A New Meaning to Teamwork
How radiologists can build high-functioning teams to improve job satisfaction, performance, and patient care.
To rate value to their practice and to their patients, radiologists traditionally highlighted their individual performance through relative value units (RVUs). They'd isolate themselves in reading rooms to focus on interpreting more images without interruptions.
But the game has changed. Increasing work volumes and 24/7 demands for care put pressure on radiologists to read more studies faster. That requires support and sub-specialization too complex for any radiologist to handle alone.
"The solo radiologist is almost extinct," wrote Lawrence A. Liebscher, MD, FACR, and Howard B. Fleishon, MD, MMM, FACR, in a JACR® opinion piece. Radiology is becoming less like an individual game of golf and more of a team sport like football, they posit, in which everyone "must perform their individual roles with skill and precision, but they all must act in unison to be successful."
The definitions and measurements of successful radiology teams are evolving. By understanding how to build teams equipped to tackle today's radiology demands, radiologists can tap into the power of teamwork to improve patient care and job satisfaction.
Pitfalls of High-Performing Teams
High-performing teams, or groups that are highly focused on metrics to spur results, were once the standard — not just in radiology, but across most industries. Leaders built high-performing teams to produce maximum output quickly and then relied on metrics such as turnaround times, financial success, and other key performance indicators.
The trouble with that approach is that it overemphasizes measurable output, encouraging radiologists to churn through images to hit quotas while undervaluing non-interpretive tasks such as participating on medical executive committees, interacting with referring physicians, and prioritizing patient- and family-centered care.
"The measurement of success for radiologists is the almighty RVU," says Liebscher, a diagnostic radiologist at Cedar Valley Medical Specialists in Waterloo, Iowa. "But if every member of the group just shuts their doors and reads film because they're focused on RVUs, you're not going to have a successful team. If you only reward productivity, you'll get people who can churn through a lot of images, but nobody to do the other value-added tasks that have to be done."
When productivity is the sole measure of radiology, important non-interpretive tasks may fall through the cracks, relationships between physicians may crumble, patient experience may suffer, and radiologists may burn out from processing high volumes in isolation.
"You have decreased job satisfaction because you're just working to meet a metric that was pushed upon you, like you're working on an assembly line," says C. Matthew Hawkins, MD, director of pediatric vascular interventional radiology and medical director of the telemedicine division and the vascular anomalies clinic at Children's Healthcare of Atlanta.
Because of the pressures of the job, paired with the tendency to work in isolation, burnout is more common among diagnostic radiologists than many other physicians, according to a 2016 report of the ACR Commission on Human Resources. (Learn more about burnout in the April BOC Chair Column). In a recent blog post analyzing potential causes and solutions for burnout, Hawkins suggested that the solution to burnout may be a different type of teamwork: a high-functioning team that doesn't just perform independently against objective metrics, but finds motivation in more subjective facets, like a sense of belonging and camaraderie, accountability, and mutual respect. For the sake of job satisfaction and its impact on patient care, Hawkins urged radiology leaders to promote high-functioning, self-motivated teams, "rather than menially manage them and monitor performance."
"A high-functioning team doesn't care what key performance metric the hospital sets; they're going to exceed those anyway," says Hawkins, who also serves as assistant professor in the department of radiology and imaging sciences at Emory University School of Medicine. "They're intrinsically motivated because they care about the greater good. They want to do a good job because they like their job. If you like you're job, you're much less likely to burn out."
Creating a Culture of Teamwork
"Building a high-functioning radiology team is not something you just do," Liebscher says. "It's an organizational culture that's developed over time. You've got to get away from the mindset that the 'work' is just interpreting exams, implying that you're not pulling your weight as a radiologist if you're in meeting while I'm reading film. Everyone has to recognize that all those different roles are important."
A team-oriented culture begins with support from senior leadership. Leaders set the tone by clearly communicating the shared vision and goals (the team's purpose), defining individual roles (each person's purpose), and emphasizing the importance of each part in the big picture. Effective teams understand how their performance impacts other departments and contributes to patient care.
"It really is a vast team of people who support a radiologist in reading an image," says Jay A. Harolds, MD, FACR, private practice radiology residency director at Advanced Radiology Services in Grand Rapids, Mich. "There are numerous individuals who support us directly day-to-day, including technologists, administrators, IT personnel, secretaries, clerks, and transporters. We're all working for the good of the patient, so everybody needs to feel empowered to speak up and contribute."
For teams to function cohesively, radiologists must understand their own strengths and appreciate what each member brings to the table — whether it's building relationships with referring physicians or handling insurance reimbursements.
Large academic practices are often structured with well-defined responsibilities, but smaller private practice groups aren't always so explicit. If nobody has the skillset or experience to participate in meetings with hospital executives, Liebscher says, "you've got five quarterbacks and no linemen. You need all these different components for the team to succeed."
Building a High-Functioning Team
While metrics are often imposed on high-performing teams, a key difference is that high-functioning teams are actively involved in setting their own goals. Hawkins asks his team to weigh in at annual retreats involving radiologists, technologists, nurses, physicians, practice managers, schedulers, and even hospital administrators. They discuss areas for improvement to establish goals for the upcoming year.
"Everybody feels like they have input in the direction of the department," Hawkins says. "When you actually involve people in the goal-setting process, there's truly a shared vision."
Advertising a meeting as being for decision-making when the CEO plans to simply get the team's rubber-stamp approval without input on executive decisions is demoralizing, says Harolds, also a professor on the volunteer faculty at Michigan State University who has lectured about facilitating effective meetings.
"For effective team meetings, make sure everybody participates, do not allow anyone to dominate the meeting, and call on people if they're not saying much," Harolds says. "For brainstorming meetings, ask people for their ideas and write them down. Do not allow any criticism at this point, since it may stifle creativity. Then take a break. By the time you come back, people have forgotten who suggested what idea, which is good, because it's important to focus on issues, not personalities. Then the team needs to group related ideas together and work on making them better."
When radiology teams focus on a shared mission of improving patient care, they can leave personal differences at the door and share diverging ideas openly.
"The team leader should start worrying when everybody always agrees on everything; what you really want on the team is diversity of backgrounds, experience, and knowledge so people have different ways of looking at things and different opinions," Harolds says. "Sometimes it's good to put out a contrary opinion that deliberately challenges the opinion on the floor just to get a discussion going. The purpose is for everybody to have input because the team's collective output is better than the smartest person on the team just getting his or her way."
Getting the whole team involved in goal-setting leads to buy-in and ownership, which Hawkins says intrinsically motivates people beyond metrics. It's not that metrics don't matter to high-functioning teams, it's just that creative problem-solving and continuous improvement are natural results of cohesive teamwork, and that sustains better performance than imposed goals and quotas.
"When you give your team ownership by asking what they want to do better, you empower them to improve performance," Hawkins says.
Taking a Team Approach to Better Care
High-performing teams may succeed short-term, but high-functioning teams sustain success because they're self-perpetuating.
"Your culture recruits for itself," Hawkins says. "You establish a reputation and become the place where people want to work. Everything about the team, from performance to hiring, continues to grow exponentially."
The end result is better care for patients. When a team pushes itself to continuously improve in pursuit of a shared mission, patients get the benefit of the whole team's collective experience, knowledge, and support. In an increasingly complex health care landscape, patients need the coordinated, collaborative approach of high-functioning radiology team that's committed to better care, not simply driven by RVUs.
"We have the responsibility as physicians to practice as patient advocates and create environments that support the highest level of care we can provide," says Fleishon, chief of service for the radiology department at Emory Johns Creek Hospital and division director of community radiology services at Emory University's department of radiology and imaging services. "With radiology groups, that translates into sharing responsibilities so that our medical imaging services measure up to our expectations and those of our patients."
By Brooke N. Bates, freelance writer for the ACR Bulletin