Leading Texas-sized Austin Radiological Association

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When it comes to size and influence, Austin Radiological Association (ARA) has few peers. The practice of 72—and soon to be more—radiologists employs 700 people (580 FTEs) in Austin. In addition to covering every one of the 16 hospitals in central Texas, ARA archives most of the radiological images generated at those sites on its regional PACS. The practice also owns and operates 15 imaging centers throughout the Greater Austin area. Doyle Rabe, CPA, served as administrator of ARA from 1996 to 1998, and he returned in 2001 as CEO. Radiology Business Journal recently sat down with Rabe to discover what it takes to lead a practice this size.

RBJ: In a large radiology practice, the CEO is charged with leading the entire organization, including the clinical, operational, and administrative staff. Would you offer some best practices for building collaboration not just with physician owners, but also with the staff?

RABE: You have to use an effective mix of leadership and management. The expectation from the physician-ownership side is that you will manage their company effectively. Strategically, that requires leadership skills to move the company in the right direction, with an insight into all of the factors that affect radiology and the medical industry as a whole. That leadership is developed through good stewardship and management of the company they have entrusted to you.

I have accomplished that by surrounding myself with a great team of managers. That includes top-level managers at the financial, clinic-operations, business-development, and information-systems levels, and six additional directors to cover clinic management, contracting and compliance, business office, human resources, and hospital services. From my perspective, it’s more about providing good leadership, based on corporate core values, to this team than it is about day-to-day management. That is their job, and I am there to offer experience and insight to guide them.

Leading such a large number of employees in this practice can be a daunting process. The diversity you encounter in a specialty-driven radiology practice ranges from neurointerventional surgeons, pediatric radiologists, body imagers, interventional radiologists, and musculoskeletal radiologists on the clinical-practice side to technologists, billing-office staff, customerservice staff, programmers, accountants, and others on the business side. I grew up as a middle child in my family, so analyzing situations and offering solutions is a natural part of my behavior.

Much of my time is spent motivating people. I think the key to bringing both of these teams together is communication. My unique style is centered around verbal communication. In the days of email and instant messaging, I still rely on one-onone verbal contact. I am apparently infamous for the stories that I use to illustrate a point or to interject a point of view. I think there is more complete communication between people when they meet face to face, rather than reading a message that often gets misinterpreted.

RBJ: Can you offer some best practices for minimizing friction between owners and employees and building one team that works as a unit?

RABE: When I returned to ARA, it was to the position of CEO, rather than administrator. I think there is a big difference between the two titles and their job responsibilities. As administrator, your job is to implement policies and procedures as defined and directed by the board and the underlying governance structure. As CEO, you have a seat on the executive committee and you are an integral part of defining the policies and creating the procedures that run the practice day to day, as well as participating in charting the strategic course for the future. As a result, the goals of the organization are clearly communicated from the owners to the employees.

All employees report to the CEO, who reports directly to the executive committee. That is not to say there is no input from the radiologists on employees. Through strategic planning and direction, the goals of the employees have been set. Through the annual budget process, the amount of resources needed to accomplish those goals has also been approved. If there are individual issues, the management structure (involving managers, medical directors, and administrators) is used, as defined by the executive committee. These parameters are set using open communication to meet the goal of creating a smoothly operating and