The Cultural Revolution: Two Case Studies on Corporate
Private and public companies alike have long sown the seeds of success by conceiving and adhering to a corporate culture that dictates how employees interact with customers and clients, as well as with each other. The rationales for adopting an unimpeachable corporate culture within the health care sector are airtight and multifaceted. Perhaps most important, establishing and adhering to a set of cultural values paves the way for improved patient services and care.
Rodney Owen, MDRodney Owen, MD, serves as president of Arizona’s Scottsdale Medical Imaging, Ltd, (SMIL) and is an executive vice president of Southwest Diagnostic Imaging Inc, of which SMIL is an affiliate. “Radiology, like all health care, is a service industry,” he says. “Only with a strong corporate culture can radiology practices achieve the caliber of care, patient service, and satisfaction needed to survive in an increasingly competitive market.” Lisa Mead, RN, MS, SMIL’s chief administrative officer, corroborates Owen’s comments, adding that functioning within a corporate-culture model is especially critical for practices that offer imaging services at multiple sites and are in a growth mode. SMIL operates 10 outpatient imaging centers in the Scottsdale area, employing more than 40 radiologists in eight subspecialties, along with more than 200 technologists and administrative personnel. “Patient care and the manner in which everyone within the organization approaches his or her job need to be consistent,” Mead states. Corporate culture is the linchpin here. Culture and Reform Having the right corporate culture in place also bolsters radiology practices’ potential to flourish despite outside forces, particularly the paradigm changes that accompany the rising tide of health care reform. This was the catalyst that drove Boston University Medical Associates (BUMA) in Massachusetts to embrace a new corporate-culture model, according to David J. Spinale, MBA, director, who was tapped to lead the charge. A 42-physician academic practice, BUMA performs more than 425,000 imaging studies annually for Boston Medical Center (its affiliated community hospital) and 15 community health centers in the greater Boston area. Boston Medical Center is the nation’s largest free-care hospital, and it serves a disproportionate number of indigent patients. “For years,” Spinale says, “the state of Massachusetts would routinely ask the cost of serving these patients and write checks to cover those expenditures, so efficiency was not a driver in its departments.” Three years ago, however, landmark legislation spearheaded (and about to be signed) by Mitt Romney, who was governor at the time, set the winds of change blowing. Enacted in 2006, Massachusetts’ health care reform law requires health insurance coverage for nearly every resident of the state. The state provides health care for residents earning up to 100% of the federal poverty level and partially subsidized health care for those earning up to 300% of that level, using an income-based sliding scale.
Alexander Norbash, MDAlexander Norbash, MD, BUMA’s chair, says, “It became clear to us that we had a short time window in which to become a competitive, metrics-driven business (particularly if we were to attract and efficiently serve patients who now had insurance cards and a choice of providers) while remaining profitable. It was also clear that we had to abolish the fiefdoms that were in place” in various subdepartments in order to achieve consistency and integration with hospital-wide operations management. “Adopting core cultural values was, for us, the best solution,” he says. A desire to minimize the ill effects of subspecialization within radiology also pushed the corporate-culture envelope where BUMA was concerned, Norbash adds. “On the academic side, radiology tends to be subspecialized, and the subspecialties aren’t necessarily aligned,” he explains. “Corporate culture allows for an alignment of mission, with the shared values that are critical to better patient care propelling us forward.” Common Values It’s not surprising that the building blocks of an ironclad corporate culture do vary subtly from radiology practice to radiology practice. There exist, however, myriad shared cultural values. In addition to an emphasis on high-caliber service and patient care above all else, such elements, many of which have a direct impact on these two overarching values, include innovation, a push toward continual improvement, collaboration, and transparent, equitable management. Innovation and improvement: In communications with physicians and, in certain cases, support staff, executives at both BUMA and SMIL continually espouse the need to seek new means of getting the job done (whatever that job might be), rather than resting on old laurels. Toward this end, BUMA uses metrics against which staff members are measured. The practice also makes it a priority to stand behind its physicians in academic development and other endeavors. Recently, BUMA was handed a mandate to trim several hundred thousand dollars from its budget. Academic development was removed from the list of line items that Spinale told management that the department would be willing to cut, based on the premise that research funded by the allocated funds could lead to important results, now and down the road. “We told the administration that to take away funds would send the wrong message, and that we would tighten our belts elsewhere,” he says, “and we did.” SMIL takes a related stance, with constant reminders to staff that generating new ideas is not necessarily synonymous with acquiring new technology. Personnel from all facets of the organization are solicited for suggestions relating to change and improvement, and physicians, technologists, and administrative staff are all represented when ideas are being evaluated in a group setting.
Lisa Mead RM, MSThe charge to strive for consistent improvement decidedly affects health care providers’ hiring practices. Two years ago, SMIL was approached by a few former staff members who wanted to return to the fold. “We asked ourselves whether they had the type of drive that would take us from good to great. We said, ‘Not really,’ and turned them down,” Mead says. Collaboration: Mead notes, “Assuming ownership of one’s patients and work is endemic in our corporate culture, but so is being a team player, taking on more than one’s fair share.” At BUMA, collaboration is fostered via rules-based models for a range of activities, from assisting colleagues with tasks and working with other departments within the hospital to staff scheduling and the purchase of new equipment. These have replaced the special deals and arrangements that were common when the fiefdoms prevailed. “Everyone,” Norbash observes, “shares the cake and the tax.” Management: BUMA promotes a style of management wherein issues are laid on the table in a direct manner. All information pertaining to the department, as well as individual roles, is openly shared by section heads and those in similar positions. Spinale and Norbash say that such openness truly encourages staff to work toward a shared vision of excellence. “Everything has become rules based, including pay scales, scheduling, and allotted vacations,” Norbash states. Compensation constitutes a prime example: In the past, salary discrepancies existed from subspecialty to subspecialty and among individuals with the same job description. These discrepancies have been eliminated, and although some attrition resulted from the move, it has been positive for the most part, according to Norbash and Spinale. Visible Means of Support Even the strongest, most carefully configured corporate culture cannot exist in a vacuum; communicating and emphasizing cultural values to the staff are critical steps in leveraging their potential for fostering practice growth. When new staff members come into the fold through regular hiring or (as appears to be increasingly the case) in the course of practice mergers and acquisitions, effective communication of these same cultural values is vital to preserving corporate culture. In their initial few weeks at SMIL, newly hired personnel are mentored by seasoned counterparts so that they may observe best practices for interacting with patients and referral sources, whether on the medical or administrative fronts. “Every clinician should be treated like your best friend from medical school, and every patient, like your mother,” Owen says, and this is the premise on which customer-service training is built. Written communications go beyond announcing the development of new processes and the piloting of new technologies, delving into the rationales for doing so and tying back into SMIL’s corporate culture. Articles in the staff newsletter and periodic educational endeavors supplement the mentoring. For instance, about a year ago, SMIL ran an inservice training series for its clinical-operations directors and site managers. The series focused on how to apply SMIL’s cultural values to improving patients’ experience at its sites; this was based on the premise that when patients go home, they talk about the treatment that they received to others, who might later find themselves selecting an imaging provider.
David J. Spinale, MBAMead also devotes significant time to discussing SMIL’s cultural values with administrative staff members over the course of their orientation periods. She says, “This means not only talking about what it is and fostering development in the key areas, but explaining why and how our values help us to maintain our competitive edge. You can bring the right people for your culture onto the bus, but you have to move them forward with training.” Communication and Support Intrinsic strength alone is not sufficient to sustain corporate culture. Like all businesses, imaging providers (and all health care providers, for that matter) must also implement best practices and an infrastructure for supporting core values. Selling practitioners and administrative staff alike on the concept of operating under a corporate-culture umbrella is key. “There has to be buy in from the start, or the entire structure will collapse,” Norbash says. “To obtain it, everyone needs not just to be told why a cultural values model is being devised, but to be asked to contribute input as to how to get there.” At BUMA, Spinale and his team held group and one-on-one meetings with individuals at all levels of the organization. The overall message conveyed during these events was that with health care reform pending and the collapse of financial markets seemingly imminent, some manner of action was warranted to prevent the caliber of service offered by the practice (and hence, its overall well-being) from being adversely affected. BUMA’s intent to be oriented toward customer service was communicated, and participants’ feedback on what they believed the needs of patients, third-party payors, and the hospital to be was solicited. Such information became part of the framework from which BUMA’s corporate culture was conceived. For both SMIL and BUMA, a dedicated human-resources infrastructure supports the emphasis on high-quality patient service and the commitment to continuous improvement. SMIL employs a process-improvement engineer with a degree in industrial engineering. This individual is responsible for evaluating all processes across the organization to identify inefficiencies and pinpoint opportunities for procedural enhancements. Not long ago, SMIL sought heightened efficiency in the use of its PET/CT scanner, without compromising the caliber of patient care, increasing staff hours, or investing in another machine. The process-improvement engineer reviewed the procedures for patient check-in, injection, and scanning, then proposed scheduling changes to accommodate a new injection process and, in turn, boost the scanner’s capacity by 33%. “We are accommodating more patients, with the same staffing and the same equipment, while also remaining within the framework of our culture,” Mead notes. Meanwhile, BUMA has in place a performance-management executive who runs and oversees performance metrics on a full-time basis. “Dedicating the resources to keep a continual, close eye on metrics and, accordingly, see exactly how we are faring against our objectives is essential to our corporate culture and ensuring its strength,” Norbash says. “For instance, only if we know exactly how well we are applying what we have learned through experience and research to patient care can the caliber of that patient care be consistent with our values.” Tools are part of the equation as well. Accordingly, BUMA collaborated with a software vendor to create a rules-based personnel-scheduling application that has, as a side benefit, completely eliminated the need to augment employee resources with per-diem personnel. Now available on a commercial basis, the software buttresses the part of BUMA’s corporate culture that prohibits arbitrary assignment of clinical and administrative staff to given tasks and time slots, as well as requiring physicians to prioritize patient care. In line with the practice’s collaborative stance, section heads from all disciplines contributed their input to the design of the system, which BUMA decided to configure in-house after off-the-shelf software solutions were deemed insufficient to meet its needs (and particularly the need to achieve decision-set parity while taking into account the disparate requirements of individual subspecialties). Spinale and Norbash say that the software tool has garnered unwavering acceptance by section heads because it reflects distinct individual contributions from all parties involved. “Properly supported, corporate culture is a wonderfully effective catalyst for the health and growth of our practice and practices everywhere,” Norbash concludes. “This will continue to be so.” Additional Reading - How Culture Informs Hiring The Netflix Cultural Revolution Julie Ritzer Ross is a contributing writer for Radiology Business Journal.