellors, and a bottle of vodka. This was the exercise lead by Dr Tanya Menon to demonstrate the importance of teamwork and the ability to define your role, identify and utilize experts, and reach an agreement with a limited amount of time and information. The first part of the exercise was to individually rank about 15 survival items recovered from the wreckage in order of importance to survive being stranded in the desert. Then, in small groups, we worked as a team to come up with a group rank list. In nearly every group, the team score was higher than that of the highest individual score. This demonstrated the concept of the “wisdom of the crowds” and how aggregation cancels out individual bias, even when an individual is more knowledgeable than everyone

else in the group. The exercise also demonstrated the immensely complex and difficult role leaders have in groups of people working toward a common goal [4]. Understanding group dynamics will have an increasing role in the future for radiology residents, as medicine shifts from the authoritative role of physicians and more toward patients and families and tightly knit collaborative care teams composed of nurses, physician extenders, technologists, become the functioning unit in health care systems. FOSTERING INNOVATION

Innovation is a key component of the mission statement of the RLI at a time when radiology is looking to transition from providing volume to value. Dr Robert Wolcott presented the audience with a haunting vision of an industry faced with change, which ignores the call for innovation and instead continues to operate under the strategy that worked in the past. Companies must be able to adapt to changing market influences and consumer demands. Data show that only onequarter of today’s Standard & Poor’s 500 companies will be part of the index by 2020, and the other three-quarters probably don’t even exist yet [5]. Radiologists must continuously adapt and find a way to come out from behind the workstation and lead the change toward promoting practice principles that are in line with the ACR’s Imaging 3.0 campaign. Dr Wolcott introduced the audience to the concept of an “incubator,” or a group of individuals with protected time and resources who are tasked specifically with developing new ideas. Industrial giants such as Lockheed Martin and IBM have used incubators for decades, with

incredible success [6]. The ACR is leading by example: the RLI itself is an example of innovation, and its annual meeting is an example of an incubator. ECHOING THE CALL

Dr Richard Gunderman closed the annual event with a session titled “A Call for Leadership.” This message applies to all of our fellow residents in training. It is critically important that we broaden our skill set beyond the knowledge necessary to pass certifying and board examinations. Participation by radiology residents in programs such as the RLI provides the tools to succeed in stewarding our profession into the complex and challenging future.

ACKNOWLEDGMENTS The authors thank Drs Matt Hawkins, Cynthia Sherry, Richard Gunderman, and James V. Rawson.

REFERENCES 1. Uzzi B, Dunlap S. How to build your network. Harvard Bus Rev December 2005. Available at: http://hbr.org/2005/12/how-tobuild-your-network/ar/1. Accessed February 11, 2014. 2. Ondategui-Parra S, Gill IR, Bhagwat JG, et al. Clinical operations management in radiology. J Am Coll Radiol 2004;1:632-40. 3. Croson R, Boles T, Murnighan JK. Cheap talk in bargaining experiments: lying and threats in ultimatum games. J Econ Behav Org 2003;51:143-59. 4. Menon T, Sim J, Fu JH-Y, Chiu C, Hong Y. Blazing the trail versus trailing the group: culture and perceptions of the leader’s position. Org Behav Hum Decis Proc 2010;113:51-61. 5. Morris L. Business model warfare: the strategy of business breakthroughs. May 2003. Available at: http://www.innovationlabs.com/ BusModelWarfare.pdf. Accessed February 11, 2014. 6. Wolcott R, Lippitz M. Grow from within: mastering corporate entrepreneurship and innovation. New York, New York: McGrawHill; 2010.

Robert A. Mackey, MD, MBA, is from the Department of Radiology, Medical College of Georgia at Georgia Regents University, Augusta, Georgia. Zachary Ballenger, MD, is from Indiana University Radiology, Indianapolis, Indiana. Robert A. Mackey, MD, MBA, Medical College of Georgia at Georgia Regents University, Department of Radiology, 1120 15th Street, Augusta, GA 30912; e-mail: [email protected].

Lessons learned at the Radiology Leadership Institute-Kellogg leadership development program: a resident's perspective.

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