Flipping a Hospital-Based IR Practice

Dr. Gueyikian first discusses his career path, from his academic training, to building an IR department in a suburban hospital, to having a chief role within a multicenter practice. All of these roles were taken on in the efforts to grow different IR practices. With each job transition, he notes that it is important to not only pay attention to who was asking him to change the department, but also who had the power to allocate resources and support for his changes. Discrepant goals between diagnostic radiology (DR) partners and hospital administrators present frustrating situations, so it is recommended to outline these challenges before signing on. Additionally, Dr. Gueyikian speaks about the importance of defining boundaries for your IR service. For example, simple procedures that can be done under basic fluoroscopy do not make the best use of the IR suite, so they should be performed at bedside or within the DR setting. Prioritizing IR time and space for complex procedures ensures that resources are being put to good use and fight burnout among IRs and staff.

In terms of increasing efficiency. Dr. Gueyikian ensures that there are pre-procedural protocols that can be widely disseminated. He says that it is important to establish mutual expectations for lab tests and supplies needed before each type of procedure, in order to enhance patient safety and job satisfaction for everyone on the team. Additionally, advance communication with colleagues about scheduling cases for each day can help ensure that workload is fairly distributed.

Finally, we discuss ways to negotiate with resistors to change, whether these are DRs, hospital administrators, or referring specialists. Dr. Gueyikian highlights the utility of re-framing clinical errors as opportunities for change. Addressing the gaps in the status quo, while also making the effort to understand resistors’ concerns, can increase support for your ideas.