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JRCERT Update

Change Management: An Overview of

3 Models of Change

Melissa A Davis, MD
James V Rawson, MD

adiology has been on the forefront of change in perceived value. Machine learning advances will change
the health care field since the discovery of the the landscape of radiologic practice, but radiologists will
x-ray by Wilhelm Roentgen in 1895. Since this determine what radiological practice looks like in the
Rtime, radiology has embraced advances and new future. One of the largest tasks that radiologists have is
technology, including new modalities (eg, computed determining how to handle innovation and change at
tomography [CT], magnetic resonance [MR] imaging), all levels of their organization while maintaining patient
the shift from film to digital images, and minimally inva- safety, security, and quality. 2,3
sive image-guided procedures. As a specialty, radiology Change management throughout an organiza-
continues to be a driving force for advancements in med- tion is challenging, but it is something that radiology
ical practice, moving toward a more patient-centered leaders must be well versed in. In the business sector,
approach to care. With technological advancements there has been a large emphasis on adapting transfor-
come the potential for disruption throughout the health mational tools to improve quality, safety, customer
care field. With the advent of the PACS, now referred to satisfaction, and profit margins. John Kotter’s 8-step
as the medical image management and processing system process for leading change was recently reviewed.
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(MIMPS), radiologists were no longer the sole propri- Another noteworthy example of adaptation tools is
etors of an image because images could now be shared lean process improvement and its predecessor Toyota
with the spectrum of the patient’s caregivers. Advance- Production System. The objective of the Toyota
ments in equipment, image storage and sharing, and Production System is to create a system that designs
dictation have further allowed radiologists to be a out inconsistencies, eliminates waste, and decreases
disruptive force in health care, thereby streamlining unreasonable excessiveness—mura, muda, muri in
diagnosis and treatment of patients through increased Japanese. Lean processing has evolved as an efficient
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efficiencies. Although these advancements increased way to implement the ideals of the Toyota Production
radiologists’ efficiency, they also opened the door to System into the hospital setting. However, there often
commoditization of the specialty. is a disconnect between implementing change in the
Recent innovations in health care have focused on clinical setting and understanding whether the culture
changes in payment mechanisms, through bundled pay- of the staff is primed and ready to implement change at
ments and capitation, and machine learning. Payment all levels of the organization. As a result, efforts to make
reform has shifted direction from fee-for-service to improvements often are short lived.
value-based purchasing. Under this paradigm, imaging There are several models of change in the business
is moving from a profit center for hospitals and large literature that give insight into leading organizations
groups to a cost center. Machine learning has a higher through change. Three models provide various tactics
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potential for disrupting radiologist workflows because for implementing new paradigms into an organization.
of its potential to decrease overall costs and increase These include the transtheoretical model, the diffusion
efficiencies in patient care. This potential for disruption of innovation model, and plan-do-study-act (PDSA).
causes much angst for many radiologists because of the Each of these models has strengths and weaknesses.
potential for job displacement and decreased individual Matching the model to the type of change needed, as

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