How to Transform Radiology Group Culture to Embrace Change

The industry is facing a call to arms for radiologists to prepare themselves for the changes that are coming. What we have seen so far is just the beginning, and we are now entering a different phase in the process of change. We must adapt to the changes already present and prepare for those still to come.

In this series of columns, we will be describing specifics on how to transform a radiology group to create and drive a new culture of activism.

We look forward to your comments.

In our first part, we explored some of the issues facing radiologists and the importance of a strong culture binding a radiology group.

Here we will describe how a new, energetic culture is the most valuable change-agent to ensure success now, and the future.Culture trumps strategy - each and every time.

In short, culture is the heart and mind of the organization. Regardless of the time, effort and energy put into developing a new strategy, without readying the culture to accept and embrace the new strategy, there will be no buy-in. So, how do we, in essence, change the culture to maximize desired performance behavior?

We have developed a transformational model for evaluating and integrating cultural dynamics in order to use culture as a change-agent for both tactical and strategic policy initiatives. Our model breaks the critical components of cultural changes into four elements - AICI:

• Awareness
• Involvement
• Commitment
• Incentives

Awareness is defined as a comprehensive understanding of the needs and requirements of the organization. All members of the organization - all stakeholders, not just the leaders and managers - need to be "read in" to the issues. If revenues need to expand to remain viable as a business unit, this fact needs to be communicated to all members of the group, not just a select few. If costs have to be reduced, the same process applies. The culture of AICI requires collaboration and consensus, not command and control.

Involvement is defined as engagement in the issues, challenges, problems and/or opportunities that face or will face the new organization. This means involves empowering each member of the organization. If someone sees something happen that requires action, they take it upon themselves to generate that action, either individually or collectively, with the help of others to fix the problem, or recommend a solution.

As Brad Hewitt, President and CEO of Thrivent Financial stated, “Both individual and community (in this case company) responsibility is required in a civil society. This is not an ‘either/or’ proposition.” In essence, everything is up to everyone at every level. There is no they; we are all collectively responsible for the outcomes either positive or negative.

Commitment indicates and requires each individual member of the new organization be on board and proactive with respect to their responsibilities and requirements within the organization. All successful organizations develop a must-win attitude amongst its individual members. It is a prerequisite for success not only for the merger and the cultural changes; it is an absolute requirement for the success of the new organization.

The order of the day is lead no matter what your level or position. Do not follow when leadership is required. Initiate rather than respond. Be part of the solution, rather than part of the problem. This kind of commitment requires a proactive culture that emphasizes and reinforces performance over politics, and results over good intentions.

Incentives are a just reward when goals are reached. Whether we are seeking major change on a large scale, or alternatives at the margin, there need to be incentives - both tangible and intangible - at the end of the long, hard road. Without incentives, good actions and good intentions will falter and, in the end, fail. All members of the group must be made to understand not only their roles and obligations within the new organization but also that they will reap their just benefits from the changes they are helping to enact.

And they need to know what those benefits are. Specific roadmaps with attainable goals need to be established. Everyone needs to know where they are on the roadmap and when, without favoritism, incentives for reaching those goals can be expected. Properly aligned goals and incentives ensure each member can participate not only in the hard work of creating and running a successful business, but they will also share in the returns derived from their efforts.

Change. But how?

Whether we like it or not, change has been thrust upon us. The question is not whether to respond, but how to respond. As we react and develop our response, two things should be kept in mind: First, as Hemingway said, “Never confuse movement with action.”

Second, when an astronaut was asked what he would you do if he had only 10 seconds of oxygen left, the astronaut replied, “I'd think for nine seconds and then act.” It is not the rapidity of our response that will determine our future, but the stability. When we have a lot of at risk, the surest way forward is most frequently found by slowing down, understanding the issues and problems and then laying the proper groundwork for success. If yours is the group that keeps its head amongst the turmoil surrounding health care, your group will likely survive and thrive in the new paradigm.

In the accompanying articles that will follow, we will explore the process for this groundwork and the keys to success.

Additional reading:

Radiology Mergers and Acquisitions: Remain Independent or Join Together?The Radiologists’ Primer: Partnerships, Mergers & Acquisitions
Diagnostic Radiology and Oncology Services: Mergers and Acquisitions 
DeepWell Archival Services: Mergers and Acquisitions in Radiology
Radiology Business Journal: Historical Review of Mergers and Acquisitions in Diagnostic Imaging [PDF]
Adkins, B. and Caldwell, D. (2004). "Firms or subgroup culture: Where does fitting in matter most?" Journal of Organizational Behavior, 25(8) pp. 969-978
Hofstede, Geert (1980) Culture's Consequences: International Differences in Work Related Values, Beverly Hills, CA, Sage Publications, reprinted 1984
Hofstede, Geert; Hofstede, Gert Jan (2005). Cultures and organizations: software of the mind(Revised and expanded 2nd ed.). New York: McGraw-Hill. ISBN 978-0-07-143959-6. OCLC 57069196.