Often, the introduction of new technology occurs with the recognition of an opportunity to provide better service and increase profits. But for a major technology change, such a transition can involve much of the staff and, perhaps, drastically change the business of radiology. This article, the latest in a series on strategic plans for technology implementation, outlines strategies useful for such transitions.
Dr. Schilling is a General Partner with Mi3 Venture Capital
and President of RBS Consulting Group. Dr. Staab is Acting
Radiology Branch Chief in the Diagnostic Imaging Program at the
National Cancer Institute in Rockville, MD. They are both also
members of the editorial advisory board of this journal.
Often the introduction of new technology into an existing
radiology service happens with the recognition of the opportunity
to provide better service and increase profits. Occasionally, this
is prompted by outside influences from clinicians or
administrators. If the new technology is mature or relatively
focused, as is the case with most modalities, then few individuals
are involved and the introduction is straightforward. But what
happens when the new technology is not as mature, involves much of
the staff in the department, or perhaps changes the way the
business of radiology is done?
There are several examples that have taken place in recent
years. Radiologists have experienced such major changes with the
introduction of a picture archiving and communications system
(PACS) or a radiology information system. Both of these have
far-reaching implications for radiology department staff as well as
those that the department serves. The merger of hospitals and
service entities is another example. To a lesser extent, but still
important to a number of constituents, is the introduction of a
voice recognition system or the development of a telecommunication
service to remote service areas.
This article will outline the strategies often employed, either
implicitly or by thoughtful planning of each step, for such
transitions. The less carefully planned process usually leads to
several false starts. It is likely that the full benefit of a
complex new technology will not be realized for years, if ever,
without careful planning. A series of tools to help with the
strategic plans for implementation of a new complex technology has
been published as a series in this journal.
The final step of introducing a new technology involves a
careful consideration of transition timelines. This is
euphemistically described as the "80-mile up" view of the entire
process. But before that view, let's look one more time at the
process of strategic thinking.
Thinking and planning are everyday activities. The sequence in
which we complete our thinking and planning steps is an important
factor in achieving maximum effectiveness. Ideally, we should
devote an adequate amount of time to thinking about all sides of a
particular problem, before progressing too far with planning or
implementing a solution. Many of us learn this lesson the hard way.
We sometimes forge ahead with elaborate plans, before focusing
enough attention on our ultimate goal. We have to go back to the
beginning to rethink our options, before resuming the planning and
Strategic thinking tools (or frameworks) can be used to aid the
process of strategic thinking. One of the most attractive
attributes of such tools is that they can be understood and applied
by radiologists without any formal business training. The broad
acceptance of these tools comes from the fact that they are easy to
learn and highly effective. Essentially, this is because the tools
communicate at a fundamental level between people. For example, in
a regional healthcare community with people of diverse backgrounds,
these tools enable everyone to cross boundaries and relate
effectively at a common, fundamental level.
A specific tool known as the "Growth Development Curve" (GDC)
will be used to present the "transition strategies for the
radiology team." The GDC is a tool or framework for thinking about
how the activities of an organization or department change as a
function of time. In a well-run organization or department, all
members of the team require the same understanding of progress
versus time, and where the focus of the entity is at any point of
time. In this manner, all parts of the team can work in
synchronization and the synergy between elements of the
organization or department can be optimized.
The framework for the GDC is simply a series of curves as shown
in figure 1. Each curve represents a different area of focus. It is
evident that the areas of focus occur in sequence and may contain a
certain amount of overlap. This is a very important aspect of the
GDC. The team must determine what the areas of focus are, and the
order, start time, (and completion time) for each of these
A well-managed team will review the GDC several times a year.
The head of each department should be represented at a team
meeting, all seated around a table. When the dialogue becomes
focused on the prioritization of resources required to complete
each area of focus and the interaction of items between areas of
focus, the result is a set of activities that fit together, and are
the most important areas of activity for the team. The activity
list by department can be managed using the "Sheet of Music."
Benefits from using tools
There are a number of benefits of using Strategic Thinking
tools; in a given application, some of the benefits are more
significant than others. However, it is important to review all of
the benefits to make sure that the users are getting the most
utilization that they can for any given application. The benefits
described below are characterized in terms of the GDC tool.
1. Developing a common framework for solving problems--The GDC
provides a framework in the form of a series of curves, with each
curve representing a different phase or area of focus for the team.
For example, in figure 1, "A. Understand business" is followed by
"B. Technical process," etc. The time relationship between the
phases is key to deployment of resources.
2. Identifying a common language for addressing problems--The
language consists of "Understand business," "Technical process,"
etc. The tool addresses a specific type of problem where transition
timelines are key to the solution. Whenever a similar problem needs
a solution, the team can revert back to the GDC tool for
implementing the solution.
3. Thinking with simultaneous focus and flexibility--Focus is
derived by having a framework. However, in establishing the content
(e.g., elements of the GDC) there is flexibility for individual
input as team consensus is developed.
4. Stimulating creativity in problem resolution--The creative
process is derived from having a team brainstorm the content within
the framework. The order of areas of focus, the percent completion
selected for each area of focus, etc. is up to the creativity of
5. Communicating by asking the right questions to find the right
answers--The questions raised by the GDC tool are: What are the
phases or areas of focus? What is the time relationship between the
phases? How do we measure the percent completion for each phase?
6. Promoting teamwork in problem solving--Teamwork is
established as the process moves from individual input to consensus
of the final result. All of the benefits of using tools are
enhanced by the use of teams wherever possible.
7. Establishing team confidence in the problem solving
approach--Confidence is achieved as the consensus process is
carried out. The utilization of a framework is essential to
organize individual input into a consensus.
8. Building a foundation for future problem solving--As
situations change (e.g., modifications or time) an update of the
GDC becomes appropriate. The foundation established in creating the
initial GDC makes this an efficient and effective process.
9. Providing outlines for planning--Strategic thinking with the
use of tools promotes "doing the right things." Planning, the
process of "doing things right" follows. The phases or areas of
focus represent "doing the right things." The details of how each
phase is carried out represents "doing things right."
10. Focus on customer satisfaction--A meaningful team activity
should always focus on the customer. The customer can be thought of
as someone receiving a service or as management receiving results.
The development and execution of the GDC ensures that customer
satisfaction is brought to fruition.
The GDC helps us focus on the issues that need to be addressed
to determine the transition timelines.
Figure 1 lists five major areas that must be considered in
sequence to introduce a major new technology successfully. Several
of the more important subtopics that must be addressed within these
major timelines are discussed below.
Understand the business--Under the topic "Understanding the
business," it is important to:
1. Identify the leader or champion of the new technology. This
may be a team.
2. Evaluate and quantify the current operations.
3. Set functional goals for the system or technology.
4. Recognize the amount of effort needed to communicate the
changes that will take place in the environment.
5. Identify all individuals affected by the new system and to
what extent they will be affected.
6. Establish cross-disciplinary needs and opportunities.
7. Establish an organizational structure.
Technical process--The second curve illustrates that soon after
you begin the process of really understanding the business and
setting the framework for success, you must begin to look at the
technical issues. Notice that each of these curves overlap and are
Under this topic we suggest that you determine what is available
in the market place today and to what extent that will meet your
needs. Depending on the complexity of the technology, it may be
useful to use outside consultants to assist with the evaluation and
education of the internal group. It will be necessary to include
all-important stakeholders early in this evaluation process so they
can understand why you have decided on a particular technology or
You will also need to plan the transition by asking the usual
questions: who will be affected, how will the technology impact
their work, and when will this take place. Two other questions that
may be appropriate is where will the transition take place and when
will it occur. It is possible that the transition will be in
multiple phases, as we have learned from the introduction of PACS
into a film environment.
Purchase process--The purchase plan will begin once the
acquisition appears to be a serious request. Frequently, this will
include the development of a request for proposal. Although not
always necessary, the process of developing such a request will
raise questions not otherwise considered. The business plan will
include the identification of capital and consideration of lease
versus purchase options. There are numerous issues that must be
considered at this stage, which are beyond the scope of this
During these stages, site visits and vendor presentations will
usually take place. One technique that helps with comparing vendors
is to invite them all to present their products and system on the
same day. We have convened a stakeholder group at an offsite
meeting and listened to each vendor, usually at hourly intervals
with time added for questions. This allows the group to formulate
many questions and understand the nuances of the differences
between vendors more clearly.
Installation--Assuming a decision is made and that the purchase
goes forward, the next phase is the installation. This is when the
work really begins. A formal plan for implementation of the
technology should be established. It will be necessary to consider
the staging of the installation, the delivery and storage of the
equipment, the validation and acceptance of the technology, and,
finally, the monitoring of the system for reliability. A training
program that is simple, available, and repeatable will need to be
established. The need for celebration at intervals from "kickoff"
to completion of major steps should be planned.
Monitor and revisit--The various parameters that will be used to
monitor the effect of the new system should have been considered.
Usually, these are identified in the first phases of this process.
If the results are not what had been anticipated, then further
evaluation should ascertain what might be done to increase the
effectiveness of the system. Methods to solve small problems, such
as help desks and trained service technicians, will have to be
We suggest the following steps to create the GDC and initiate a
well thought out plan of action:
1) For the technology introduction under consideration, identify
the people or groups who will make up the transition strategy
2) Using team brainstorming, determine an initial set of major
areas of consideration that are required, in sequence, for the
3) For each of these major areas, assign a leader to investigate
the necessary requirements to complete the designated area.
4) Using team brainstorming, review the results of step 3 and
determine if modifications to step 2 are required. Establish
consistency between steps 2 and 3, resulting in completion of
figure 1--including percent completion and timing for each major
5) With the results of step 4 as a roadmap for the technology
introduction, the transition strategy team can now prioritize
activities leading to a plan of action.
6) The action plan, including all of the base assumptions
leading up to it, should be monitored and reviewed on a periodic