Growing Old Together

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A lesson in business maturity: Microsoft CEO Steve Ballmer met the company's cofounder Bill Gates when they were both undergraduates at Harvard. Gates dropped out to build one of the most successful companies in history. Ballmer went on to graduate from Harvard and eventually ended up at Stanford, in the graduate school of business. By the time they got together as business partners at Microsoft, the company had matured to the point where Gates' entrepreneurial model desperately required buttoned-down business principles and infrastructure in order for the company to succeed in achieving his original vision of a completely linked and computerized society. What's the lesson for today's radiology practice leader or imaging executive? Vision eventually requires infrastructure and proven business leadership in order to realize its full potential. Businesses evolve and change in order to thrive. Those that don't do so stagnate and eventually become obsolete.

The trick is to know, as Gates did, when the time is right to evolve the organization from a laissez-faire, mom-and-pop operation to a big-time structure designed to implement the ideas that result from the vision and to provide for long-term growth and maturity. Of the many questions that I am asked as I traverse the country and meet with various practices, the most frequent is, "How will I know when we are ready to take this next step? Do we need a CEO?"

Gates knew instinctively, which is one of the reasons that he is ranked among the wealthiest people in the world. The rest of us, as mere mortals, need signs, signals, indicators, and a clear plan of action that show us definitively when and how to buff up the business infrastructure at just the right time. Too early, and the culture will implode upon itself, creating stifling bureaucracy and killing innovation. Too late, and the culture will have become so entrenched in its way of doing things that it might be impossible to retrofit sound business models into calcified and resistant attitudes.

Ideally, the radiology practice or imaging company will have a firm grasp of its reason for existence, developed into a business plan clearly outlining how its vision can and should be realized. Within this plan, a linear progression from purpose, vision, mission, process, values, culture, objectives, goals, structure, and measurement will provide key indicators of a business's life cycle and maturity; these will be opportunities to set the parameters for deciding when the time is right to integrate professional management.

That determination is more likely to be based, however, on where most groups are in their business life cycles. The discrete segments of the business are poured together in some sort of structural stew that inevitably makes it through successive board meetings, without decisions being made on the related hard topics of governance, structure, and changing the corporate culture. Those who have addressed those topics have found it both liberating and frightening at the same time. Vesting a third party with authority, power, and responsibility while relinquishing shareholder autonomy, control, and scrutiny is very disconcerting, to say the least.

Having said this, I am convinced that we have arrived at a point in the overall level of maturity in the medical imaging marketplace that requires organizations to face a new reality if they are going to be among those who succeed in a more difficult environment. In fact, professional management for radiology groups of reasonable size is probably not optional any longer. Groups could once make it through the next cycle because the year-over-year scan-volume increases kept their businesses flourishing, despite a lack of infrastructure and business accountability, but it is likely that, in the future, slower scan-volume growth will expose cracks in the organization that had historically remained hidden. Volume can hide a multitude of incipient threats.

The best way to protect and grow the business is for the visionaries running the practice or imaging company to outline, in the business plan, the point at which the organization will embrace the ideas of hiring a CEO, of building support, and of investing around an existing management team (or developing management teams from latent talent within the current staff). You have read about some of the best practices' models in our various case studies over the past couple of years.

In each case, the leadership team