 |
Roland W. Rhynus, Jr, CRA, FAHRA, RT(R), (NM), (MR), has followed a career path that was once, on paper at least, typical: get certified as a radiological technologist and work your way up the command chain until finally you get named a radiology administrator, hopefully at a major hospital.
Rhynus did begin his career as an RT, and he is the administrative director of radiology at a major hospital, Florida Hospital in Orlando. But in the years from 1975, when Rhynus became an RT, to 2004, when he became radiology administrator for Florida Hospital, a seven-hospital system, Rhynus followed a path of employment that was anything but a series of stepping stones. Along the way, he has acquired a skill set that has uniquely prepared him for the challenging and sometimes impossible task of managing a hospital-based radiology service today.
He began as an RT at Loma Linda University Medical Center in California, where he had also been a student. By the time he left Loma Linda in 1988, he was an assistant director of radiology. But he opted out of the hospital environment to become an account representative of imaging equipment for a major vendor. From there, he moved to a series of jobs in the outpatient imaging sector, including two stints as a regional vice president for major providers of outpatient imaging.
Just prior to joining Florida Hospital, he spent a year heavily immersed in informatics, while serving as chief operating officer of a Southern California-based provider of integration and multi-vendor support services for PACS (picture archiving and communications system).
Rhynus says his eclectic career path might once have been frowned upon by hospital radiology departments, but these days it is seen as an advantage because radiology is being pushed into so many settings that a breadth of imaging experience has become a blessing, even a necessity.
As radiology administrative director at Florida Hospital, Rhynus oversees a seven-hospital system in central Florida. It is part of a larger 17-hospital network run by the Adventist Health System’s Florida Division. Rhynus oversees a $60 million operating budget, with charges of more than $550 million per year. The Florida Hospital system contains 3,025 beds, and more than a million patients are treated there each year, making it one of the busiest hospital systems in the country.
IMAGING ECONOMICS: It has been well over a decade since you were sitting in a hospital hot seat. How has the radiology administrator’s job changed in that time?
RHYNUS: It’s more and faster. It’s a more formalized business with finance and strategic planning dominating. I left the hospital setting at the leading edge of the transition to outpatient imaging. Hospitals must compete with the small, nimble outpatient competitors. That’s a challenge, and the larger your institution, the more challenging it is.
Monte Clinton, one of my mentors, wrote an article a number of years ago about the number of hats that radiology administrators must wear. I think back then there were fewer hats. Then it was 10 to 12 hats; it’s 40-plus hats now.
IMAGING ECONOMICS: What are the most critical new functions that were not there years ago?
RHYNUS: I think JCAHO (Joint Commission on Accreditation of Healthcare Organizations) has morphed and changed significantly. Regulatory and legislative issues are more daunting and controlling. Even something as simple as the construction codes have changed so much. For instance, in remodels now you have to control airflow. It’s a change that takes more time and adds to the cost in an era when we’re trying to do things faster.
We do have the efficiency of imaging and informatics—PACS, RIS (radiology information system), speech to text, the power and speed of image acquisition, plus image processing have just exponentially exploded and will continue to do so. But we’ve also got more disruptive technologies, in the sense that we have crossovers—those technologies where there are multi-physician specialties wanting to play. So we have the decentralization of the traditional radiology department.
It used to be that radiology was a department. Now, it’s a support infrastructure, like your telephone system. Radiology is everywhere, and it does touch every specialty. What does the radiology of the future look like? I think it’s very distributed. Our product, the report, is decentralized now, and you can get the images anywhere.
We’ve got a lot more to keep up with. I’m concerned about the constant communication. How do I prevent my staff from feeling overloaded because we have our Blackberries on and we’re all doing e-mails at midnight? How do we maintain the high volume of work and the independence of that communication workflow and yet find the balance when we need rest and recuperation? That’s a challenge.
It’s a 24/7 business, and you’ve got to have a good network and a great team. You’ve got to be able to distribute the workload. Radiologists are saying the same thing. Nighthawk services are important, but there are a lot of groups out there who are wishing they had more people to share the load.
IMAGING ECONOMICS: What are the greatest challenges facing the radiology administrator now?
RHYNUS: Timeliness is the biggest challenge. Our patients expect very timely scheduling, and our physicians expect speedy results—making sure we are meeting customer needs, and ensuring that expectations are appropriate where we have the ability to influence them.
We need some faster way to move patients through the process, without making them think they are in an assembly line. When you have an adverse incident in a quick turnaround time frame, it only intensifies the problem, and in imaging you don’t have the opportunity to go back the next day and say I’m sorry. We have to make sure we do our very best, and set expectation levels with our senior leadership. Imaging is different than the other nonimaging specialties in that you normally don’t have that repeat opportunity for excellent customer service support. If we don’t make that good first impression, it’s difficult to recover in imaging. I think you do have a recovery option in specialties where you have repeat business.
I also think a great challenge facing radiology administrators now is radiology’s increased scope. We have advances in all the subspecialties. We need, as radiology administrators, to have a working knowledge of how these new procedures work—what kinds of workflow processes they involve, what kinds of equipment they require, what kinds of financial projections and analyses are required for each of them. When they come up, they come up very quickly. A neurosurgeon may want a new portable CT that can scan a patient in bed. Staying current with all the new technologies is an exciting challenge.
IMAGING ECONOMICS: What did you learn in the freestanding world that will be most useful with your current hospital-based assignment?
RHYNUS: When I went to freestanding, it was just starting, and I felt like I knew some of the holes in hospital operations. Now, I’m here and I see holes in the operations of freestanding services, which I can use to my current employers benefit.
We do general anesthesia MRI cases; our freestanding competitors don’t. Referring physicians who utilize that service realize its value, and the parents of children who need general anesthesia MRI, clearly understand that value. But how do we, for example, help the payors realize the significant advantages we bring to them in that area? The codes for an MRI of the head don’t give much credit for doing a general anesthesia. How can we help the payors and the refferring physicians understand that that examination doesn’t have enough margin for us if we only get that examination from them? The difficult cases go to the facilities that can do them, the cases that are the cream often don’t. How do you mitigate that disproportionate reimbursement level?
The radiologist can say, “My revenues are going down. I can go to work tomorrow across the street. Come in at 9, leave at 3, and make more money.’ My technologists see the same thing. As a radiology administrator, I’ve got to be pretty creative to show them that there is real value in doing what we do, even if for them personally and financially, there might be better options elsewhere. You’ve got to instill that idea of team, that mission, that vision. You have to be an expert in team.
IMAGING ECONOMICS: What did you learn in the informatics consultancy that will help you in your current assignment?
RHYNUS: I was fortunate to learn some hands-on IT skills. Those help me on a regular basis now, such as when we are talking about network gateways, broadband transmission speed, routers, switches, and some of the other details. The problem is that sometimes you can know just enough to get yourself in a lot of trouble. I wouldn’t want to position myself as an expert on IT or PACS, but this skill set helps as we are deployed fully for PACS except for mammography and some angiography. We’re across all seven hospitals, and we move imaging data anywhere in the network. We can cross interpret across the 17, but we’re not doing it routinely. Other radiology group contracts are involved.
As an industry, we need to stop moving film and CDs. For the patient’s benefit, we need to have direct connections, with firewalls of course, to send informatics to even our local competitors. We’re going to compete, and yet we need to cooperate so that it’s to the benefit of the patient. I think everybody agrees with that, but nobody makes it happen. It’s easy to do when you talk about a distant competitor, it’s a different story when it’s the guy down the street. We can send dictation and images around the world, so let’s get so the local hospitals can do this, smoothly, seamlessly, and to the patient’s benefit.
IMAGING ECONOMICS: What are the most daunting aspects of your job now?
RHYNUS: The variability is the most daunting aspect of the job now, clearly. Am I seeking a higher skill set, absolutely. We can be in the middle of working our budgets when suddenly a patient care issue comes up. You have to change focus and deal with that issue, so the important things sometimes must wait for the urgent. We have so many balls in the air that you have to be a pretty good juggler. I like the visual of a symphony conductor. It would be great if we could play every instrument as well as the first chair, but that’s impossible. You’ve got to have those first chairs and section leads. They have to know the latest and greatest, and you’ve got to rely on them. Clinical, marketing, finance, service, teamwork. We use those five pillars of excellence. The daunting aspect of the job is that there are so many of them, and they’re so varied.
IMAGING ECONOMICS: Do you have suggestions for your peers?
RHYNUS: It’s who you know. There’s no doubt in my mind that we have to know more people. We have to know where our resources are. We’ve got to maintain contact with those people even when it’s not critical. You’ve got to send regular greetings so when you need them to take your call, and they’re in the middle of a crisis, they’ll take the time to respond. It’s important that we have good relationships like we do with our families and our personal support groups. We have to have the same feelings with our colleagues. Our mentors, of course, are going to be that way. Are we mentoring others so that as their knowledge increases they are willing to share that back with us?
IMAGING ECONOMICS: Will a graduate degree be part of the tool kit of the administrator of the future?
RHYNUS: I think a graduate degree is going to be very important. More education, experience, and, of course, contacts can only help.
IMAGING ECONOMICS: Are we, then, seeing the final days of the technologist turned administrator?
RHYNUS: I think we saw that a while ago in the larger institutions. I think the job has changed, and I don’t think that being an RT is the pivotal point or the convergence point now. It helps you to understand the technical end, but I think it may hinder you on the ability to be proactive. As technologists, we are trained and educated to do what the radiologist says. When you get into a crucial conversation, most of us are not trained with the skill set to appropriately question an authority figure. I think that can hinder you when you become a manager or an administrator. You have to be able to say the difficult thing when the stakes are high. At Florida Hospital, we are educating our entire radiology team to manage these crucial conversations. How do we step up and say the right thing, to the right person, at the right time, without offending or without anger? That’s something that doesn’t necessarily come to you when you come out of the box as a tech. Yet, you really need that when you’re an administrator.
IMAGING ECONOMICS: Administrators are being called on to do financial analysis, motivate staff, implement digital imaging, and compete with entrepreneurs for outpatient imaging. What can an administrator do to bolster his or her toolkit?
RHYNUS: It’s so true. How do we get all that in our toolkits? Again, it is who you know. I’m not a whiz on pivotal spreadsheets, but I’ve got an analyst who is. I’ve got to have that analyst. I’ve got to have access to the COO and the CIO for the RIS and PACS, and I’ve got to have the ability to get the right people into the organization to implement the changes that need to occur—to give us speedy, deliverable results that we must get to our customers, so that we can grow resources, grow the business for the institution to grow. A favorite saying from my COO is: “Culture eats strategy for lunch.” We strategize and try to put all these plans in place, but the culture is what makes it happen. As an administrator, you’ve got to set the culture. You’ve got to get culture to move along with the mission and the vision. I mean the culture of excellence in caring for people, for example. When you walk down the hallway, whistle and smile. If you don’t do that naturally, figure out a way to do it. That culture means people are friendly. People like friendly people. People buy from friendly people.
IMAGING ECONOMICS: As radiology becomes more distributed, what are the implications for the structure of the department?
RHYNUS: Everybody is in the same boat. Interdependency and support are really what imaging is now. It’s going to be more of that. How are we going to work with, instead of for, specialties? For example, cardiology for a long time has been doing peripheral vascular run-off work. Cardiologists have the patients and control of the patients in the sense of a referral mode. When they see a patient for a coronary angiogram, they can take a quick look down the legs. Will cardiologists begin to do carotid stenting and maybe even move into intracerebral work? That’s challenging. It’s outside the normal scope, but so was peripheral vascular.
Then what happens is the radiologist begins to feel that the cardiologist will do the peripheral vascular cases Monday to Friday, 8-5, and particularly those patients that have a good payor profile. For the ones that come in at 2 AM Saturday morning, and they’re not insured, probably the radiologist will get a call to do those cases. That really doesn’t work very well in a distributive model. But who is going to step up and say to the various specialties, “OK, folks, we have to play nice here”? It gets down to cash and lifestyle and quality of life issues. Those are the challenges that we are facing and will continue to face until there’s some cooperation. I think the world, not just America, is in this quandary with these disruptive technologiesMR—focused, guided ultrasound ablations and so many new imaging procedures cross traditional lines.
At Florida Hospital, we are networking with consultants who are interacting with their customers across the nation and around the world to say, Who has the best model? What is the model that is going to work and have survivability? I don’t think that anybody has come up with the silver bullet on that one. It’s not the old style model we’ve been comfortable with. It goes back to that crucial conversation issue—we’ve got to say, let’s go to a higher issue, what’s best for the patients, for the community and for our industry?
I’m right in the hot seat here. My administrators are saying, please make sure the radiologists play nice with the cardiologists, let’s get this working collegially. I say, I’m not sure I can accomplish that. It has to come from senior administration, yet I’ve got to help facilitate. So when I have the opportunity, I’ve got to say, “This will be better for our patients.” I have to help physicians, and to plant the seed whenever I can as to how to best do things. There are a lot of smart people working on these issues. I don’t think anybody has the answer yet.
IMAGING ECONOMICS : What about the chain of command and to whom radiology administrators will be reporting, will that change?
RHYNUS: I’m not seeing a clear model come out that’s different than what we’ve had. Imaging is definitely getting more play with all the specialties. In that regard, we’ve got to “report” to them. I’ve got to make sure of my turnaround time on breast biopsy localizations, for instance. The surgeon is waiting for that. If I’m dilly-dallying and not prioritizing that exam, that can waste a lot of resources. I work for that surgeon at that point in time.
A radiology administrator gets to report to many people. I report to the senior VP, but I also report to each radiologist and to each of my directors. If my role is not supportive wherever I go, then I’m not doing a good job. If I hold something up, the trickle-down effect can cause real problems.
IMAGING ECONOMICS: What about the relationship between the administrator and the radiology chief or chair? In the past some administrators have felt like they were walking on eggshells around a prima donna who didn’t necessarily have the business interests of the department in hand. What is the ideal chairman/administrator relationship in your view?
RHYNUS: The relationship has got to be good. It has to be based on a culture of mutual respect. It’s so much easier when you can agree to disagree and work on resolutions to problems. If you’re working with a prima donna, you have to use leverage and know how to carry on a crucial conversation. My responsibility is to move the business side of imaging along, and I’ve got to maintain patient care. If I’ve got somebody who’s not moving in the same direction, I’ve got to use all the resources I have to turn that around. We’ve got to make sure our staff has the skill set and tools to either shield or infuse common decency in those scenarios. You can go to “silence or violence” or you can handle it appropriately. We have to give our team the best skill set and tools, and to improve on communication.
IMAGING ECONOMICS: What is the role of the American Healthcare Radiology Administrators (AHRA)? A new director has been named. What will be the challenges awaiting that person?
RHYNUS: He will experience many of the same challenges we all face.
This question is really better suited for an AHRA board member, but I think one challenge will be to increase involvement by more members. The problem is we, as an association, are asking for more support at a time when everybody is wishing we could get a split on our hours. I suspect we would all love to have a 48 hour workday, but I bet it would get just as full.
The more people you know outside your own institution, the more access you have to good data, the better decision you can make. It’s all about more.
George Wiley is a contributing writer for Decisions in Axis Imaging News.
