In 1994, Rosabeth Moss Kanter coined the phrase “collaborative leadership” in Harvard Business Review to describe the leadership skills and attributes needed to successfully develop and manage interorganizational strategic alliances.1 The authors of a 2014 book, New Leadership for Today’s Health Care Professionals, also explored this concept, explaining that collaborative leadership requires a leader who can achieve success by motivating individuals in multiple organizations while bringing together and aligning the goals of many stakeholders.2
I think about collaborative leadership is critical during these uncertain times. It is incredibly important in radiology, especially in light of the current drive to increase quality and reduce cost. In today’s complex and ever-changing healthcare environment, collaborative alliances between physician groups and their hospital counterparts are essential. Successfully working together makes it easier for hospitals and private practices to stay afloat financially and fulfill reporting requirements related to quality metrics.
Here at Radiology Associates of South Florida (RASF), a large multi-specialty hospital-based radiology practice, we provide services to a large health system in South Florida comprised of six hospitals and 20+ imaging centers and urgent care centers. Ricardo C. Cury, MD, president and CEO of RASF, has been a leading force for helping practices transition from the traditional, fee-for-service model to one where success is measured in terms of high-quality patient care. One of Dr. Cury’s biggest goals in the last few years has been to strengthen the relationships between RASF’s radiologists and the health system as a whole, and that focus has made a huge impact on our practice. "Radiology will have increased value in the continuum of care, but radiologists will need to collaborate with other specialties and hospital administrators to develop and implement clinical pathways that will lead to the best imaging test offered to the right patient at the right time and read by a sub-specialty radiologist,” Cury says. “Radiologists also will need to prove the value of imaging by developing structure reporting with clear recommendations that will have an impact related to true quality metrics efficiency and cost.”
Collaborative Leadership In Action
One way that RASF has worked to find success through collaborative leadership is working cohesively with both hospital administrators and IT leadership to implement the new Centers for Medicare & Medicaid Access and CHIP Reauthorization Act (MACRA) quality measures. (We felt this was especially critical in radiology since the specialty is no longer viewed as a revenue center within the hospital.)
After a series of strategic sessions with our billing company, we selected six core measures that seemed the most relevant to our practice. We selected measures we knew we could successfully achieve while hoping to reduce the risk of pursuing goals at risk of being topped out in 2018. Since MACRA is budget neutral, practices are incentivized with having an opportunity to receive potential bonuses by being in compliance with the first six core measures as well as reporting three additional quality driven measures at the expense of others who do not comply with this new requirement and continue with claim-based billing. Once we agreed on all nine measures, we then presented at imaging leadership council meetings, speaking with leaders from across the system. We wanted to work closely with the leadership so that they could assist in driving communications and implementation of the required verbiage of these measures to their technical teams. RASF uses structured reporting, so templates both organizational and personal also had to be revised.
Our outpatient imaging billing is generated globally in partnership with the hospital’s outpatient division and constitutes a rather large percentage of our patient revenue. It was important to have a clear understanding of which measures we had agreed on and why, so we took the time to schedule numerous meetings with executive and operational employees to assure everyone was on the same page. We also presented this information to the hospital’s third-party CMS clearinghouse, because you always want to communicate with as many stakeholders as possible.
To properly report some of the quality measures we had chosen, we needed key information captured on the hospital side to populate into our reports. Working closely with IT leadership was essential for us to accomplish this, because we needed all of the system’s imaging equipment, our RIS, and our voice recognition solution to all be connected.
IT also spearheaded three additional core measures, which was a bit more challenging because they were already in the midst of a large and rather complicated execution of a new EMR across the entire system. However, after various discussions, they understood their part of this endeavor and how critical to the success for both the health system and our practice this would be. One of the selected Core Measures in particular—Measure #363: Optimizing Patient Exposure to Ionizing Radiation: Search for Prior Computed Tomography (CT) Imaging Studies Through a Secure, Authorized, Media-Free, Shared Archive—required the use of an image sharing software solution. The solution we had in place previously had been available to our referring physicians, but was underutilized. Therefore, we then needed to support both IT and the medical group leadership by educating the referring physicians of the availability of this improved solution. Following the philosophy and culture of inclusion that CMS is trying to impart on all without true collaborative leadership would have made this endeavor all but impossible to accomplish.
Of course, the work never stops when it comes to collaborative leadership. A current focus of our collaborative efforts is assisting our hospital partners with the implementation of clinical decision support. As these and other inter-organizational initiatives continue to require quality-based care models for the patient population we serve, we shall continue to work together to achieve save costs and earn incentives that benefit all parties.
The influence of the phrase Kanter coined in 1994 can be seen everywhere at RASF. Collaborative leadership has proven to be integral to RASF and the hospital to be in full compliance with MACRA. This helps our bottom lines, yes, but the most important impact is improving the quality of care we can deliver to our patients.
Barbara Perez Deppman is the executive director of Radiology Associates of South Florida in Miami.
Kanter RM. Collaborative advantage: Successful partnerships manage the relationship, not just the deal. Harvard Business Review. 1994.
Rubino LG, Esparza SJ, Chassiakos YS. Collaborative Leadership. In: New Leadership for Today’s Health Care Professional