Cultural Considerations Key to Combining Radiology Organizations

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Brian Baker2011 proved to be another banner year for consolidation in the radiology industry, and with increasing downward pressure on reimbursement, the trend of groups joining together to provide more specialized care (while achieving economies of scale) can be expected to continue. While operational and financial assessments are premerger hallmarks, however, little attention is paid to combining business cultures, according to Brian Baker, president of Regents Health Resources, Franklin, Tennessee. “Practices focus on bringing together all the business aspects, on merging the PACS and RIS, on service contracts, and on legal and operational issues,” Baker says, “but we rarely see them take the time to work on the cultural issues.” The consequences of this oversight can be dire, Baker says, when the new, combined operation begins losing some of its most valuable staff as a result of insufficient communication and transparency. “Lack of knowledge during the transition breeds fear,” he observes. “People start looking for excuses to leave and go to other jobs, even when the scenario may, in fact, be very stable. Some companies will say they don’t have time to focus on cultural issues, but the truth is, you can’t afford not to; how much more expensive will it be when you start losing staff? This is a topic we consider very important—but it’s rarely addressed.” Assessing Culture Assessing the culture of a prospective new partner can begin as simply as making a visit to one of its facilities, Baker says. “When you walk into an imaging operation and it’s disorganized—a lot of stuff on the walls, a lack of professionalism in the way the staff is dressed—you often find that the organization itself is a little dysfunctional,” he says. “There probably isn’t a lot of communication, there’s no vision, and when you start asking for information, it’s hard for the practice to produce.” Contrast that with a facility that appears neat and orderly, with professionally dressed staff, and more often than not, he says, “You’ll find that you can easily get the information you need and that the organization can clearly communicate its vision and mission.” In his work with Regents Health Resources, Baker has seen two primary types of radiology-practice cultures, which he terms the quality-of-life group and the customer-service group. “Organizations follow their leadership, when it comes to culture,” he notes. “If the practice leader has an attitude of leaving at 5 pm, taking an hour and a half for lunch, and making sure he gets his 14 weeks of vacation, everyone else will have adopted that attitude fairly quickly. It doesn’t have to be discussed—everyone just naturally follows. Culture starts at the top.” On an individual basis, Baker says, personality tests (such as DISC® assessments) can be useful for both parties as they attempt to integrate their staffs successfully. “It’s a nice way of gauging who people are and how they work, both alone and together,” he says. “It teaches different personality types how to work with other personality types. Knowing the rest of the team members’ personalities can help the groups deal with each other, and that’s a very important part of merging cultures.” Reconciling Cultures Baker recommends that groups work with a third-party facilitator, when joining their cultures, to ensure that neither party feels deprioritized by the process. “It’s rare that one organization would wholeheartedly adopt another’s culture,” he notes. “You always wind up with something new. You need to understand their perspectives and their goals, what their hot buttons are, what they really want, and what’s needed for the success of the organization, from all perspectives.” Critical to this process is bringing stakeholders together in a nonthreatening environment, where members of both staffs can share their perspectives on the future of the combined organization. “People get nervous when there’s a new manager or changes—they have questions they want to ask, but feel that they can’t,” he says. “A facilitator can help bring that barrier down and enable them to ask questions without management in the room or fear of retribution; then, management can address the answer to the group without knowing where the question came from, building trust.” By initiating a discussion centered around common goals—as well as common concerns—a facilitator can help members of what were once two distinct organizations find the middle ground. “When you have common goals, and perhaps even common differences, that brings people together,” Baker says. “When they can solve small problems together, they start feeling like a team. Momentum builds quickly from there.” He cautions, however, that groups should not feel disheartened if this approach doesn’t work for a staff member or two. “Some people you’ll never bring into the new world order,” Baker notes. “It just won’t happen.” Combining organizations and establishing a new culture need reinforcement and should be sustained through communication and transparency, Baker says. The facilitator’s role should continue through the first quarter or so; after that, the new group’s leaders should reinforce its core values and mission through events such as annual strategic-planning retreats. “Once a year, it all needs to be refreshed,” he says. “Involving the entire team in strategic planning is a key way to promote the culture of a new business as it evolves. The mission and vision need to be promoted and communicated regularly by leadership as the new culture matures.” Cat Vasko is editor of and associate editor of Radiology Business Journal.