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