Strategies for implementing informatics initiatives beyond the radiology department and effectively leading change closed out the 2021 ACR Imaging Informatics Summit. Innovative leaders in imaging informatics, including moderator Nabile Safdar, MD, MPH, vice chair of informatics at Emory University, facilitated a timely discussion on navigating complex, evolving healthcare environments to maximize the impact of imaging informatics projects. Safdar also touched on the importance of establishing sustainable relationships with other departments.

Defining Governance

Namita Gandhi, MD, MScHI, FSAR, associate chief imaging informatics officer at Cleveland Clinic, led the enterprise imaging power-hour with a thorough introduction to governance, highlighting the significance of a fluid approach that evolves to address each institution’s changing needs.

“Governance is a process, not a project,” said Gandhi. “There is no one size that fits all.”

Building on concepts outlined in the Technical Challenges of Enterprise Imaging: HIMSS-SIIM Collaborative White Paper, Gandhi outlined operational considerations (i.e., central versus distributive structure) and strategic items (i.e., local versus national growth strategies and patient engagement) key to developing an effective foundation for enterprise governance. Gandhi emphasized that, ultimately, effective governance requires strategic alignment across the enterprise. Institutions must design processes that mature over time, accommodating for increasing growth and autonomy at the enterprise level.

Effectively Managing Change

The conversation transitioned to leveraging established frameworks to drive innovation, as Melissa Davis, MD, MBA, medical director of quality at Emory University, presented on change management. Acknowledging that resistance to change is inherent to human nature, Davis referred to Kotter’s 8 steps for leading change to provide guidelines that may aid clinical champions in their efforts to garner support for new ideas.

“Being a change agent is always going to be an uphill battle,” said Davis. “Find people who resonate with your ideas and vision, and start to test small changes. And when those changes are successful, message that success around your organization to build momentum in your vision.”

Staying Ahead of the Status Quo

Davis’ points were echoed by Christopher Roth, MD, MMCI, vice chair of radiology, clinical informatics and informatics technology at Duke University, who added that those proposing new initiatives should “convey that your missions will evolve…demands on your infrastructure will evolve…and at some point the infrastructure itself is going to evolve, and you are the right changemaker to make that happen.”

Roth drew on his own experiences as a former athlete on the University of Michigan football team to illustrate the importance of maintaining a unified team mission, understanding one’s teammates and stakeholders, and avoiding complacency to remain competitive as an agent of change.

“Bill Parcells [iconic football coach] would say, we’re in, ‘a competitive environment. To stay the same is to regress,’” cited Roth. “The hospitals and competitors around are improving, and you need to improve with them.”

Roth used practical examples, such as PACS deconstruction and adoption of early enterprise imaging platforms within the last decade, to demonstrate the notion that technology and solutions once thought to be an advantage become disadvantages as interoperability demands evolve within increasingly complex healthcare environments. However, adopting new technology to “relentlessly improve” can face several barriers, including hesitancy from clinician colleagues and hospital leadership. To overcome this hurdle, Roth underscored the importance of communicating the necessity of change in terms that are relevant to a designated stakeholder, such as focusing on workflow efficiency of a solution when addressing physicians and patient satisfaction or return on investment when proposing the same solution to administrators.

Practical Take-Aways

The panel concluded the session by providing actionable items to effectively lead enterprise-level change. For instance, Davis recommended approaching risk-averse settings with objective metrics that quantify the impact of a proposed solution, which necessitates having “good data infrastructure around the healthcare system so that you can pull out data as seamlessly as possible.”

Aligning with his previous sports metaphor, Roth provided a buzzer-beater response to Safdar’s question of effectively inspiring one’s team in an era where individual members are often separated across the enterprise, interacting virtually from remote locations. In addition to using a “team wall” of group photographs and mementos as one’s Zoom background, Roth emphasized a need to take advantage of every opportunity to “explain the why of what it is you’re doing. You should want people to be psyched to work where they work…to keep people engaged and really more productive.”

Ali Tejani, MD | Postgraduate Resident in Diagnostic Radiology | University of Texas Southwestern Medical Center