The Power of Partnership: What Does that Mean in Radiology?

What does the “power of partnership” mean to you in the medical imaging field? It’s the theme of the upcoming RSNA 2013 conference, so we asked radiology thought leaders for their views on what partnership looks like in today’s changing medical world. Here are their responses in their own words.

James A. Deye, PhD[[{"type":"media","view_mode":"media_crop","fid":"21170","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_3289149600769","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1419","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 5px;","title":"James A. Deye, PhD","typeof":"foaf:Image"}}]]
Program Director, National Cancer Institute, Division of Cancer Treatment and Diagnosis, Radiation Research Program

When asked to talk at the RSNA about imaging and “partnership” I immediately thought of partnership in the context of both physics and quantitative medicine.

Why? Because, as a physicist myself, I have become convinced that the current push for precision medicine, including activities at the NCI and NIH, will only have a chance of success at the bedside if the biomedical community utilizes the essential elements of the physical sciences which involve both the development of novel concepts and technologies driven by cutting edge physics, coupled with rigorous analysis of uncertainties and validation of methods.

And I am not alone in this belief since there are now a number of NIH-funded initiatives which support such partnerships: eg. the Quantitative Imaging Network and Academic Industry Partnerships , to name just two. I also feel that RSNA provides a perfect venue for proselytizing this view to the widest radiological audience given the number and breadth of attendees and given that RSNA has been a leader in promoting quantitative methods within radiology through the likes of its QIBA program.

Ajay Wadgaonkar, MD[[{"type":"media","view_mode":"media_crop","fid":"21171","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9436261212099","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1420","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 280px; width: 200px; margin: 5px; float: right;","title":"Ajay Wadgaonkar, MD","typeof":"foaf:Image"}}]]
House Officer, Department of Radiology, Johns Hopkins Hospital

Optimizing physician- to-physician and physician-to-patient partnership has never been more critical to the field of radiology. With our project [that he’ll speak about at RSNA], we wanted to outline the essential steps for creating and maintaining an online radiology department alumni portal.

Such a portal offers tremendous educational, mentorship, professional, and social opportunities for its members and the department as a whole. It also engenders improved collaboration and communication with alumni who may have lost touch with department activities. In today's increasingly demanding healthcare environment, the importance of continued relationships and physician partnerships cannot be underestimated.

Jim Lipcamon, Manager of Outpatient Imaging Services
East Cooper Medical Center, Charleston, SC

The ability to provide welcoming, assuring and compassionate care in the imaging industry takes a collaborative effort from a team of individuals who see themselves as equals and focus on one thing, the patient.  

Success evolves from a partnership of physicians, technologists, administrators, support staff and vendors who are passionate about what they do and are focused on the five pillars:  service, quality, people, finance and growth. 

The power of partnership also requires the ability of those involved to listen and work together. One of us is not as smart as all of us! Processes are formed to do things better than in the past, in a smarter and more effective way.

I believe Winston Churchill said it best: "If we are all together, nothing is impossible. If we are all divided, all will fail."

Lawrence R. Muroff, M.D, FACR[[{"type":"media","view_mode":"media_crop","fid":"12346","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_9808860450100","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"478","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 294px; width: 225px; margin: 5px; float: right;","title":"Lawrence R. Muroff, MD, FACR","typeof":"foaf:Image"}}]]
CEO and President of Imaging Consultant Inc. in Tampa, Fla.

The future for radiology is bright; the future for radiologists is far less certain.

Radiologists have fared very well the past few decades by practicing independently. We have embraced technologic change, but have always done so from the perspective of “this is what we can do for you.” The “you” might have been a patient, although most often it was the referring physician.

Compensation was independent of outcomes, and the more one did, the more one got paid. Under a fee-for-service reimbursement system, this modus operandi worked well. Such a volume-based healthcare system is no longer sustainable as the only (or even the main) way to compensate physicians for services rendered.

In the new healthcare dynamic, radiologists will have to be partners in a team approach to the care of entire populations. There will need to be a change from “this is what we can do,” to “what is it that the patient needs?”

Fully integrated teams of physicians, hospitals, and other providers will care for patients from cradle to grave. Payment will shift from a system that reimburses independently of outcomes to a fully at-risk system (presumably some form of capitation) that rewards for successful outcomes. If radiologists are to remain relevant, they will have to show value, and value will be defined as outcomes/cost. 

This new paradigm, labeled by the ACR as Radiology 3.0, stresses the need to shift from “output to outcomes” and from “volume to value.” In essence, if we are to survive as specialists, we will have to demonstrate significance.

In order to do that we must function as integrated partners in the new patient-centric healthcare enterprise.

Richard Gunderman, MD, PhD[[{"type":"media","view_mode":"media_crop","fid":"12327","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_8801483556762","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"462","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 286px; width: 250px; margin: 5px; float: right;","title":"Richard Gunderman, MD, PhD","typeof":"foaf:Image"}}]]
Vice Chair of Radiology, Indiana University

Anyone who doubts the power of partnership should compare the very different biographies of Microsoft Encarta and Wikipedia. 

In the 1990s, Microsoft, one of the wealthiest companies in the world, sought to develop and market a digital encyclopedia as a business proposition. Access would require purchase or subscription, and it would also generate revenue through advertisements. The company poured a great deal of time and money into the project, eventually accumulating more than 60,000 articles. 

By contrast, Wikipedia, born in 2001, was produced not by paid writers and editors, but by volunteers, and allowed anyone to write and edit articles. 

Today Encarta is dead, while Wikipedia contains nearly 4,400,000 articles and represents the fifth most visited website in the world. Its content is available free to anyone with a connection to the internet - a testament to the power of millions of people all over the world, most of whom have never met one another, but whose energetic partnership in the advancement of knowledge has produced an educational resource for the ages.

The case of Wikipedia reminds radiologists that true security does not lie in hoarding or controlling information for short-term profit, but in the willingness to collaborate with diverse groups to advance long-term knowledge.  

James Thrall, MD[[{"type":"media","view_mode":"media_crop","fid":"12335","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_1680914460119","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"469","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 267px; width: 250px; margin: 5px; float: right;","title":"James Thrall, MD","typeof":"foaf:Image"}}]]
Chairman Emeritus, Department of Radiology, Mass General Hospital
Distinguished Taveras Professor of Radiology, Harvard Medical School  

The term “partnership” has become popular, even ubiquitous, in the business world over the last two or three decades.

Somewhere along the line the term “customer” was lost - customers were no longer customers, they became “partners.” In this contemporary usage, the term has lost important meaning and impact - exchanging money for goods and services establishes a business relationship but does not constitute a true partnership.

Rather, I believe the term “partner” or “partnership” should be reserved for situations where both parties contribute to a common purpose with the goal of creating shared value, such as advancing a research agenda or validating and improving a clinical application.

The most powerful partnerships are those where each side has unique capabilities to contribute, there is mutual respect and there is a fair balance in sharing the value created.

M. Elizabeth Oates, MD[[{"type":"media","view_mode":"media_crop","fid":"12343","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_1011618412395","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"476","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 253px; width: 250px; margin: 5px; float: right;","title":"M. Elizabeth Oates, MD","typeof":"foaf:Image"}}]]
Professor and Chair, Department of Radiology
University of Kentucky

Partnership takes many forms. Likewise, leadership takes many forms. Partnership and leadership intersect strategically and practically in many ways. 

Dyads, triads, and so on have become popular in healthcare administration - teams of physicians, nurses and administrators focused on specific problems. These complementary interdisciplinary working relationships create dynamic groups that accelerate progress in support of our clinical, educational and/or research missions. 

Working closely with one or more thoughtful, committed individuals tends to be more professionally satisfying than working in isolation. It is rewarding to brainstorm ideas, develop problem-solving solutions, and implement new workflows with others who share common goals. As the saying goes, the whole is a lot more than the sum of its parts.

Julie Gill, PhD, RT(R)(QM)[[{"type":"media","view_mode":"media_crop","fid":"21172","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_4135319214287","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1421","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"margin: 5px; height: 315px; width: 225px; float: right;","title":"Julie Gill, PhD, RT(R)(QM)","typeof":"foaf:Image"}}]]
President, American Society of Radiologic Technologists

The American Society of Radiologic Technologists has a long-standing history of collaborating with radiologic technology organizations to spearhead initiatives to improve patient care and strengthen the profession. These partnerships have resulted in some amazing programs that have had a positive effect throughout the entire radiologic technology community.

A great example is the Image Gently campaign. As a member of the Alliance for Radiation Safety in Pediatric Imaging, we’ve developed programs that are increasing awareness about the opportunities to promote radiation protection in the imaging of children.

In addition, we have solid ties with the organizations that accredit healthcare facilities and educational programs, and we’ve developed relationships with federal and state legislators. These partnerships have helped us stay current with trends in professional practice, education and health policy, and established our place at the table to participate in important discussions about issues that affect patient care and the radiologic technology profession.

Our partnerships are crucial to our members and affiliates as well. ASRT members represent all of the radiologic technology disciplines and specialty areas, so they look to us to develop customized educational materials to help them stay up-to-date on medical imaging and radiation therapy trends. In addition, we rely on affiliates to keep us informed about frontline issues affecting their practice, and they rely on us to provide them with the support they need to succeed in their states. Our ongoing collaborations with vendors, equipment manufactures and other radiologic technology organizations helps us develop the tools and services our members need to succeed in the workplace.

On a personal note, relationships are critical to me as an educator. The people I work with - such as our clinical affiliates and agencies - allow us to offer students high-quality education with hands-on clinical experiences. This ultimately benefits patients because the students we’re educating are competent and prepared to provide top-notch care when they enter the workforce.

[[{"type":"media","view_mode":"media_crop","fid":"21173","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_553894271158","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"1422","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 313px; width: 250px; margin: 5px; float: right;","title":"Cynthia Sherry, MD","typeof":"foaf:Image"}}]]

Cynthia Sherry, MD
Chair, Department of Radiology
Texas Health Presbyterian Dallas

The most powerful partnerships enable us to do more and to be more together than we are individually. 

Radiologists are engaged in a wide variety of different partnerships every day. To name a few, we are in partnership with our hospitals, where we should try to align our incentives and goals so we can both be successful; we are in partnership with our referring staff, and should collaborate to provide the best possible care for our patients; we are also in partnership with all the other professionals across our specialty, and together we have brought amazing, lifesaving imaging technologies and procedures to American healthcare that have advanced our specialty to the center of the modern healthcare team. 

It is crucial for us to constantly nurture all these different partnerships so they can flourish and become all they can be. Today, with all the uncertainties of the Affordable Care Act and the impending shift from volume to value, the synergy resulting from strong partnerships is key. 

Saurabh Jha, MD, MRCS, MS[[{"type":"media","view_mode":"media_crop","fid":"12328","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_2029136385314","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"463","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right; margin: 5px;","title":"Saurabh Jha, MD, MRCS, MS","typeof":"foaf:Image"}}]]
Assistant Professor of Radiology and Cardiovascular Imaging
Hospital of the University of Pennsylvania

Radiologists find themselves juxtaposed between multiple sets of stakeholders, whose goals are sometimes, not always, in opposition. These include referring clinician and patients, patients and anxiety-provoking media, technology and payers, payers and policy makers and policy makers and clinicians. Being in the middle can place considerable strain on the radiologist, but seen differently, it is an unprecedented opportunity for value and empowerment of the profession.

Perhaps the most important partnership radiologists need to rekindle is between imaging interpretation and clinical context. Radiologists can no longer afford - and I use afford in the very literal sense - to read in a vacuum. There is nothing terribly innovative about this partnership.

Like Galen's division of the circulatory system, this piece of orthodoxy has no immediate mortality. It's the essence of being a physician. We stray from it at our peril.