– By Matt Skoufalos –
What makes a successful imaging department often turns as much on the technology of the facility in which it’s housed as well as the staff within its walls. Critical to executing the missions of those departments are the people who lead them. Over years of holding positions of responsibility, their experiences comprise a wealth of significant information that can benefit colleagues doing the job in various environments. We asked a few of them to share their knowledge, the better to support others in similar roles.
Husband and wife Joe and Sandy Phillips have been working in medical imaging all their professional lives. Joe is the Director of Clinical Services–Diagnostics at Connecticut Children’s Hospital, and Sandy is the Director of Radiology at Hartford Hospital. (Like the couple, both facilities are interconnected; the Phillipses even get to share a commute.)
In more than a half-century of combined experience, they’ve gleaned a lot from working their way up the ranks, from technology to leadership roles. Along the way, Sandy Phillips said, she’s focused on a three-part credo: trust, transparency and teamwork.
“As a manager, I really value those,” she said. “To motivate my team, I have to be transparent with them in order to earn their trust. That helps you build a solid foundation.”
Transparency to Sandy is anchored in the ability to remain in the moment when speaking with colleagues: no cellphone usage, no cross-talking and listening actively during meetings. To cut back on distractions, she sets achievable boundaries, like prioritizing and organizing her workload. She tries to address email twice a day, once in the morning and again in the afternoon.
“Otherwise, I think people get addicted to their email all day, and it gets hard to get any other work completed,” Sandy said.
Hand in glove with making herself available and present for her peers is the value she places on follow-through. When asked for help or tasked with the responsibility of addressing issues that need to be looked into, there’s no greater priority for her than seeing things through once she’s committed to handling them.
“Whether it’s a yes, a no, or a maybe, make sure you get back to your staff. Follow-up is extremely important,” Sandy said. “That’s the same for patient care: patients should not wait more than 15 minutes for delays in care. Communication is key.”
To Sandy, it’s equally important to be sure staff are acknowledged for excellence. If a colleague’s name comes up in patient satisfaction surveys, she makes a habit of celebrating the good stuff instead of only focusing on things that need improvement.
When it comes to rounding, “I don’t just round for patients,” she said; “I make sure that I’m rounding with my staff so I can keep a pulse check on my department. I find that in the morning, just going around to staff and touching base is huge.”
When people go the extra mile – picking up an additional shift, staying late to support a peer – Sandy also believes that small notes and thank-you cards cement personal connections that can yield a big difference for their outlook. That’s especially true in a field where employees hold onto demanding roles for years.
“I try to have a 10-and-five rule,” she said. “I have 244 employees, so it’s really hard for me to know everybody’s name, but I find that at 10 feet I smile, and at five feet, I always say hello. I always try really, really hard to get to know everybody’s name so I can say hi when they go by.”
Given the intensity and pace of the job, Sandy said she always tries to incorporate opportunities for her colleagues to de-stress, whether taking someone for a coffee break or setting up a mini putting session in the hallway. Ten- to fifteen-minute windows can be enough to help people refocus, she said.
“I find that managers will go home and they’re constantly on their phone, doing emails, getting calls, and I tell them, ‘You need to learn that between your family and work life, there is a line,” Sandy said. “You need to be able to decompress. The work’s always going to be there; it’s like laundry.”
The necessity of being “fair, consistent and standardized” with employees is another of Sandy’s leadership tenets, especially given the number who report to her. Critically, she also said that remembering her own background in imaging has informed her behavior in leadership roles.
“You never forget where you came from,” she said. “I always still think of myself as a technologist, and I never forget what it’s like to be in those shoes and how hard the staff works.”
Joe Phillips, who serves a key leadership role at Connecticut Children’s Hospital, said that to be a successful leader requires learning the technical aspects of management. As he’s risen in the ranks, Joe said he’s learned that the role of a leader is to “have a vision and allow your team to make mistakes and do the work.”
“My job is to break down barriers,” he said. “All of us have gone to school to develop, but I don’t think that’s what gives you the tips and tricks to be a great manager. The most important skill set is your own ability to be astute and learn from the mistakes of others.”
“Leaders often forget that the best answers to solving the problems are not in their brains and their desks,” Joe said. “It’s on the floor by the people who do the work. You have to involve your team in the thought process of trying to solve your problems. You’d be amazed how many people make that mistake and then you’re back to ground zero because you have to rework the same problem.”
Another critical aspect of leadership involves focusing on the issues to be resolved and not the people involved. Failure to do so can destroy relationships, Joe warned. He also advised that an engaged staff is what contributes to achieving the highest levels of customer satisfaction; therefore, supporting staff to connect with patients and with their work will yield dividends.
“When you go to school to be an X-ray tech, they don’t really spend a lot of time on whether you asked the patient if they’ve had a comfortable experience, or if their privacy is being met,” he said. “How do you know that I’m a good X-ray tech? The tech will say, ‘Well, I’m certified.’ The only thing you can distinguish yourself with is that you’re competent.”
Given the emphasis on patient experience, however, failing to make critical connections with the people being cared for means a huge opportunity missed, Joe said – particularly in the pediatric environment in which he operates.
“The only thing patients can base their opinion or experience on is how you treat them,” he said. “It seems rudimentary, but you’d be amazed how people get jaded on the technical aspects. And in our world with kids, we’re not only managing the child’s experience, but the family’s experience. Making sure a family is treated to the best of your ability should be in your DNA.”
“It boils down to hiring for personalities that are going to help you achieve what you want to achieve,” he said. “Where possible, you have to make your culture focused on these things, and make it OK to talk about them.”
The migration of health care from a transactional, fee-for-service arrangement to accountable care systems that turn on larger efficiencies has also affected how work is approached in the imaging suite, Joe said. Given the institutional focus on how many covered lives an organization can cover, resources that support radiology are also divided among a broader pool of needs. Benchmarking forces facilities to measure themselves against other, similar organizations. Many variables influence the delivery of patient care, particularly the pace of change within a health system.
Instead of being fodder for criticism, Joe said those broader metrics can actually help imaging departments advocate for additional resources as they need them.
“Organizations benchmark their efficiencies against those of other hospitals, and it’ll tell us if we have opportunities to grow in other arenas,” he said. “That’s a way to see if you can expand your practice and add more staff or not.”
“Most progressive institutions are looking to find a few minutes over the course of the day so they have time for one more patient,” Joe said. “As a leader, it’s important to understand your business at a tactical level, and find small areas for continuous quality improvement. There’s always another lever that you can pull to save a few seconds there, a few minutes here. Everything nowadays is about quality, safety and efficiency because it’s all tied to revenue at the end of the day. If your revenue doesn’t cover the needs of the organization and allow room to grow, you’re going the wrong way.”
Jenilynn Porter, director of imaging services at UPMC Shadyside/Hillman in Pittsburgh, Pennsylvania, said collaboration is an essential aspect of leadership in the imaging suite, both among people in the department and those outside of it. She especially pointed out the need to have one-on-one meetings with professionals in hospital nursing units to help coordinate patient services.
“Sometimes we have a lot of challenges where patients have no idea when they’re getting their tests done,” she said. “We have to get it done in a timely manner, especially when they’re going to be discharged. We get staff input to make sure that the process is good for everybody.”
Service coordination is critical in the high-volume environment at UPMC Shadyside/Hillman, where staffing presents another significant challenge. Teams organizing as one help to ensure that all shifts are covered as necessary, or that changes are made to the schedule otherwise.
“We’ve done different tactics to make sure that the appropriate staff is involved,” Porter said, “but communication is the biggest challenge. Everybody’s so busy that it’s hard to take somebody away from patient care. We want to go in, one on one, and make sure that we’re able to implement [dialogue] for our patient care.”
Another piece of that communication involves letting employees in other departments understand how yours works, Porter said. She’s dealt with requests for service that sometimes can’t be met simply for logical reasons. Given the size of her imaging department and the variety of modalities it manages, that can be a challenge to explain.
“I wish people would understand the limits and what goes on in radiology,” Porter said. “You can get an X-ray within 10 minutes and a read within 20 minutes. But sometimes people will say, ‘I need this patient squeezed in for an MRI,’ and I can’t squeeze them in because that takes 45 minutes.”
Before she became the director of professional practice for the American Society of Radiologic Technologists (ASRT), Becky Apodaca spent years in the medical imaging field as a registered radiographer and certified radiology administrator. On the strength of that experience, she recommends that good leaders focus on identifying victories as much as challenges, and celebrating the successes as they come.
“When you leave for the day, what bothers you?” Apodaca said. “But also, when you leave for the day, what’s a really good thing that happened? Identify the wins and the challenges, and then share with others, as they may likely benefit from that sharing. In imaging, when we focused on wins, challenges, frustrations and victories as a way to identify projects, we opened our door for any other department to come in and take a look at the results.”
Sharing what worked as well as what didn’t helped her departments avoid getting stuck in unproductive habits or taking unnecessary steps, and removed the stigma around trying something different – which is necessary in the ever-changing field of health care, Apodaca said.
“It’s just being open to looking at how you do things, sharing that, and then asking ‘Why?’ five times,” she said. “Don’t be afraid to have those crucial conversations that help you get better. Be open to new methods of doing things, and crossing department lines, because it’s so easy to get siloed. If you share your victories and concerns, the next guy may be having them too.”
Conversations and communication can be productive – until they aren’t, Apodaca said. She cautioned that the best leaders give important issues their due, but they also don’t hold unnecessary meetings just to have them.
“If you can share the information visually, or have a five-minute conversation as opposed to a scheduled staff meeting, that is fine,” she said.
“One of my big A-ha! moments came when I was a director. I overheard one of the chief technologists say to a staff technologist, ‘If it’s OK with you, can we connect about this later? I want to be able to give you my full attention.’ ”
“She wasn’t brushing the staff technologist off, she made sure it could wait, and she closed the loop later,” Apodaca said. “It was such a respectful interchange.”
Finally, Apodaca pointed out the value in taking time to make sure that things are done correctly. The old adage that “There’s never time to do it right, but there’s always time to do it twice,” underscores the resources sunk into course-correcting after a mistake. When things aren’t relatively consistent, quality can be affected, and that goes for staff as well, she said. Relationships can be preserved by good behavior and attention to interpersonal perspectives.
“Growing relationships is a big deal,” Apodaca said. “Be respectful, break down the silos when you can; as these things can impact the caliber of care that one is able to provide for the patient. Be open to improvement. Welcome when concerns are shared with you, because you can’t make something better if you are unaware.”
“Patients come to you at perhaps their most vulnerable point, and need their caregivers to be at their best,” she adds.