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The Stories We Tell

Change doesn’t just come from mandates on high.



June 2015

Quality improvement and value are hot topics these days. Radiologists are seeking to ensure that they remain viable participants at the health care table.

Value has even become ingrained in our training — the ACGME requires that diagnostic radiology residents participate in quality improvement programs. But these requirements don’t ensure that your residents will pursue value-oriented programs and policies after they’ve finished the required certification components. Nor does it ensure that your colleagues will pursue them in their practices. Although the imaging world has begun to transition to value, we still live in a relatively volume-based system. And with constant demands on a radiologist’s time, it’s easy for quality-improvement projects to be overlooked. To create a quality-driven department, you need to change your culture.

Changing the culture of a practice is easier said than done; you can’t trade in the culture of your practice like a used car. Cultures are complex systems with many interrelated parts, and changing the status quo is not easy.

So how do you chip away at a system that has probably been in place for years? You change the stories you tell.

What do I mean by stories? Stories communicate the less obvious assumptions and implications made from the actions you and your department live by. What our department did last week, problems we may have encountered, and issues that we’ve solved — those are our stories. They’re not the rules or training packages you get during your orientation. For example, when something is done really well in our department — a good patient experience or an award — we have cake. That’s our story. We are a practice that celebrates our successes.

Here’s another example. When I first became head of my department, I didn’t make any drastic changes. I did, however, change the agenda of our staff meetings so the first items discussed were awards, publications, or presentations that members had given. We are an academic radiology department. Our academic accomplishments came first because that is the story we wanted to tell. This emphasis on sharing achievements pushed some of our members to tell us about successes they had otherwise been silent about.

To begin changing your stories, start with yourself. Consider your practice culture and the stories you and your colleagues tell. How do you react to situations? What things do you discuss with your colleagues? What do you prioritize? Then consider the stories you want people to tell. Do you want to be more patient-centered? How do you discuss patients in your practice? Do you talk about the experiences your patients have — good and bad? How do you respond to these experiences? If you’re silent on the matter, people will assume that patient experience not valuable. It’s not a priority because it’s never on the agenda, never discussed. But if you discuss improving patient experience improvement often, celebrate your successes and address the concerns, then everyone in the practice will understand that it’s a priority for you as a leader. And it becomes their priority too.

Our stories make up who we are. They communicate to others our goals, our priorities, and what we look for in the future. By telling our stories and listening to the stories of others, we position ourselves to adapt and grow during a time of constant change.

By James V. Rawson, MD, FACR, Chair of radiology at Georgia Regents Health System, and Meghan Edwards, copywriter for the Bulletin

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