President’s Address on Leading Through Change: Agility, Resilience Will Ensure Success in Radiology

RSNA 2023 kicked off Sunday with the exhibit hall opening and numerous presentations and sessions. The president’s address and opening session in the Arie Crown Theater addressed the topic on everyone’s mind, captured in this year’s theme, “Leading through Change.” As the specialty faces rapidly accelerating changes in care delivery systems, payment models, patient and referrer expectations, an unstable labor market, competition, and technology applications, “radiology’s leadership in driving healthcare innovation becomes increasingly important” in response, said president of the RSNA Board of Directors Matthew A. Mauro, MD, FACR, FSIR, FAHA, interventional radiologist, president of the UNC Faculty Physicians, and senior physician executive of the UNC Health Care System Revenue Cycle.

In his address, Dr Mauro discussed the meeting’s theme of change in light of various market factors and the need to innovate to stay competitive.

“As leaders, success and managing change requires us to be cognizant, intentional, and proactive in leading our teams, departments, and organizations,” he told attendees.

In response to both the specialty and individual work environments evolving amid changing conditions, Dr Mauro referenced various frameworks and models from which to draw support. This included the six forces model that impacts businesses, designating competitors, complementors, customers (patients), suppliers, innovation, and potential competitors as the primary forces to consider in maintaining agility. He also discussed the significance of the strategic inflection point wherein the balances of forces make a major shift to new ways of competing and succeeding. A “10X force” transitions a medical practice from one state to another until a new equilibrium is achieved, which radiology practices must embrace for a sustained competitive advantage, he said.

“…A 10X force began impacting our [interventional radiology (IR)] practice and we reached our strategic inflection point. The 10X force was the power of future competitors such as cardiologists, vascular surgeons, and interventional nephrologists,” Dr Mauro said. “In a relatively short period of time, our primary referrers became our competitors.”

While it took nearly a decade for changes to fully materialize, IR leadership recognized that training programs were insufficient in preparing physicians for this shift in the expanding market of image-guided intervention. The inflection point ultimately resulted in “creation of the current dual IR/DR curriculum and certificate as well as the elevation of IR to specialty status,” explained Dr Mauro, noting an increased focus in IR training on both the technical component and patient management skills required for success.

Continued changes in the peripheral endovascular market, pressure to enter the neuroimaging arena, and advancement of point of service ultrasound through different clinical areas are also impacting the field as potential inflection points.

“I see more competitors on their rise as image-guided minimally invasive care becomes more important in the management of disease processes,” Dr Mauro said. “As the competition grows in all our subspecialities, are we willing to step up…to protect our areas of expertise? If the answer is ‘yes,’ then we’ve reached our strategic inflection point.”

To demonstrate value, radiologists must continue to adapt and evolve. This will be done most effectively with a strategic vision and plan since uncertainty, confusion, and hesitancy often accompany change. Leading through it begins with the focused intentions of a strong, cohesive leadership team that trickle down through the entire organization, Dr Mauro said, noting the five critical elements of building trust, mastering conflict, achieving commitment, embracing accountability, and focusing on results.

“People need to weigh in in order to buy in,” he reminded attendees of the commitment, emphasizing the importance of communicating through the transformation.

As leaders establish their vision, communicate it, empower others, celebrate short-term wins, and institutionalize new approaches, they should rely on organizations like RSNA to provide the networking, support, education, and resources to guide periods of transition, particularly technological change.

“Our imaging techniques are powerful and becoming more powerful with every advance.  There is no doubt the future of imaging and image-guided interventions and what we can do for our patients is bright,” Dr Mauro concluded, noting that artificial intelligence (AI) is the specialty’s 10X force right now.

“It’s up to us to adapt and embrace it, or be left behind,” he said.

Howard Chrisman, MD, MBA, president and CEO of Northwestern Memorial Healthcare, and professor of radiology and surgery at Northwestern University’s Feinberg School of Medicine in Chicago followed with his presentation, “History Never Repeats Itself, But It Does Often Rhyme.” He likewise highlighted the growing use of AI in radiology, emphasizing that it should not be feared but rather embraced. Encouragement can be found in the “rhyming nature” of what the specialty has achieved over time through periods of discovery and controversy.

“’History never repeats itself, but it does often rhyme.’ I interpret this to mean…there are historic parallels: in our own circumstances, we can learn from the past,” Dr Chrisman said.

After referencing John Kotter’s eight-step change model, Dr Chrisman explored various industries’ experiences of change and how they “rhyme” with radiology’s encounters in current day challenges. In the realm of music, he shared a clip of Elvis Presley from the 1950s and the skepticism and uninvited feedback he provoked. A generation later, artists like NWA and Madonna engendered similar reactions in the media and around kitchen tables, he recalled. In the transportation industry, evolution from horse and buggy to automobiles to even the autonomous vehicles of today aroused similar concerns as in air travel around safety and congestion. Considering migration, modern day immigrants face discrimination while governments manage interventions that facilitate assimilation—similar challenges experienced in the 1800s in the U.S., he observed. In the financial sector, the banking and housing crises of the early 2000s echoed the market crash of the late 1920s and early 1930s. In healthcare, Dr Chrisman noted the similarities between the Covid-19 pandemic and the Spanish flu of 1918-19. While each generation’s challenges were unique, they were familiar to an earlier time; related obstacles had been faced and overcome.

Radiology, specifically, has faced its own share of challenges, Dr Chrisman explained. After Roentgen’s discovery spawned great curiosity and expanded use, injuries from radiation materialized, and many people questioned other potential side effects.

“Before we were even a specialty …the forefathers of radiology were being criticized for being ‘irritable’ and ‘irascible’ and having mental disturbances. Despite that, we continued to move forward,” he said.

Move forward they did, “with all these great wonders around us [at RSNA],’ Dr Chrisman said, from a simple X-ray photograph to the immense power of today’s MRIs, CTs, and interventional radiology procedures, “it’s remarkable and a testament to our forefathers.”

In radiology, Dr Chrisman reminded attendees that great discovery usually led to controversy, then to more discovery and more controversy as tec