Meeting or exceeding customer service needs is on the agenda for radiology groups with ambitions to be best of class. Conversations with radiologists and managers alike indicate a growing understanding that superior service can give a group a competitive advantage over others stuck with a TGE — that’s good enough — mentality. A TGE mentality means that a group is vulnerable to being classified as a commodity and therefore subject to the pricing pressures that all commodities face. Groups, on the other hand, that offer customer services that equal or exceed the quality of their clinical services can use this as a way to differentiate themselves from the competitive field. As with other service industries, the most unique providers are above the normal pricing pressures: people are willing to pay for the value they receive.

Well-run radiology groups include physicians, patients and their families, hospitals, and payors, as well as such allied health personnel as nurses on their list of customers. They realize that patients once directed by other physicians have put themselves in the driver’s seat and are becoming more knowledgeable about the care given by subspecialty radiologists, including radiation oncologists and interventionists.

Services are provided to each key customer in a number of ways. Some follow the mantra of popular service guru and author, Ron Zemke, who says that “Good service is whatever your customer says it is!” Vicky Bradford, PhD, author of The Total Service Medical Practice, offers another definition, “Service refers to the nontechnical aspects of health care, sometimes called the psychosocial or nonclinical aspects of care, the practice development issues, or, almost poetically, the art of caring.”

The old adage, you can not manage what you do not measure, is certainly true for all service organizations, including radiology practices. And without data about where a group stands and what its current service strengths and weaknesses are, it is hard to know what new programs to put into place and where to spend money and time on improvements. Doing baseline surveys of key customers or potential customers is a necessity before launching a service-based strategy.

Groups concerned about the costs of surveys should look to local colleges or universities for help. A growing number today have specialized tracks for master’s degrees in health administration and MBA programs with an emphasis in health care. Designing surveys and analyzing the results make a great class project, which will be seen as meaningful. Tap graduate students to conduct focus groups with physicians in particular specialties where growth is desired. Targeting those physicians in specialties that refer the most cases or that represent the largest revenue streams is one group. Just as important, look at the doctors who represent lower than expected volumes for their specialty.

Few radiology groups, surprisingly, regularly measure customer satisfaction themselves. Instead they rely on surveys generated by the hospital marketing department. These instruments frequently are more focused on the hospital-controlled aspects of the service, and reliance on these tools does not provide insight into the attitudes and feelings of the outpatient populations served by the group. Nor do they document how referring physicians feel about the timeliness and quality of service they receive. One interventionist recounts how he developed a very successful venous access service by being more available than the surgeons. He also won points from the hospital administration when it discovered that patients with ports put in the day they were requested could often go home and not run up another day’s length of stay.


Kristine Peterson, an expert in customer service and author of The Strategic Approach to Quality Service in Healthcare, points out that her radiology clients largely ignored patient waiting time before the study and almost always failed to inform patients about the total elapsed time required for certain studies with contrast media. Peterson points out that family members who accompany the patient often are shocked to discover that they will have missed more than the expected few hours of work. “Basically, the groups create dissatisfaction with the process,” she says, “because they fail to manage the patient’s and family members’ expectations. Dissatisfaction is often caused by an experience that is different than what was expected.”

Inadequate information about the procedure itself, sometimes why it is being done (do not blame the referring doctor — help him or her out), and the process required is another area where patients surveyed by Peterson voiced discontent.

While more radiology groups are initiating and addressing service issues before the hospital threatens to bid the contract or before the cardiologists develop or expand their own imaging capabilities based on conversations with radiologists at meetings, it is clear that more needs to be done. Service is a critical component of any marketing plan. Creating advertisements that make phones ring — or Web pages that create email — that no one answers correctly is wasting money big time. Yet, in the minds of most radiologists, marketing is not a concern and service is not connected to marketing. In an industry-sponsored marketing and service survey conducted at the Society of Cardiovascular and Interventional Radiology meeting in 1998, Nicholson Research reported that:

  • Only 38% said their group practice conducted any marketing or service-related activities.
  • 69% said that their group did not have a written marketing plan or that they were not aware of it.
  • A mere 22% said their group currently has an employee who addresses marketing or uses an independent firm.


Someone in each group practice or in large groups must own the issue of service quality — clinical and otherwise. In one large Illinois-based cardiology group, service is taken so seriously that physicians who generate frequent complaints are fined. The administrator says that this financial consequence has heightened awareness and attention to keeping patients and referring physicians happy.

Many group practices have service problems that often center around the behavior of individual group members who still believe that technical competence is all that is required. For example, group members who behave like hourly line workers, leaving the hospital when there are still studies to read, can undo the service or goodwill marketing programs in which their group invests. Colleagues whose bedside manner is deficient, erratic, or non-existent are also a concern for many radiology group practice leaders. Training is being encouraged by some groups to help colleagues develop consultative skills and change attitudes about service, but this is still in the early stages for most groups. One useful tool toward developing improved communications skills is a book titled Making the Patient Your Partner by Thomas Gordon, PhD, and W. Sterling Edwards, MD. Radiologists who want a more interactive learning situation are considering taking one of the Dale Carnegie courses to refine their communication skills; these courses have been popular among plastic surgeons and orthodontists.

Innovative service programs being initiated encompass a wide range of activities. Some radiologists admit that in years past, service-related issues would not have made it to the monthly meeting agenda but growing competition has caused some radiology groups to decide that competing on service, not just technical competency, is a must.


Education can be an important part of the group’s service plan. One radiology group based in Spokane, Wash, provides regular in-service education on new studies to referring groups of doctors at their practice. “We invite both doctors and staff to attend,” says Rodney Raabe, MD. “Our business staff comes along and makes a short presentation about scheduling, forms, and making the process as easy for them and their patients as possible. Face-to-face relationship marketing is important. Reading a name at the bottom of a report does not give us an identity.”

The Internet is a tool that is reshaping radiology groups’ relationships with their patient customers. Opportunities exist for groups to educate and meet the informational needs of patients interested in everything from intrauterine fibroid embolization to bone density scans and the benefits of having mammograms read by dedicated mammographers. Facilitating online patient registration and scheduling is an excellent way to meet the expectations of Internet-savvy patients and streamline those practice administration functions.

Furthermore, changes in personnel, locations, technology, hours, or services make it expensive and time-consuming to reprint brochures and other marketing materials. Groups using the Internet can make available quality information in real time.

The opportunity to connect with referring physicians via the Internet and to send reports and images is another fast-growing area of interest. Eliminating delays in report transmission is a service enhancement that wins kudos from technologically savvy referring doctors. More appreciation goes to the radiology group sites that provide the clinical criteria for procedures and studies, simplifying the ordering process.

Radiology groups interested in providing superior service will use technology to support customers’ needs and expectations for all sorts of information. They will have the capacity to deliver better, more complete information to all of their constituencies more quickly, more conveniently, and less expensively through the Internet. At the same time, face-to-face, high-touch, personalized care to patients and referring physician groups and their personnel will not be replaced. Radiologists who are as likable as they are technologically skilled will be valuable and sought after.

The groups that are likely to be the winners in the next round of health care reformation will be the ones who have redefined themselves and the services they render.

Chicago-based Karen Zupko is a frequent speaker at radiology meetings. She contributes to publications on practice management and marketing. Her web site is