Crossing the Streams

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By Bruce Hammond, CRA, CFAAMA

Since joining the RACC, I have used terms related to imaging for my Link article titles; this one will also reference the movie Ghostbusters. In our careers we have all “crossed the streams,” and we were all as scared of the outcome as the characters in the movie. In our careers we have all changed, just as the Ghostbusters did when their business became successful. We have all had, or will have, those times where we realize we are not quite as independent, smart, strong, gifted, or invincible as we thought. What we may not have is the Annie Potts character telling us we are a little too full of ourselves.

We have crossed the streams from technologist to management; however, we still fancy ourselves clinical at our core. But when we are faced with our own or a loved one’s healthcare issue, everything changes. This year, I had to deal with how crossing the streams changed me. I was used to being in a position where I was knowledgeable and could manage things. I found out quickly how long ago I crossed the streams, how fast things changed, and how far removed I was from day to day clinical work. I can account for, quantify, inspect, motivate, verify, and perform many other functions essential to proper operations, but none of that matters when you’re the family member of the critically ill patient.

I found out that color coordinated uniforms didn’t matter, that what clinical knowledge I had didn’t either, and my analytical skills were worthless. I found out the only thing that mattered was across the rails and I was helpless to act. I found out, despite all the management training, degrees, registries, credentials, team building ideas, and other things we preach all the time, very few things made any difference. I was transformed from secure healthcare administrator to scared, uncertain patient family member in uncharted waters. I don’t care what we tell ourselves: when it is your close family member on death’s door very few of us are equipped to deal with it from an objective clinical view.

We had the very good fortune to be in an amazing facility. In my forty years in healthcare, I have NEVER seen a facility so well run; personnel so caring, and doctors so engaged. This was a for-profit, physician owned, corporately managed, specialty hospital on a religiously owned property. Talk about a recipe for disaster, according to the experts! I should be writing about how greedy, uncaring, and cold the place was, not how we can take a lesson from it.

After the initial storm of unanticipated issues passed and we knew we would be there a while, I started to notice things. The hospital had a unique system of staffing the ICU. They had a finite number of staff assigned there, and they all took ownership – not just of their positions, but the floor, the care, the patients, and their families. They held each other accountable. They cared, and it showed. They anticipated issues acted and reacted above their requirements, and embodied the concept of complete care, not just for the patient but for the family.

Most of us, back in the day, were promoted because we were the best tech, not because we were the best manager. We exhibited caring, compassion, and a desire to do more.  After crossing the streams, the further away from our tech job we got, the more distant we got from the patient care and the direct contact with families, and the closer to our phones, computers, spreadsheets, meetings, and deadlines.

We sometimes forget what we once took for granted and why we are here in the first place. We set up training and programs, talk about production, budget variances, personality traits, and team building. We run our departments based on third party customer service scores from those even farther removed from our patients than we are. What we really need to be doing is walking around, talking less, and listening more. We need to be less sure of our answers and more attuned to the solutions our staff are providing, giving them ownership of the process and allowing them to affect outcomes.

My own situation turned out fine, and my loved one eventually returned home, a lot worse for the wear, but regaining their life. The staff and physicians at that hospital changed her life by saving it and mine by exhibiting everything that was right about what we wanted to do our first few days clinically and managerially. I saw first-hand that physician ownership can work. It’s not the concept of physician ownership that matters; it is the physician, the person who is the owner that matters, the professional that makes it work. It is the administration that develops a culture of ownership for the staff. It is the staff that takes ownership and holds each other and clinical contemporaries accountable.  We should do the same.

Imaging departments and ICUs are comparable in many ways. We both have a defined staff, we have patients for a short amount of time, and we have to respond immediately. We can and should develop a culture of ownership. Pride of ownership is why you keep your car clean, your house painted, your dog groomed, and the grass mowed. It is the same result when properly applied to our work environment. Engaging our employees, trusting them, holding them accountable, and using peers to manage peers is a good thing.

We need to remember patient outcomes are what we are there for. Some outcomes are not good, that is a fact of life, and we have to help our staff and patients and their families deal with those as well as the good ones. No one wants to go to a healthcare facility and feel like they are at the quick oil change place; we want to feel we are being treated well and our needs met, we want to deal with people we view as engaged and taking ownership.

As we enter this holiday season, remember the goodwill and warm feelings. Remember year-round why you started your healthcare journey, before you crossed the streams, before you came to the management side from the clinical. Vow to let your staff be their best and remember there is only one rule that matters: the patient comes first.

Radiology administrators have a difficult task. We have responsibility to both the board room and the patient room, and we must find the right formula to do our best for both.  Go ahead and cross the streams; we can, and most often do prevail.

Bruce W. Hammond, CRA, CFAAMA is the CEO of The CailcoGroup in Fort Worth, TX. He can be reached at

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