Sandy Benson, CEO, Seattle Radiologists, PC: Keeping the Hierarchy Low

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You could say that Sandy Benson grew up at Seattle Radiologists. If you said that Seattle Radiologists grew up with Benson, you also would be correct. A former radiologic technologist with interventional-radiology experience, she joined the practice in 1983 to open an outpatient interventional lab and, 25 years later, continues to serve the practice, now as CEO. In the interim, the practice has grown from six radiologists with a 20-person staff to 35 radiologists with an 85-member staff. Seattle Radiologists has been in business for more than 45 years and is affiliated with a large hospital in downtown Seattle. The practice opened its first imaging center in 1987 and a second in 1990, and it provides professional services for several large multispecialty groups and orthopedic practices. Most recently, Benson presided over a reorganization of the practice administration, with an eye on planning for her eventual succession. How is practice governance structured?
Sandy Benson
Benson: The biggest change, over the past several years—and I credit this to the practice president—is that the partners are working at the committee level. We’ve always had committees, but they were not as active, and everything was discussed in greater detail at the board level. Now, most important issues go to committee, and the committee brings them to the board with a recommendation. If something hasn’t gone through committee, it is sent back to committee for recommendation. We have committees for personnel; practice development; equipment (which encompasses the technical equipment, PACS, and IT); and workflow, along with an executive committee and the standard compliance and continuous quality improvement committees. The most recent change is that we are doing more within the executive committee. Instead of having two board meetings a month, we have one executive-committee meeting and one board meeting. At the annual meeting coming up, we will propose to add two new ad-hoc members to the executive committee, to include two additional board members. The intent is to empower that group of people to handle issues at a more granular level and provide some analysis. When something gets to the board level, a core group of physicians has already done some due diligence, and whether analyzing a new opportunity or strategic thought, then that group can educate and involve the board. You can’t go through a lengthy financial analysis of every opportunity in a board meeting; you would be there until midnight. That is the strength of having the executive committee do the first level of due diligence. When the issue gets to the board, a very high-level executive summary can be presented, and the board can be confident that the executive committee has looked at all of the details. Sometimes, a committee will go directly to the board with its report, and on larger deals that will get more scrutiny, that committee will go to the executive committee for its support. What is the role of the practice administration? Benson: The evolution has been very much based on keeping the hierarchy low and keeping people involved in day-to-day operations. Having filled many roles here over the past 25 years, I am very knowledgeable about the operations of the imaging centers and the business. When I was promoted to the top administrator’s role 15 years ago, we outsourced our accounting division to the company that did our billing. As we evolved, even though we didn’t necessarily want to bring billing back in-house, we were large enough to have a financial division. I proposed a CFO and people to support that division two years ago. At the same time, our director of imaging was planning to retire, so we changed the position to a COO position to offer the company redundance and depth of leadership. Our current structure now is CFO, a CEO, and a COO. Over the years, if you have worked in many positions, what happens is that some of those tasks just stay with you, and you can’t work at the level where you need to work. I needed someone I could hand off some of the duties to, with the idea that, if that person is a great fit for the company, then this would be part of a succession plan for me, and I would start to download information. My former director of imaging was here for 20 years and I’ve been here for 25; we had a lot of knowledge, a lot of history, and a lot of information that now needed to be disseminated to other people to provide comfort to the radiologists. Now that COO Tricia West has come in, I see that, each year, that vulnerability will decrease. Are there any key touchstones for communications with the practice president? How frequently do you communicate with the president? Are there formal protocols for this? Benson: Our group is a little unique in that we do not give the key leaders dedicated time to do their administrative work. We just work around their schedules: I have an active list of things I need to discuss with him, and we set up a time to talk. I work in the same facility where he primarily works. The theory is that everyone is here to grow the practice, and everybody gives time. If an officer spends an enormous amount of time on a project on his day off, then administrative time is granted back to him. How about communication with the board? How is this accomplished? Benson: With the new leadership team, this is the structure: the president, the board of directors, me, my CFO and COO, and we work down from there. The director of IT reports to me. The CFO and COO report directly to me. The atmosphere I have tried to create is that the three of us are a team; we are all in this together. We each have a report that we present at the board meeting. The board is very active in the management of the practice. The leadership team does not drive the direction of the company; we drive it together. We have some definite strategic goals that we are responsible for, but the way I see it is this: We are there to support the board; whichever way they would like to move forward in the practice, we support that. You hold an annual retreat for key staff members. What is your process for conducting the retreat, and what is its purpose? Benson: In addition to the CFO, the COO, and our human-resources person, on an ad hoc basis, I bring in the director of IT, the director of marketing, and a support-services manager who is responsible for receptionists and the clerical people. Under that is the management team, the leaders of all the modalities, medical records, and receptionists; we have leaders in all those areas. Anyone in a leadership role is considered part of the management team, and for the past three years, I’ve been holding a retreat for the management team. My initial intent was that I wanted to create a more cohesive team to understand what we are doing for the organization, not just the individual departments. What is the bigger mission? Part of my intention is for them to get to know each other better and to acknowledge responsibility, and appreciate them for assuming that responsibility, by giving them the opportunity to go away for the weekend (as appreciation for what they do for the company). The second intent was to educate them—really to bring them up to speed on what is happening in health care from a broader perspective—and then to encourage them to set goals, and craft a strategic plan to accomplish those goals, in the coming year. Then, we also review and discuss successes of the previous year. For the past three years, I’ve brought in an outside person to do some team building, and that has been well received. Last year, the leadership team had a retreat prior to the management team’s retreat, where we delivered what the leadership team intended to accomplish and then spun the agenda off of that. Could you provide some examples of how the retreat results in strategic direction for managing the business side of the practice? Benson: One accomplishment of the management retreat is that the leaders are absolutely working better together. They are not looking at themselves as individuals in their departments only, but in the broader spectrum, seeing how what they do affects the entire operation and company. They have also developed that peer-to-peer relationship, so if they are having trouble with something, or if they see that someone has a better skill than they do, they will cross over and ask for help. In the past year, the COO has decreased staff through attrition and showed them the vision of doing more with less. We lost a person in one section and we are now cross-training someone to cover that position. With cuts in reimbursement, we are having to work smarter, and have nearly frozen hiring. If someone leaves, we really scrutinize that position to see if we can do without a replacement. Three years ago, the leaders would not have embraced that. Now, they are looking at it at a higher level and understanding they are not just one piece of the pie, but part of a whole. Yours is a complex practice, with many client relationships. What is the process for managing these key relationships? Benson: The client relationship is all about partnership: it is multidisciplinary and multitiered management from the physician side, from my side, and from my staff. We have all of these relationships; whether they are with the hospital or the multispecialty clinics that we service, we are all there, promoting partnership and team effort to make them successful and to make us successful. It is a multitiered approach to providing the best service possible, whether to the patient in an imaging center, the patient in the hospital, or the patient at one of the sites where we provide professional services. We are a partner and a team member with all of those entities, from the physicians all the way down. The president takes a huge physician-leadership role in the practice and is very key to physician relationships. On the administrative side, certainly, the buck stops with me. What I try to do is engage everyone in the opportunity and the solution. You said earlier that you try to keep the hierarchy low. Could you expand on that? Benson: An organization of our size could have a much larger management infrastructure, in which the CEO would not be involved with the staff on a daily basis. It starts at the top and sifts down to all the staff. You can add all of these management layers and not add any value to the organization. If an MRI technologist or a receptionist does not have a relationship with the top person, then he or she is not going to share a common goal. All of the employees here know me and what I am about. If we can keep that as narrow as possible, then you are more in touch with what is happening, who is working for you, and what they are doing. Even though we are a large group—we are at a level of 80 employees and 35 physicians—we are pretty connected.