Few would argue that one of the most impressive accomplishments of engineering, throughout history, has been the bridge. From the towering Golden Gate to the simple plank stretched across a stream, bridge design and construction are the essence of problem solving. Bridges exist for no other reason than to overcome the obstacle of a river, a valley, or a road, and to provide access to new possibilities for the traveler. Building relationships between imaging providers and referring physicians is a lot like building a bridge. The best (and, often, the strongest) physician relationships are those built with a thorough understanding of the obstacles that must be overcome and a commitment to solve problems for mutual benefit. When those bridges are properly constructed, new opportunity abounds. In beginning this activity, remember this: Not all bridge designs are created equal. The same holds true for physician relationships. Successful bridge design (like successful physician relationships) is dependent on how well the engineer identifies the size, shape, and magnitude of the obstacles. Bridge construction would be impossible without the benefit of engineering and design. Attempts at practice building without an understanding of the referring physician’s practice-specific imaging requirements and obstacles could have the same consequences. Consciously or unconsciously, imaging providers are continuously building a physician-relationship bridge. Conscious, practice-building design will result in a relationship that can weather additional weight requirements and will prevent the unintentional buckling that can occur with everyday use. Building the Bridge Architects approach bridge design by first assessing the distance that must be traveled between the starting and destination points. Providers of imaging services must perform a similar evaluation. What (and how large) are the obstacles that might prevent building and maintaining a healthy referral relationship? There are absolutely no successful bridges that fall short of reaching from point A to point B. Too often, though, we (as practice bridge builders) fall short of our destination from lack of proper planning or failure to construct the necessary infrastructure to support a robust referral stream effectively. Bridges are essentially classified as belonging to three categories: beam, arch, and suspension. Which one the builder chooses depends on the complexity of the task. All three have two essential elements: supporting piers and a roadway. Piers bear weight; they are foundational to roadway support. They are designed to distribute the stress and weight of the roadways uniformly. The greater the distance between the starting and destination points, the greater the structural design requirements. Once the foundational pier system has been constructed, the roadway is added. Roadways span the distance from point to point, overcoming the obstacles that prompted the bridge’s construction in the first place. Roadways are designed based on the type and frequency of potential traffic. There simply is no way to build a bridge without some kind of foundational pier system and a roadway taking you from one side to the other. As you build your physician bridge, begin with analysis of these critical elements. Be cautious not to create a one-way relationship where there is communication directed to the physician, but not back to your center. Without the necessary mechanisms and support structures in place to facilitate return communication, the relationship bridge will fail. A strong imaging center with a vibrant two-way communication roadway will be able to overcome any obstacle and support your message. Before you approach a referring practice, identify and define the distance between your practice and your referring physician. What practice-specific imaging requirements are needed by the physician practice? What is the distance between the clinician’s request and your services? Does your referring physician need immediate access to your radiologist for consultation, same-day appointment scheduling, insurance-support and -verification services, and/or a consistent procedure for communicating critical results? Does the referrer’s specialty require a specific technology or subspecialty interpretation? Have there been imaging-provider breakdowns that have created a greater distance? Are there staff dynamics that increase the slope of your bridge’s roadway? The answers to these and other questions about obstacles (real or perceived) will dictate where to lay the foundation that will build the most sturdy referring-physician bridge. Does your practice support a structure that will bridge the obstacles and build a strong referral relationship? Structural architects see obstacles as design opportunities. Imaging centers often see obstacles as a detour away from opportunity, but they should look, instead, for revised designs. The Piers Consider your practice foundation, or in bridge-building terminology, your piers. What bears the weight of your service? Is it your technology, client services, ease of use, radiologists, longevity, reputation, commitment to your business promise, or integrity? Are your mission, vision, and values foundational to your structure? What brand promises and service elements support the communication/service roadway? Piers, whether they are bricks and mortar or business strategies, have one critically important function: They must be designed to support weight. Your practice piers must reliably permit your communication/service traffic to maneuver smoothly. If the foundational elements of your practice will not support the weight of your physician-relationship bridges, it is time to shore up your foundation. It is time to clarify, strengthen, and add the necessary practice cement to your bridge. Take a long, hard look at your practice. Identify your weak spots, and take steps to strengthen your foundation. If your practice foundation’s chemistry is a mixture of commitment to service and communication, then the compound must have sufficient measures of each to solidify your piers and support your referral traffic. Nothing is more frustrating than promising a referring physician that there is always a radiologist available to consult on difficult imaging decisions, only to find that your radiologists are not willing to take the call when the need arises. Service promises that are broken or missed not only weaken the foundation of your bridge, but create reluctance on behalf of the referring office to trust the structure for future referral traffic. A patched-hole approach will not address the long-term problem. In fact, it will weaken the overall integrity of your bridge. What practice piers have you planted, as an imaging provider, that will reliably support your practice-communication roadway? The Obstacles Simply stated, the greater the distance between point A and point B of the relationship bridge, the greater the importance of your practice’s foundational piers. If your bridge needs to be constructed to overcome large obstacles, or if your communication/service roadway requires more expansive travel, your foundational piers will require very strategic placement to meet the referring physician’s needs. Perhaps you must overcome past IT, service, or political problems in your relationship with a particular practice. These obstacles can be much larger than they would be in a relationship with another practice, for example, that communicates its appreciation of your services.
Soft lines and lighting are hallmarks of Epic Imaging’s Women’s Center in Portland, Oregon.Large practice obstacles require a redistribution of your service bridge’s weight. For example, if a referring practice requires very specific imaging sequences and measures, has explicit reporting requirements, and makes other image- and report-delivery demands, multiple support structures must be constructed throughout the facility to keep the referral traffic moving into the center. If one or more of those requests creates a steeper roadway, you will need to refortify your bridge’s support structure. Often, imaging centers navigate away from expansive, highly problem-ridden referral streams that appear to be doomed from the start. Don’t shy away from a challenge. Successful service design and careful construction of the physician bridge just might result in a referral wonder that opens doors to unanticipated opportunity. Just remember, builders of strong physician-practice bridges anticipate the load and reinforce the structure accordingly. Too often, providers tempt fate and exceed the limits of their referring-physician bridges. This exercise not only has immediate (and often disastrous) consequences, but develops a long-term reluctance to refer on the part of the physician. The Road Most Traveled Once our foundational practice piers have been strategically placed, based on a realistic analysis of the obstacles and the span of service requirements, it is time to consider road construction. Road construction and material choices are critically important to strong, long-term relationships. Referring-physician pathways should be designed to accommodate two-way communication. No matter how often your marketing team visits, or how many glossy brochures you deliver, if there is no communication pathway directed back to your facility, your message will reach a dead end. Strong referral relationships require a facility controller who will listen to, disseminate, and act on a physician’s service concerns. No news is never good news when it comes to referral sources. Physicians who are faced with guessing who their controller or service agent is will simply take the path of least resistance and detour to a provider more willing to acknowledge their requests and comments. Road design cannot be rigid; it must have the ability to give when necessary. Anticipating the burdens that will be placed on the center’s foundational piers will certainly help to facilitate necessary shifts resulting from referring physicians’ requests. If your service pathway is not responsive to request-driven shifts, you will not be able to adapt to an ever-changing market. Communication pathways must bring value to our customers. Referring physicians generally do not experience the same total amazement that we imaging professionals do when we share our news about the latest big, white machine with a hole in it, capable of scanning a small country during one held breath. They are, however, interested in knowing that the very same scanner has the ability to scan the small bowel and to differentiate small-bowel anatomy, providing a more comprehensive imaging procedure to diagnose active disease in patients with Crohn disease. By letting them know about this capability, you have opened a value-added pathway. Value initiates two-way dialogue and motivates a physician to use your service. How we travel our communication roadway is as important as the roadway’s structure. Physicians expect our services to be agile, active, and quick to respond. Short communication delays might be interpreted as disinterest, or as indicating that we have devalued the physician’s referrals. All great bridge designers anticipate the less likely when they initiate their structural designs. Weather, wind, and other natural forces dominate decision factors in design, engineering, and construction. We, as providers of a valuable diagnostic tool in patient care, must be equally aware of external factors as we build our referring-physician bridges. Imaging experts, as well as all health care providers, are preparing for the effects of upcoming health care reform. While there is considerable speculation and uncertainty as to what form that will take, what we know for sure is this: Our industry will not remain the same. There is an opportunity to see reimbursement and utilization appropriateness improve, but we might also experience a reimbursement decline while overutilization goes unchecked. Many feel that, as an industry, we should be prepared to weather the latter scenario. In today’s imaging-service climate, and with the potential stormy weather that we face ahead, we must take a serious look at each physician who is willing to trust our service bridge. Our strategy must be to work industriously to ensure that referrers can trust us, every time. All referring-physician relationships, whether they are long-standing or new, are vital to our continued success. Conclusion Today, diagnostic imaging faces a significant increase in competition. A decade ago, many successful imaging services were essentially untested. Now, however, referring physicians have a number of imaging providers calling on them almost daily. Referrals based only on friendship are few. As imaging providers, we operate in an environment of unparalleled competition. As most highly competitive businesses do, diagnostic imaging now faces the inevitable: When competition increases, so do expectations. These expectations are not just those of the referring physicians; our patients ask more, read more, and expect the experience to exceed their expectations as well. Patients no longer see themselves as recipients of whatever happens next, but as agents of their own care. As such, they exert a new and stronger influence on referral streams. Building a stronger physician referral base is a collaborative venture involving every department in your center. It begins with a careful analysis of the bridges that you need to build. It moves from there to an honest assessment of the foundational support structures within your organization that deliver value to your customers. As construction begins, all departments should work together to shore up the piers that will bear the weight of the referral bridge. Once completed, each bridge will then require careful maintenance by your team. Melanie Haymond is marketing director, Epic Imaging, a 16-physician outpatient imaging practice in Portland, Oregon.