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Ultrasound departments are consistently challenged with increasing patient loads, backlog/access, repetitive stress injuries, operator dependent technology, and the recruitment and retention of qualified sonographers. The value of the volume ultrasound workflow will dramatically enhance the operations of any ultrasound department. Although change is always a stressful transition for everyone involved, perserverance will lead to great rewards and will benefit all personnel involved. Sonographers currently using this new workflow model state they will never turn back to the traditional 2D stillframe repetitive imaging from the ability to reconstruct volumes and visualize in the 3 orthogonal planes. Together, volume imaging workflow and structured reporting will shift work from the scan rooms and radiologist reading rooms to a central workstation. This technology is truly changing the traditional and less efficient workflow of the ultrasound department to a more consistent and easier way of working.

The radiology manager can be influential in promoting group cohesiveness within the department. Identifying qualities that radiology managers believe to be descriptive of cohesive work teams could be very informative for other radiology managers. The surveyed radiology managers had a positive perception of their work groups based on the factors that promote cohesion and achievement. The survey instrument developed has high internal correlation for future use with other radiology managers and employee groups. Continued research is needed to determine if these group results are indicative of the larger field of radiology management

For the first time in history, radiologic science (RS) workplaces consist of 4 generational cohorts. As each cohort possess their own attitudes, values, work habits, and expectations, motivating a generational diverse workplace is challenging. Through the understanding of generational differences, managers are better able to accommodate individual as well as generational needs and help create a more productive and higher performing workplace. The purpose of this paper is to assist managers in the understanding and utilization of generational differences to effectively motivate staff in an RS workplace. Generational cohorts will be defined and discussed along with an in-depth discussion on each of the generations performing in today's RS workplace. Motivators and how they impact the different generational cohorts will be addressed along with how to best motivate a multigenerational RS workplace.

This article encompasses the basics of branding and how it relates to radiology organizations. It also provides tools to help develop your brand. To effectively use branding as a component of your marketing strategy, it is important to follow 3 basic principles: focus on where you excel, understand the existing markets, and be consistent. You do not need to be a large hospital, imaging center, or department to create a brand identity.

Productivity is defined as the efficient and effective use of resources with minimum waste and effort to achieve outcome. We live in a world that has limited resources. The health care industry faces this limitation more than any other industry. With these challenges facing health care administrators, the concept of productivity, job satisfaction and motivation become very important. Employee satisfaction and retention have always been an important issue for physicians, medical centers and businesses in general. Conventional human resources theories, developed some 50 years ago by Maslow and Herzberg, suggest that satisfied employees tend to be more productive, creative and committed to their employers. People are essential to productivity. The success of productivity improvement strategy is dependent on employee commitment, job satisfaction, skills, and motivation. Maslow's theory consists of a 5-level pyramid: physiologic or basic survival; physical and mental safety; sense of belonging; accomplishment, creativity, and growth; and self-actualization. Herzberg's theory suggests there are 2 groups of factors: hygiene (which satisfy) and motivation. The terms "job satisfaction" and "motivation" have, in my experience, become used interchangeably. There is a difference. Job satisfaction is an individual's emotional response to his or her current job condition, while motivation is the driving force to pursue and satisfy one's needs. Maslow and Herzberg's theories can be easily applied to the workplace. Managers can help employees achieve overall job satisfaction, which, with the employee's internal motivation drive, increase performance on the job.

Launching a new diagnostic imaging center involves very specific requirements and roadmaps, including five major areas of change that have a direct impact on planning: Imaging and communication technology Finances and reimbursement Ownership structure of imaging entities Critical workforce shortages Imaging is moving outside radiology First, planning must focus on the strategic level of any organization, whether it is a multi-national corporation or a six-person radiology group. Think of all organizations as a triangle with three horizontal levels: strategic, managerial and operational. The strategic level of decision-making is at the top of the triangle, and here is where planning must take place. For strategic planning to work, there must be focused time and energy spent on this activity, usually away from the reading room and imaging center. There are five planning strategies, which must have the explicit goal of developing and growing the imaging center. The five strategies are: Clinical and quality issues, Governance and administration, Technology, Relationships, Marketing and business development. The best way to plan and implement these strategies is to create work groups of radiologists, technologists, and administrative and support staff. Once the group agrees on the strategy and tactic, it takes responsibility for implementation. Embarking on the launch of a new outpatient diagnostic imaging center is no small undertaking, and anyone who has struggled with such an endeavor can readily attest to the associated challenges and benefits. Success depends on many things, and one of the most important factors relates to the amount of time and the quality of effort spent on strategic planning at the outset. Neglecting or skimping on this phase may lead to unforeseen obstacles that could potentially derail the project.

The AHRA CRA examination development process is based on the sampling plan (or test blueprint) developed from the role delineation study implemented in 2001. Panels of radiology administration experts have written and validated multiple-choice questions and assembled the first version in accordance with the test blueprint. The number of questions in each domain is listed in Table 2.

Radiology administrators may need to rethink their responsibilities in light of the generation gap. They should provide leadership for the broader changes to come by listening to staff members both as individuals and as representatives of their generation. Administrators can restore harmony by getting people focused on mission instead of personalities. They should get every person's input about missions, goals and roles; promote ongoing dialogue; and seek buy-in. The administrator must be sensitive to the potential of each group. He should direct each individual to discover and attain his or her full potentials and guide individuals to levels of accomplishment that they might not otherwise reach.

On January 4, 2001, the Health Care Financing Administration (now the Center for Medicare and Medicaid Services or CMS) issued Phase I of the final Stark II regulations (Final Rule). The Final Rule implements the Ethics in Patient Referral Act of 1989 (Stark I), as amended by the Omnibus Budget and Reconciliation Act of 1993 (Stark II), collectively the Stark Law. It is intended to provide more flexibility to providers by interpreting the prohibitions narrowly and the exceptions broadly. Generally, the Stark Law prohibits physicians from referring Medicare or Medicaid patients to an entity for the provision of "designated health services (DHS)" if the physician (or a member of the physician's immediate family) has a direct or indirect financial relationship with the entity. The Final Rule establishes two principal exceptions to the referral prohibition that apply to both ownership/investment interests and compensation arrangements. The physician service exception permits referrals for DHS that are furnished by a member or physician in the same group practice as the referring physician, or under their supervision. The in-office ancillary services exception permits referral for provision of DHS in the same building in which the referring physician or his group routinely provides the full range of the group's or physician's medical services. The final regulations redefine the prior description of radiology and radiation therapy services subject to Stark II. The principal change is to segregate radiation therapy and supplies from radiology and other imaging services. It is uncertain whether Stark Law enforcement will be a priority under the Bush Administration. Nonetheless, because the Final Rule offers more flexibility than the proposed rule, providers and suppliers should revisit proposed and abandoned arrangements that they believed to be prohibited.

For many decades the practice of radiology grew slowly in America and was largely a secondary function under the control of hospitals. In more recent times it has vastly expanded its array of diagnostic, interventional, and therapeutic abilities. There is increasing consumer logic for direct access. Motivations have grown to create large independent entities with broadly diverse capabilities in order to succeed in the new millennium. Most regional markets are evolving rapidly in terms of managed care penetration, health system formation, physician practice consolidation and aggressive purchaser behavior by employers and consumers. To understand the enormity of healthcare evolution, it is useful to look at the industry's paradigm shifts in recent decades. Virtually every aspect of organizational infrastructure, delivery approaches, and the business environment has evolved markedly during the past fifty years. These changes will accelerate. To succeed financially, radiology groups must strengthen their market positions, technical capabilities, continuums of care and geographic dominance. Equally important is the wisdom of diversifying incomes into related services and businesses that provide additional related revenues. Key factors for successful development include facility market growth, full coverage of managed care contracts, high efficiency and aggressive diversification. A fully evolved system generates significant revenues and profitability by protecting and strengthening its financial position in this environment. That is accomplished through the development of strategically located radiology groups, aggressive alliances with medical practices in allied disciplines, and managed radiology departments and facilities for partner health systems. Organizational success ultimately depends on the ability to accept capitated payments under risk-bearing arrangements. The strategic business plan should be organized with the appropriate levels of detail needed to establish executive focus and priorities. These should be woven into operational and capital budgets to reflect expectations of the revenues, expenses and investments tied to the plan. While formidable, all of these objectives are realistic and can be accomplished if the right decisions are made. Initially, the entity's principle business objective is to formulate and begin implementation of methodical yet aggressive strategies for growth that are sensitive to sustaining high levels of quality patient care. The next phase features mergers with large, independent radiology practices in key geographic areas and successful acquisition of smaller practices. The objective of the final phase is to aggressively expand into select metropolitan areas with regional coverage and full teleradiology capabilities. High levels of market strength and financial performance are necessary to succeed. Passive limitations to small geographic areas and narrow practices will undermine their market position and dissolve financial strength with no hope of recovery. Only the dominant systems will survive and prosper.

Opportunities for minorities in healthcare increased with the Civil Rights movement in the 1960s. More recently, funds from the U.S. Public Health Service have been targeted toward disadvantaged minorities. The workforce in healthcare, and in business in general, has become increasingly multicultural. Much of the literature in healthcare management lacks practical guidelines for managing a diverse workforce. Communication, both verbal and nonverbal, and culture are closely intertwined. Managers, as they develop multicultural teams, will need to understand how culture influences communication in their organizations. Space, spatial behavior, and cultural attitudes influence people's behavior. This is a particularly important consideration for a radiology staff, which must often work in close quarters. For some cultural groups, the family as an organization has more significance than even personal, work-related or national causes. People's orientation to time, whether for the past, present or future, is usually related to the culture in which they grew up. Again, this may become an important issue for a radiology administrator whose organization must run punctually and time-efficiently. How patients feel about their environment, whether they believe they are in control or believe in an external locus of control, is of particular interest to those who attempt therapeutic changes in a patient's healthcare. Does the patient believe that illness is divine will or that suffering is intrinsic to the human condition? There is increasing research in the United States to show that people do differ biologically according to race. Such differences exist among patients as well as among staff members. It has been popular to assume that differences among races do not exist. Unfortunately such an attitude does not allow for different attributes and responses of individuals. Managing a multicultural staff presents a challenge to administrators who must be skilled in working with culturally diverse people and must help their staff members do the same.

Radiology administrators are experts able to provide radiography educators with the input they need to produce competent graduates. This article reports on the view of a group of leaders in radiology administration regarding the need for, and the skills needed by, baccalaureate graduates in radiography to meet the needs of the future. In general, there was support for the baccalaureate graduate as an adjunct to the two-year graduate, although some felt that baccalaureate programs would provide inadequate technical preparation. The results of this research were used in a strategic plan for the development of a new baccalaureate program in radiography.

This report, from the Chairman of the 1991-92 Long Range Planning Committee, outlines the AHRA's strategic plan. Mr. Schwartz presents some strategic management challenges and self-assessment models and identifies the key trends impacting radiology management. He also defines the AHRA's customers and competitors, products and services, strengths and weaknesses, and presents the AHRA's "distinctive competence" statement, which identifies the major assets of the association. He concludes with an outline of the AHRA's five primary businesses.

According to the author, radiology managers can improve staff morale, increase commitment to patient care and decrease their workloads by "reversing the hierarchy" and empowering their staff. Despite what some managers may think, she says, employees can make good decisions and stay committed if they are given authority, encouragement and trust. She also describes some of the steps managers can take to reverse the hierarchy at their organizations.

"To be effective, coaches need to exercise different forms of power," writes Dr. Herakovic in lesson two of his correspondence course on coaching and counseling employees. According to the professor, power has five forms: reward, coercive, legitimate, referent (charismatic) and expert power. He defines the five types of power and describes the uses and abuses of each type.

Many hospitals are exploring free-standing facilities as an option for providing more efficient imaging services. Mr. Brown discusses the pros and cons of an emerging building technology, manufactured construction, in which building and site preparation are done simultaneously. He presents the criteria managers should use to make a knowledgeable decision.

The Statistical Resource Committee surveyed 1,232 AHRA members in March 1990 to determine their current responsibilities and related salaries. Part I of this report reviews respondents' responsibilities, administrative relationships, job satisfaction, level of education and the level of institutional support for educational seminars. Part II, scheduled for reporting in the fall issue of Radiology Management, will review data extracted on radiology administrators' salaries and related responsibilities for procedure volume, budgets, departments, FTEs, institutional committees, and education programs.

The AHRA has made considerable progress in the past few years in expanding its liaison activities to an international level. Mr. Osborn, the association's Coordinator for International Relations, traces the development of this effort and looks at goals and objectives for the future.