Lessons in Fostering Change
When balancing the viewpoints of diverse stakeholders, what lessons can we learn to foster change?
Being a steward of imaging and assisting referring physicians with imaging appropriateness are essential to demonstrate our value as radiologists. Referring physicians are accustomed to getting any imaging studies they request. Radiologist efforts at reducing inappropriate imaging studies may increase referring provider dissatisfaction. Radiology Support, Communication and Alignment Network (R-SCAN) was created to empower radiologists to engage with referring physicians to improve appropriateness of imaging.
A successful R-SCAN project requires collaboration, and that comes in the form of intersecting goals and an aligned commitment from our clinical colleagues. In practice, how do we achieve that? When faced with the task of fomenting an embrace for change, I have always recalled a lesson from the book 7 Habits of Highly Effective People by Stephen Covey: seek first to understand. The ability to create positive influence with others requires listening with first the intent to understand, not with the intent to reply.
Our first goal when leading our R-SCAN project on lumbar spine MRI appropriateness was not to achieve what seemed most beneficial from the radiologists' perspective. Rather, most vital was understanding the problem from the perspective of the referring physicians. When we initially reached out to our institution's head of outpatient clinics to initiate the R-SCAN project, his elaboration of the referring providers' circumstances ultimately allowed us to frame a solution that would also better address their needs.
Specifically, there was growing patient dissatisfaction of the long wait times from the backlog of scheduled MRIs at the imaging facilities. From what we suspected, a substantial number of inappropriate lumbar spine MRI referrals was contributing to this backlog. The prospect of greater throughput and shorter waiting times from the referring providers' viewpoint and the improved appropriateness from our viewpoint provided an intersecting goal to strive for. Most importantly, to our referring physicians it conveyed the perception of our sincere intent to act as helpful consultants, rather than one that may be construed as self-serving or paternalistic. For example, I believe our willingness to travel in-person to the clinics to present our educational materials served as an overture to our sincere motivation to act as helpful consultants. Moreover, our educational presentation and materials were deliberately designed to be simple, straightforward, and cogent. They were not designed to add another layer of complexity to referring physicians' already busy schedules.
When performing a follow-up clinic visit late last year, we were happy to witness the strong reception and the many clarifying questions referring providers had on imaging appropriateness. It also provided us an opportunity to better understand what components in an imaging report are most useful and actionable to a primary care clinician (e.g. candidate for neurosurgery or neurointerventional radiology). The relationship between radiologists and referring providers was certainly more collegial following this collaboration. This experience has allowed me to conclude that if we truly wish to convey our value as radiologists, we cannot tackle such challenges alone. Collaboration is essential and I don't believe we can successfully demonstrate value as radiologists using a unilateral approach.