When Verlon Salley, MHA, CRA, arrived six years ago as executive director of radiology at UPMC’s Presbyterian and Shadyside Hospitals in Pittsburgh, he vowed to give his staff a more powerful voice. It was more than mere lip service. Consider: he sat down with a patient care aide who had 40 years with the organization and asked for her candid thoughts on how to improve personnel engagement. One of her ideas, recognizing members for perfect attendance at five-year intervals beginning with the fifth year, was soon adopted. So was a program to single out those whose names kept popping up on patient satisfaction surveys, along with many other employee- and patient-focused efforts that followed, all designed to give members greater ownership and authority to make radiology a better specialty to work in.
Within three years, turnover declined and Press Ganey patient satisfaction scores, a proxy for employee satisfaction, soared from a 25th percentile rank to a 75th percentile rank among the 25 hospitals in the vast UPMC system. “I realized that staff members in support roles—like nurses, receptionists and patient care aides—had knowledge and opinions they wanted to share, and that they wanted to be heard,” recalls Salley, who is now executive director of radiology for UAB Medicine in Birmingham, Ala. “And I knew if I could ensure we had happy and engaged employees, it would trickle down and help to ensure we also had happy patients, radiologists and referring physicians.”
A new awareness is taking hold in radiology practices and departments as they come to grips with the growing complexities and demands of the non-clinical side of the business. In an environment where patients post online performance reviews and referring physicians want quick and well-informed responses to questions when they phone in, radiology practices need to be more certain than ever that their staff is not just knowledgeable, but personable and compassionate. To be sure, vetting people for non-physician or technologist positions—a broad swath that includes not just nurses and patient care aides but billing clerks, schedulers, IT specialists, administrative assistants and more—has become as rigorous a process as screening for radiologists.
“What I’ve learned when it comes to hiring is that you need to take seriously the due diligence—not just reading letters [of recommendation] but actually calling colleagues and institutions where the people are coming from to try and get them to talk frankly about the job candidate,” says Richard Gunderman, MD, PhD, professor at Indiana University School of Medicine in Indianapolis and a pediatric radiologist. “My experience is that if you hire a bad person, it can generate by an order of magnitude the work and headaches it would if you had hired a qualified individual.”
Communication vs. Clinical Skills
In the minds of many radiology administrators, interpersonal skills have become as important in frontline employees as clinical capabilities. “Everybody is moving toward a quality-based model where patient satisfaction surveys and referring physician satisfaction surveys are the norm,” notes Jim Hamilton, MHA, CMM, immediate past president of the Radiology Business Management Association (RBMA) and business manager for Medical Imaging Physicians in Dayton, Ohio. “And that means people with communication skills and personalities to match are very, very important in this business.” Indeed, Hamilton recalls the recent hiring of an interventional radiologist physician assistant at Medical Imaging Physicians. “We were looking for somebody who could not just do the job clinically, but who had the temperament to help market the business and make sure that patients, providers and referring physicians were satisfied,” he says.
Finding candidates who can comfortably clear that bar has become something of a holy grail for leaders such as Rick Perez, FAHRA, CRA, administrative director of the department of radiology at NYU Winthrop Hospital in Mineola, N.Y. “We look for people who speak well, present themselves well, and really like dealing with others,” he says. That includes people who can adroitly handle “difficult” or irate patients—a point which Perez and others in his department who interview candidates carefully explore. “We want to know how they would disarm a challenging situation,” he says, citing as an example front-desk personnel who are often required to keep the peace among walk-ins and scheduled appointments.
In the search for employees equipped to help promote or “market” the business, prior healthcare knowledge and experience may no longer be requisites. “A person new to the field can bring great energy and fresh ideas to the practice where an experienced hand might bring some stability to the team, but also come with baggage from their previous job and now require retraining,” Hamilton says.
People who have prior experience interacting with customers—even in decidedly non-healthcare jobs such as waiter or sales clerk—could be a good fit for front-end jobs in a radiology office with the right on-the-job training. Bill Algee, CRA, director of imaging services at Columbus Regional Hospital in Indiana and new board president of AHRA, says he has sat through job interviews over the years where candidates with service industry backgrounds clearly outshined those without it.
“You can often single these people out when you ask them behavior-based questions, like, ‘Tell me about the time you had a really bad experience with a customer,’” he observes, adding that the critical thinking they used to defuse the situation could provide a window on how they would react to future issues.
One way to help ensure that the most qualified people are being hired, Algee maintains, is by running candidates through a multi-tier battery of interviews. At Columbus Regional Hospital, which has an 80-member radiology department staff, prospects who get past HR sit down with a manager and, if they make the grade, are sent to a team of staff members who grill the individual and must give their imprimatur before a candidate is hired. “These staff interviews can be tough,” Algee says, because group members know that the eventual success (or failure) of someone they approve is a reflection on each of them.
Making Continued Education a Priority
In no small way, hiring people who support the work of core radiologists is only as effective as the follow-up effort to train and develop them. At many institutions, that education depends heavily on on-the-job training. Perez explains that NYU Winthrop’s department of radiology couples hospital in-service training with educational initiatives aimed at front-end staff. That effort recently brought in an outside consultant, for example, to discuss enhancing customer relationships. Perez says he also attempts to build esprit de corps through newsletters and staff meetings that bring all members up to speed on what’s happening within the department. Employees at many radiology offices also are encouraged—and in some cases required—to keep their knowledge and skills current by taking outside courses or enrolling in continuing education programs from professional associations. RBMA, for its part, offers courses in financial management, governance, information management, marketing and business development.
Even with these opportunities, some leaders feel the industry is falling short of the mark when it comes to employee development. “Training is more important today than ever in the history of medicine because of all the changes we’re seeing in areas like regulation, quality and reimbursement,” says Hamilton, a 38-year veteran in the radiology field. “A lot of hospitals and facilities have tried to reduce costs by cutting out education, and I think that’s the wrong message. Continuing education of your staff, no matter what level they are, is something they should always continue to do.”
Gunderman traces the decline in professional development and continuing education to the financial crisis that gripped the country around 2008. “The time is past where we should reconsider that,” he says. “One of the ways we can show a person that we care about the quality of work they do and help them grow in their job is to invest in their continuing education. That is really important if we are going to avoid stagnation and burn out.”
One institution that has truly taken the interests of employees to heart is UPMC. Upon becoming executive director of radiology at UPMC’s Presbyterian and Shadyside Hospitals, Salley replaced the top-down management system with one he called “communal management.” This meant creating committees with names such as “Patient Focus” and “Employee Focus” and giving each of them broad stakeholder representation, from nurses and receptionists to patient care techs and aides.
Members of the Patient Focus committee took full advantage of their newfound powers. They built upon patient comments from Press Ganey surveys, for example, to brainstorm ways to enhance the customer experience, and came up with a “What to Expect” brochure designed to relieve the anxieties that patients often feel prior to an imaging site visit. The four-page brochure—which explains in simple language every procedure performed by the department and even provides details on finding the facility and its parking garage—was sent to the offices of the top 20 referring physicians in each imaging modality. Companion poster board displays, the brainchild of a CT tech whose idea in the past had fallen on deaf ears, are also on display in hospital waiting rooms.
“It’s good for employees to see that their opinions truly matter,” says Salley, who says he learned the value of teamwork as an athlete while growing up. “For leaders, it’s about listening objectively to everyone and their ideas on how to fix things. At meetings I would say to people, ‘Ignore that I’m the executive director. At this table, every opinion has the same weight as mine.’”