Great leadership will distinguish winning imaging organizations from those that struggle I recently facilitated an all-day retreat for the management staff of a large hospital outpatient division that is part of a well-respected academic medical center. As I have done on many similar occasions, I asked the group’s members, prior to the meeting, to outline their respective issues and concerns so that we might spend the day working toward alignment around a common vision for future success. It is always a revealing process. One thing that became very clear early in the group discussion, in this particular case, was the need to work through the fact that most large integrated health care systems (this one included) have evolved along functional lines in the delivery of care. That is, each department within the typical organization becomes its own functional silo. Critical to the alignment of these silos is the building of cross-functional teamwork around a common purpose. It’s often easier said than done, and that’s why many organizations opt to have someone help them identify methods of communication that can transcend parochial interests, lest they become codified into protected turf and isolated cultures. Building a common culture based on mutual understanding of the vision and mission is one area in today’s medical imaging practices, departments, and centers where I believe that I can help the enterprise compete more effectively in an unforgiving market. The creation of a corporate culture based on accountability, mutual respect, accessibility, service, trust, and communication is perhaps the most significant accomplishment for which any leader can strive. This is especially true in today’s medical imaging profession. As we worked through the discussion at the retreat, I was fascinated, as I always am, at the assembled group’s ability to grasp the urgent need to find new ways of developing a sense of community and teamwork. In these types of settings, the best and the brightest reach out to other departments and segments of the organization as a means of connecting and rising above traditional roles and preconceptions. The technical staff often feels isolated and disconnected from the business office and administrative staff. The radiologists typically don’t connect with the line staff to help them understand the necessity of the clinical protocols that they develop. Marketers are often at odds with the operations staff and feel that hard-earned referrals are taken for granted and service issues are not taken seriously. Likewise, the operations staff frequently thinks that marketers are constantly making them look bad by bringing bad news from the referring physicians’ offices. Linking these functional departments through leadership is not easy, but I believe that it will be among the most important elements of a manager’s job description in the future. Whether that manager is running a private-practice radiology group, a hospital radiology department, an imaging center, or a group of centers, the challenges will be similar in each setting. The ability to bring this disparate (and often suspicious) group of department heads together frequently—teaching them to communicate more effectively and helping them focus on the battles that need to be fought outside the organization (with competitors, regulators, payors, and others)—is the better part of leadership that will separate tomorrow’s winning imaging organizations from those that will continue to struggle, or will even disappear. I remain encouraged by the talent, commitment, and level of understanding among the majority of our profession’s front-line managers and leaders. Ours is a profession under siege: a part of the health care delivery system that is fast becoming the bad guy in the eyes and minds of legislators and regulators. The competitive landscape is brutal, and the demands for accountability and efficacy are unrelenting. It is not a profession for the faint of heart. Nevertheless, I see pockets of excellence and examples of leadership that are redefining medical imaging leadership unfolding each day around the country. As with this most recent day spent with a talented group, it is gratifying for me to be a part of shaping the model that will constitute tomorrow’s successful medical imaging practice, and to nurture leadership focused on good, solid business practices that are built on community and through communication.