Role of the Center Manager: Driving Productivity by Nurturing Cooperation
The team at OGH Imaging LLC, Grand Coteau, La, faces a daunting task every day: living up to the expectations of both OGH’s hospital and physician investors while managing approximately 70 patient studies a day across eight modalities (MRI, 16-slice CT, ultrasound, DR, digital mammography, fluoroscopy, bone densitometry, and calcium scoring). Employing just six technologists—or seven, on the frequent occasions when David Rushing, center manager, steps in to help—OGH optimizes productivity, in a health care environment that’s increasingly focused on the bottom line, by maximizing staff cooperation, even while minimizing staffing.
David Rushing
Rushing explains that OGH Imaging was born out of a 2003 partnership between Opelousas General Health System, Opelousas, La, and four radiologists wishing to separate from the hospital and begin their own ambulatory service center. The partners jointly invested in OGH Imaging, and the new business opened its doors in December 2005.
“The hospital initially missed the opportunity to invest jointly with some of its physicians, and when they saw their error, they used OGH Imaging as a way to reach out to the radiologists and invest with them.” — David Rushing, manager, OGH Imaging, Grand Coteau, La
Though the idea for a new outpatient imaging center came before the DRA was even on the books, by the time OGH Imaging opened, the radiology industry was quaking in the face of drastically reduced reimbursement. Some might have seen this as a sign that the business was doomed from the start, but to Rushing, it was a fortuitous opportunity. His team would learn to operate in a worst-case scenario, and things could only improve from there.
Vicki Buller
“The DRA was nothing new to us, so we really didn’t have to make any drastic changes,” Rushing says. “Our staffing was already cut to the bone. There was no room to cut jobs or cut back hours, so instead, we concentrated most on getting more volume into the center. If we’re doing everything right, we’re getting the most out of every procedure we perform.” Customer Service Counts Rushing’s used to hitting the ground running. Before Opelousas General Health System brought him in to oversee MRI operations at the hospital in 1999, he worked in the mobile MRI environment, setting up new customer accounts and building rural centers’ MRI referrals until they had enough volume to bring in their own MRI machines. “I’ve got a lot of experience working in customer service to build volume,” he says. After leaving Opelousas General to run OGH Imaging, Rushing found himself wearing more hats than ever before. He says, “We have a management company that I answer to as the manager of the center, and now that I work with them directly, I’m overseeing a few other centers around the country, as well as this one here.” What does that mean, in day-to-day terms? “It seems like the paperwork is neverending,” he says, “with accreditation, making sure everyone stays up on their licensing, and paying the bills.” Then, there are those tasks that are aimed at building the kind of volume that a center needs to stay out of the red. “I do public-relations work and marketing as well,” Rushing says. “I make it part of my job to get out there and meet any new doctors in the community. We do everything we can to expose the center; we go to symposia in the area, and we’ve given PowerPoint presentations. Whenever we have the opportunity to educate the community about our services, we take it.” Customer service is also important, and here, yet again, OGH’s small staff is more of an asset than a liability, Rushing says. “We portray ourselves as having a really personal kind of atmosphere,” he says. “We try to recognize patients by name, and we open ourselves up to them in a way that’s really different from what you would typically encounter in a hospital environment. We kill them with kindness, and we finish with a timely report—and we follow up to make sure the referring physicians are getting everything they need.” All the volume in the world is useless, though, if your team can’t manage it. Operating continually with a skeleton staff, Rushing has had to put his money where his mouth is where productivity is concerned. “I do offer assistance in the technologists’ work whenever I can, especially on busy days. I jump in so that people can be freed up for their lunch breaks and so on,” he says. Driving Productivity Driving productivity is crucial, and Rushing says that the very first step is hiring the right staff members. Every person on the OGH team is comfortable playing multiple roles. “Everybody really does pull more than their own weight,” he says. “They offer to help each other out in any way they can.” In terms of managing technologists, this means that each staff member is cross-trained for different modalities. “All our technologists were credentialed as x-ray techs first; then, they went into different specialties,” Rushing says. “We let them know, from the start, that our expectations were that they would do x-ray as well, and they rotate through the receptionist’s position, so they understand scheduling and data entry.” Vicky Buller is OGH Imaging’s head technologist, and she describes her job as “solving everybody’s problems” in order to keep things running smoothly. “For any issues the techs may have, be they technical or with a patient, they come to me to get everything done,” she says. A technologist for 17 years, Buller specializes in mammography. “This position gives me more time to treat patients like actual people and add a personal touch.” she says. “That’s really what I love to do.” From 1993 to 2004, Buller assisted in building the mammography department at Opelousas General, and she hopes to do the same at OGH imaging. “Our mammography numbers have probably tripled since I came on board,” she says. “I like to do more. I like to work harder and see the satisfaction of the patient.” It’s an attitude shared by her fellow technologists, she says, who constantly strive to offer outstanding patient care in a timely fashion. “Some days, it gets kind of hairy,” she says, “but we’re a good team. We look after one another. At the end of the day, everyone might be tired, but we know we’ve accomplished something.” Buller is in charge of managing scheduling, time off, and vacation days for the center’s technologists, but Rushing notes that they often take care of this among themselves. “I really have to hand it to our staff,” he says. “They always make sure we have the right people here at the right times. They’ll come up to me and say, ‘I want to take a vacation, and here’s what I’ve worked out.’ They take a lot of the burden off Vicky and me by working as a team.” Other technologist incentives include the occasional half day in the slower summer months, as well as Friday lunches provided by OGH for staff members. It doesn’t hurt that the leaders are happy to get their hands dirty whenever necessary. “I try to lead by example,” Rushing says. “I get in there and get involved as much as I can without getting in their way. I’m not above walking a patient to mammography, if that’s what needs to be done, or performing an MRI so one of my techs can go to lunch. I’ll relieve someone so he or she can do an x-ray, or talk to a patient and keep them comfortable until it’s time for the exam. We all carry the ball.” Rushing also attributes his staff’s cooperative nature to the nurturing attitude fostered at OGH. “We promote an environment where family comes first,” he says. “We take every opportunity to make it easy to manage your home life and support a career as well. That makes this place very attractive to employees.” Buller has experienced this firsthand. “Sometimes you get a phone call, and we all hate to get them, saying one of your kids is sick, and you have to go,” she says. “Some places demand all of your time, but here, you line up your relief and you go.” Radiologist Productivity Radiologist productivity is also key to managing volume, and again, Rushing cites his staff’s flexibility as the factor that differentiates OGH Imaging from other small centers. “If you have a radiologist who only wants to do MRI, that can make or break your facility in terms of providing a good turnaround on reports. If our technologists do a great job and our receptionist does a great job, but the radiologist doesn’t get the report out for a week, then that’s the impression the patient is left with,” he says. When it comes to optimizing radiologist productivity, Rushing says, it’s all about state-of-the-art, efficiency-maximizing technology. “We provide the best equipment that we can for our staff to do the job as quickly as possible,” he says. “When you’re trying to encourage a physician to change his or her way of thinking, it can be very challenging. You have to break it down into dollars and cents, showing that by changing this or that, we can make more money—and you can make more money.” The occasional financial incentive to maximize performance never hurt anyone, so at OGH Imaging, whenever the quarterly budget is exceeded, everyone on staff gets a bonus—from the receptionist to the radiologists. “It’s important that everybody gets the same piece of the pie,” Rushing says. “I want my techs to do multiple things. I want my receptionist to do multiple things. If everyone works together as a team, then we have to share the spoils as well.” Rushing charts the success of OGH’s customer service and efficiency via feedback from patients, of which he receives a surprising amount. “People are always writing letters,” he says, “especially regarding our women’s imaging. We make the ladies feel very comfortable, and most of them aren’t afraid to voice their opinion in one form or another.” If a patient positively mentions a specific staff member, Rushing posts the letter in the break room for everyone to see. Negative feedback is equally (if not more) important, so Rushing is sure to follow it up with a phone call to find out what specifically troubled the patient and how the problem can be addressed. “I like to hear it from the horse’s mouth,” he says. “It’s usually a misunderstanding: The patient was told the wrong date by the doctor’s office, or came in for a procedure not knowing it required blood work. We do our best to accommodate patients the day they’re in our office, but with some of these misunderstandings, we do bear the brunt of their dissatisfaction.” In the future, Rushing hopes to see OGH Imaging expand into nuclear medicine, and maybe even breast MRI. “We really just want to continue to impress people when they walk in here,” he says. “I want them to realize what medical imaging should be like. Again, it’s a team effort. Patients may walk in here upset because they had to come eight miles from their hometown to get a procedure, but the receptionist is quick to calm them down, and when there’s no wait time, they’re happy by the time they leave.”