Ascending the Hospital’s Leadership Ladder

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Times of change generally present increased opportunity for those willing to find the right door and open it. With hospitals merging, buying practices, and acquiring imaging centers, there is just such an opportunity, in health care, to rectify what many believe is a paucity of radiology representation in the upper echelons of hospital administration. Room at the Top As unusual as it is to find imaging experts in general-leadership positions, Robert Grossman, MD, has attained a position in his field that makes him even more of a rare species. Grossman, who is both dean and CEO of NYU Langone Medical Center (New York, New York), logged 20 years as a neuroradiology chief and another six as department chair. His career as a researcher is equally distinguished: He won a a National Institutes of Health (NIH) Javits Neuroscience Investigator Award in 1999 for research on multiple sclerosis, and from 1997 to 2000, he chaired the NIH Diagnostic Radiology Study Section. Grossman also invested time in the service of organized radiology, as a past president of the American Society of Neuroradiology, as editor of the American Journal of Radiology, and as a fellow of the International Society for Magnetic Resonance in Medicine (ISMRM). He received a gold medal from the ISMRM in 2010 for his pioneering research in MRI in medicine and biology. By some measures, though, one of his greatest achievements was turning all that experience into a true C-suite position. After all, radiologists are physicians first. “I didn’t have a linear pathway at all for this job,” Grossman says. “I was never focused on being the dean/CEO; I was focused on doing what I did at the time that I was doing those jobs.” The accolades didn’t stop piling up once he got the job, either. In the years since he’s held the dean/CEO position, two NYU Langone Medical Center facilities—Tisch Hospital and the Rusk Institute of Rehabilitation Medicine—have twice earned Magnet Awards from the American Nurses Credentialing Center. In recruiting the dean/CEO, the board of trustees at NYU Langone Medical Center sought a candidate with a background in research and medicine who would help integrate the school and hospital aspects of the institution. The reason that the board chose Grossman, he says, is that he had sampled a variety of different leadership opportunities along the way. “If I were trying to talk to young physicians who want to be deans or CEOs, the most important thing I’d say is not to be afraid of something that you may not be comfortable with,” Grossman says. “Extend your comfort zone, and go with your passion,” he says. “Ultimately, you want to maximize your job satisfaction and happiness, and in order to do that, you have to be willing to stretch, sometimes. By sampling a lot of different opportunities, I gained experience that provided me with a skill set that our board found appealing.” Raising All Boats Grossman says that his passions—and his appetite for taking on added responsibilities—were fueled by his recruitment of talented staff, along the way. When he was a section chief, he says, he mentored excellent people and looked for ways to help them conduct research that would embellish their careers. When he moved up to become a department chair, he simply scaled up his approach, seeking individuals who could help transform an institution into something greater and more successful than it had been. “There’s nothing formulaic, as far as I’m concerned,” he says. “The best thing is to be a good learner. I think that what you have to do is manage people and have a vision for what you want to make of your institution.” At NYU Langone Medical Center, Grossman’s vision has to hold for 19,000 people who always ask what’s in it for them, he says. That’s where the effectiveness of a leader is made: in communicating effectively a vision for the future of the organization and in coordinating the deliverables necessary to execute it. Grossman says, “Ideally, you want to have a vision and then manage the components to fulfill the aspirations.” Unifying those qualities of assessment and implementation, he says, is what makes an effective leader: making an appropriate evaluation (of talent, resources, or strengths): seizing opportunities that other people don’t see; and then delivering on those expectations. “It’s easy to see them,” he says. “It’s harder to make sure that everything works. I think you’re chosen as a leader if you can deliver on vision and your promises. There are many people who are highly articulate, but it’s about rolling up your sleeves and making a decision into reality.” Beyond having the ability to execute plans, Grossman says, a good leader must also demonstrate emotional intelligence. Good leaders have a lot of authenticity, he says—and many times, “Very creative, innovative, smart people don’t understand why they can’t be good leaders,” he explains, if they lack emotional intelligence. A radiologist hoping to climb the executive ladder must have something from each of many skill sets, Grossman says. Imaging professionals are in short supply at the top for any number of reasons—not least of which is that many, he feels, enjoy economic rewards that are sufficient to keep them where they are. “They don’t have any seats at any tables,” he says. “They don’t embrace, or haven’t recently embraced, leadership training. They’re underrepresented in Congress; there are none in CMS.” Of more than 150 US medical-school deans, he estimates, four are radiologists, and radiologists account for even fewer hospital CEOs. “I think that the specialty hasn’t really promoted or embraced leadership,” Grossman says. “It’s been very inwardly focused.” Private Practice to an Integrated Delivery Network That assessment is one of the things that deeply frustrates Keith S. White, MD, medical director of imaging for Intermountain Healthcare (Salt Lake City, Utah). The notion that radiologists can’t become administrative leaders until they achieve a certain status as senior medical leaders has really handicapped the profession, he says. White, who has more than 20 years of experience in diagnostic and pediatric radiology, says that since becoming a radiologist, he has tried to expand the role of the discipline within a broader system that doesn’t place as much emphasis on RVU production; instead, it allows radiologists to contribute to care process model development, treatment planning, operational efficiencies, “and other areas of our expertise that are underused,” he says. He continues, “I think the business market compensation models and IT solutions under which we’ve practiced have so strongly pushed personal productivity that they have taken us away from direct contact with patients and referring physicians—and in some cases, out of leadership roles. What happens if there’s no apparent or immediate opportunity for a radiologist to demonstrate viability as a leader?” In such instances, White advocates “becoming involved in whatever administrative opportunities become available to you,” he says. Some of these smaller opportunities to gain administrative experience frequently present themselves both within health systems and in associated private groups. “Although these opportunities may not be in high-profile areas, active participation and positive performance will open doors,” he says. “My personal experience was one of just gradually growing, step by step, along the way. There were opportunities in IT, quality improvement, business-office management, and departmental operations.” White’s own experiences, he says, consisted of working for several years in an academic environment; then, joining a private-practice radiology group; and ultimately, becoming the corporate president of that group. After that, he says, it was another natural step to his current position at Intermountain Healthcare. The Teleradiology Problem Working against the kind of hands-on experience that develops good administrative leaders (as well as good physicians), White says, is the expansion of teleradiology. In many circumstances, the demands of the profession remove imaging professionals from direct personal contact and from the relationships that are needed for radiologists to have a powerful impact on care decisions. White says, “I think that a real challenge we face, in radiology today, is not to be dragged along by the natural business incentives that are present in a volume-based, fee-for-service model, and to build a new, superior model more compatible with the value-based incentives of the future.” He adds, “Appropriate utilization of imaging services has a huge impact on cost. Controlling and managing cost and preserving the well-being of a patient are going to be the name of the game in the future, and radiologists are key players in that process. It’s very important for us to be able to create these care-process models, and we can’t do that if we’re not contributing members of the multidisciplinary care teams that will develop these models.” What is needed (more than anything), White says, is a new generation: leaders who can look beyond the field of radiology to being part of a global multidisciplinary care team that turns away from arguments over turf to focus on defining and implementing best care within an integrated delivery system. To achieve that, he says, imaging professionals need to abandon a department-specific bias. “If we were to embrace this other model of driving patient-care initiatives, then the value of our expertise and of our tools would speak for itself,” he says. At the intersection of these competing interests, White adds, is an opportunity to use the quantitative analytical assessments of good medical practice to drive a more patient-centered model of care delivery. In fact, he says, there is a surprising lack of attention to the basic science of quality improvement in the day-to-day lives of radiologists, even as imaging professionals are compelled to deliver outcomes-based services. “That’s another major opportunity for young radiologists interested in pursuing a leadership track: dedicating themselves to learning about the science of quality improvement,” he says. “That’s what’s going to be necessary for us to have an impact, in the future, and there will be ample opportunity for radiologists who have these skills to lead.” Technologist to COO Richard Helsper, MBA, FACHE, agrees with White that change is at the core of everything that radiology leaders are called upon to achieve—and that such change doesn’t necessarily demand an adherence to traditional measures. Helsper is COO of Genesis HealthCare System (Zanesville, Ohio). He was vice president of operations for Clarian Health (now Indiana University Health) and was COO of its Midwest Proton Radiotherapy Institute (now the IU Health Proton Therapy Center)—but he says that his foot in the door in health care was in patient transport. Later, he became a radiologic technologist. “My last boss, CEO of two hospitals and COO of an 18-hospital system; a previous boss, CEO of a major hospital system in North Carolina; and I—all of us were radiologic technologists who no longer keep our licenses because the CE credits we now earn no longer apply to radiology,” Helsper says. “Now, it’s not as though any of us are going to go get behind a camera again, but I actually thought about going back to get the CEs.” Sometimes, the field is at cross-purposes with itself, Helsper says. Imaging rewards its subject-matter experts with departmental promotions, but to get out of the department, “You need more than that,” he says. “To me, it’s the culture that the only thing that’s important is radiology expertise,” Helsper adds. “That doesn’t help the radiology leader grow beyond radiology.” Even when imaging professionals ascend to other leadership roles, Helsper says, they often become known within their organizations only as radiology leaders, not as leaders in the broad sense. “Being a technical expert is a great thing, but it doesn’t lead you into the next realm,” Helsper says. “When the radiology director is seen as an expert only in radiology, and not in any of the other initiatives and priorities, it’s more difficult for him or her to break out” of being thought of as a technologist. Subject-matter expertise doesn’t differentiate an imaging professional from other leadership candidates over the long term, Helsper says—but leadership capabilities do, and one of the easiest ways to demonstrate them is to earn an advanced degree, such as an MBA. “To move up in the world, into a vice president’s or COO’s position (or one of those kinds of roles), you absolutely must have a master’s degree,” he says. “There’s too much competition out there. If that’s where you want to be, then the only way to get there is to be prepared at the master’s-degree level.” One in Five What keeps many professionals from obtaining MBAs, he says, is either intimidation at the prospect of taking on such a task or an unwillingness to sacrifice some of the creature comforts that will be lost on enrolling in advanced education. For Helsper, who didn’t earn his MBA until he was in his 40s, it required 22 months of priority realignment, as he puts it. “I was working at the time, and I think I gave up six or seven weeks of my vacation to make sure I was successful in the program,” Helsper says. It was a deliberate decision, he adds, and it was definitely worthwhile. “There are a lot of people who want their home lives, want to work fewer hours, and also want to be promoted,” he says. “There’s nothing wrong with that; however, it often does not lead to growth. One should understand that the measure of work is accomplishment. When I got out of school as a technologist, I was driving around in a $1,000, seven–year-old car,” he says. Helsper always encourages people who work for him to consider pursuing an MBA, MHA, or other master’s degree, and he offers his assistance in putting a program together, he says. He believes that the imaging field should be attempting to develop no fewer than one in five of its members into executive/administrative leaders. That’s tough to do in an environment where the goalposts are always moving, he says, but it is, ultimately, a necessary strategy if the profession is to exert greater influence on the future of health care. \ “Look at the number of things in the past 15 years that have flipped radiology,” he says. Health care is going through similar changes, causing fundamental differences in how care is delivered, compared with how it once was performed. Without leaders who have radiology backgrounds, he asks, “How do we incorporate those changes into our practices and execute them effectively?”