Applied Radiology

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. ^1-4

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.

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 implementation processes.

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 areas.

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." ⁴

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 the team.

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? etc.

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.

Transition timelines

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 continuous.

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 vendor.

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 presentation.

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 established.

Conclusion

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 team.

2) Using team brainstorming, determine an initial set of major areas of consideration that are required, in sequence, for the technology introduction.

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 area.

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 basis. AR