By Dr. Geoffrey Rubin, AuntMinnie.com contributing writer

September 5, 2017 -- You are now the chief of your department and about to attend your first capital budget meeting. Your hospital service line director has submitted a new business plan. It makes the case that the hospital should replace the 15-year-old MR scanner with a brand-new, state-of-the-art machine. That's quite an investment.

You want to set yourself up for success. You want to demonstrate your value to the executive committee, and you want to show your department's value to the hospital. What do you do? Here are six things that can help:

Dr. Geoffrey Rubin
Dr. Geoffrey Rubin from Duke University and the Radiology Leadership Institute.

1. Know the plan

First: Read the plan. Don't accept it and put it away, or flag it in the email and think you will come back to it later. Read it through. Is the right scanner model being requested? Does it have the right features? Are you asking for the new machine for the right reasons?

Does what is written in the plan represent the priorities of you and your group? Are the most cogent arguments in favor of the purchase included? And are the risks of not purchasing included? Are the consequences of not upgrading spelled out? What are the benefits if the upgrade is performed? And most importantly, are all of these arguments backed up with data? Data are important for hospital stakeholders. So when you are confronted with data tables and calculations, you need to ask yourself: Do I understand them?

You are probably going to get three types of data:

  • Operations: This might relate to clinical volumes, with different services and perhaps backlogs at certain times of the day.
  • Marketing: What is the opportunity for growth in the community in different service lines?
  • Finance: This will likely be a time series analysis that looks at performance over time. You will be confronted with discount rates and the time value of money and net present value (NPV). Become familiar with these. Ask yourself: Are the numbers on the page correct? Don't assume that a hospital administrator (who may have a finance title) has made the right assumptions and understands your business. If the numbers seem off, verify them with your colleagues.

2. Know the service line director

Now that you're armed with a strong understanding of the plan, your next step is to meet with the service line director. Get his or her view on the plan and see if you two are aligned. Are the director's reasons for supporting the upgrade in line with your group's reasons? Do this beforehand so that if there are differences in views, you can figure out the gaps in understanding.

Share strategy with the service line director. How are you going to approach the meeting? Who are the key people with whom you need to engage to ensure a successful outcome? Use that person for insights into the tendencies and priorities of other top hospital stakeholders.

3. Know the players at the table

You will need to know who the ultimate decision-maker is before entering the room. Is it the CEO or the chief financial officer? And who is likely to have the greatest influence on the decision-maker? Who will that decision-maker listen to and for what reasons? If you know who those persons are, you may be able to find out or anticipate if they are likely to support or block your goals.

And you will need to know who else is going to be at that table and what their roles are. Do your homework on the individuals in the room. What are their tendencies? What are their "hot buttons"? Knowing their desired outcomes will give you a strong strategic advantage for understanding how to proceed in the meeting. Knowing this beforehand will allow you to predict possible challenges.

4. Know the culture

Culture is a big topic. Your radiology department has a culture, as does the radiology group and the hospital. And there is a culture amongst the executive committee. When you first walk into the meeting, gauge the feel of the room. Is chummy banter the standard? Or does everyone sit silently until granted the floor by the CEO?

You should also consider if there is an official seating chart. Even little things like knowing if it's OK to eat or check your phone or emails during the meeting can affect how you are perceived -- and, by extension, how well your message resonates.

Understanding the nuances of the culture will help assure your colleagues that you are the right person for the job and ensure that you are accepted by the committee. This can result in a stronger degree of respect and credibility.

5. Know your role

You know who you are. But does everybody else in the room? Do not underestimate the respect your experience and knowledge should provide you. Is there any doubt about the value of having an imaging expert in the room to explore a potential investment in a new MR scanner? If so, then it is up to you to help them understand what that value is.

Be prepared to articulate your experience and why your expertise is required for this type of decision. But also position yourself as a team player, particularly early on in the executive committee.

It is important for people to appreciate that you are not just there to get wins for radiology. You need to demonstrate that you understand your role as a steward for the larger organization and that other people in the room have important priorities as well. By supporting their priorities, they will, in turn, support yours. Think critically about how you can offer positive contributions to other people at the meeting who are making requests or who simply need support.

6. Know the handouts

Finally, right before the meeting, you may get an email that has a dozen or more 30- to 50-page PDFs or a big binder that has been prepared for you, complete with tabbed sections. Whenever possible, make time to go over the entire set of handouts. This is important to help you understand the scope of what will be covered during the meeting. It will allow you to identify areas where you can substantively contribute, demonstrate your value, and show that you are a team player.

The big picture here is just to remember the Scout Motto: Be prepared. Be prepared to represent the department. Be prepared to show yourself as a team player for the hospital as a whole.

This will set you up for the greatest opportunity to finally get that 15-year-old MR scanner replaced. It will also lay the groundwork for long-term respect as someone who belongs in the room when big decisions are made.

Dr. Geoffrey Rubin is a professor of radiology and bioengineering at Duke University, where he previously served as chair of radiology. He is a board member of the Radiology Leadership Institute (RLI), chair of the American College of Radiology Education Innovation Committee, and co-chair of RadiologyInfo.org. Rubin is also the president and board chair of the International Society for Computed Tomography.

For more insights into how to handle new leadership positions, listen to the RLI Leadership Insider Podcast episode featuring Rubin and Dr. Geraldine McGinty as they discuss the key items any new leader should know.


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