OPINION
Networking Richard B. Gunderman, MD, PhD, William D. Kerridge, MD One of the more thought-provoking presentations at the July 2013 ACR Radiology Leadership Institute course held at the Kellogg School of Management at Northwestern University was offered by Kellogg faculty member Brian Uzzi. The topic was networking, a subject of particular importance to radiology leaders. Leader performance hinges in large part on effective networking, yet the topic is rarely addressed in medical schools or radiology residency programs. Uzzi illustrated the importance of the topic with reference to the US revolutionary-era midnight ride of Paul Revere, the purpose of which was to warn colonialists that the British were coming and summon militias. Another rider, William Dawes, left in the opposite direction, and in fact rode more miles and warned more people. Yet Dawes was considerably less effective at calling forth militias than Revere. Why? As Uzzi sees it, the crucial difference between Revere and Dawes was the fact that Revere was the far better networked of the two [1]. Most of the people Dawes notified resembled him and were thus part of the same echo chamber. They only told people like themselves and did not do a good job of reaching others. By contrast, Revere was networked with people in a variety of walks of life, who helped spread the message far beyond small circles of similar people. In contrast to Dawes, Revere was an “information broker.” In his Radiology Leadership Institute presentation and published work, Uzzi also describes the crucial role networking played in the early career of Bill Gates [1]. Gates’s mother served on the board of the United Way with IBM executive John Akers, and this connection provided a vital link between the hardware giant and a tiny startup software company called Microsoft. Because of this connection, Gates and his company had the
opportunity to land the contract for the operating software for IBM’s personal computers, subsequently known as MS-DOS. Uzzi argues that networking offers 3 crucial advantages. First, it gives well-connected people access to “private” information not accessible via official channels. With so much information available across the board on the internet, access to such private information provides even greater value than it did in the past. Those who have access to it can make better informed judgments and seize opportunities sooner than others who lack it. Second, networking provides access to diverse skill sets, an advantage that has become progressively more important as the field of radiology, the profession of medicine, and knowledge in general have become more and more specialized. Those who can bridge such knowledge domains often perceive and make connections that escape those who view matters from the perspective of a smaller number of disciplines or fields. Third, most effective organizations have tended to become more horizontally, as opposed to vertically, organized over the past several decades. The people at the top of the organizational chart do not necessarily exercise the most power, and information brokers can often exercise greater power by connecting different parts of the organization, as well as by connecting the organization with external constituencies. Uzzi offered several principles by which radiologists can determine how well networked they are. One is the self-similarity principle. Most of us have a natural tendency to interact with people who are like us and to avoid people from whom we differ in substantial ways. This is a self-defeating strategy, in part because people who simply echo one another’s sentiments are less likely to
ª 2014 American College of Radiology 1546-1440/13/$36.00 http://dx.doi.org/10.1016/j.jacr.2013.11.001
encounter new ideas and therefore operate at a competitive disadvantage when it comes to creativity. Another principle concerns proximity. We have a natural tendency to network with the people we spend the most time with, which often means that we network with others in our own section, department, school, hospital, and so on. Such people tend to have similar backgrounds, similar training, and similar ideas. Again, our networks end up seeming very homogeneous and narrowly circumscribed, depriving us of the kind of genuinely diverse perspectives that promote innovation. The final principle concerns shared activities. Simply put, it is important that we organize our work and our lives so that we regularly share activities with people who differ from us. This means seeking opportunities to interact with nonradiologists, nonphysicians, nonehealth care workers, people from other places and cultures, people of different ages, and so on. Great opportunities can include sports teams, book clubs, community service, and faith communities, among many others. What do such shared activities need to have in common? Generally, they need to evoke genuine passion and have something at stake in them, so that they have the potential to build relationships on the basis of trust. If we are not passionate about such activities, we are unlikely to stick with them, depriving us of the opportunity to develop such relationships with people who differ from us. The key is to come together with others around a common goal. Naturally, solo activities do not offer this benefit. Consider some practical examples beyond those offered by Uzzi. Some consultants and companies specialize in helping organizations diagnose their networks to spur collaboration and creativity. Through observation, surveys, and other diagnostic testing, 1
2 Opinion
it is possible to identify the information brokers within an organization. With this information in hand, it is possible to bring such people together regularly to better stimulate innovation and its adoption. Applying such an approach can help an organization turn a setback or even a disaster into an opportunity. For example, a major aircraft manufacturer lost one of its plants to a natural disaster. Employees had to be sent to other facilities. When several dozen engineers were temporarily placed on the production floor, they began to interact with workers in new ways and achieved marked increases in productivity. So impressed were the engineers that they eventually asked to remain there [2]. As radiologists think about networking, they need to ask themselves some fundamental questions. First, who are the information brokers within the radiology department, among different departments in the medical school and hospital, or between the medical center and the larger community? Perhaps even more important, who can become such information brokers, and what would it take to help them do an even better job of networking? Ironically, many radiology departments already resemble a hub on which the spokes of a variety of different specialists and departments converge, connecting key constituencies in health care. Radiology is in many respects extremely well positioned as a networker, in part because of its regular contact with a wide variety of disciplines and in part because of its long experience with increasingly important integrative resources such as IT. What might enhanced networking look like in a contemporary radiology department? Some institutions offer fine examples. Radiologists can
reposition their reading rooms in closer proximity to the patients and referring physicians they are serving. For example, emergency radiologists can be stationed in the emergency department, and musculoskeletal radiologists can position their reading rooms in the orthopedic clinic. In some cases, however, radiologists do just the opposite. Reading rooms are located at a distance from patients and referring physicians. Moreover, some radiologists are located in the midst of a veritable maze of hallways with poor signage, behind closed and even locked doors. Even when a referring physician manages to find one either by phone or in person, that radiologist sometimes proves less than helpful. Many have become invisible to patients and colleagues. Such practices undermine networking and thereby undermine the field of radiology and the radiologists who practice it. As we move into an era of bundled care, interdisciplinary collaboration, and accountable care organizations, it is becoming more important than ever that radiologists think outside the box, becoming not just imaging gatekeepers but true information brokers who bring valuable transdisciplinary perspectives to patients and enhance patient care systems. Similar challenges arise in other areas of radiology. For example, the ABR recently implemented a number of major changes in areas such as the board certification examinations and maintenance of certification. Such changes have provoked considerable consternation among key constituencies, such as radiology educators, program directors, trainees, and practicing radiologists, provoking what some associated with the board view as a surprising backlash.
How did this happen? Viewing the situation from the outside, it is difficult to know for certain, but it is possible that the ABR’s staff and board members found themselves unknowingly functioning as echo chambers, reinforcing one another’s enthusiasms without engaging those who would live with the changes day to day in sufficiently rich conversations around their impact. Whether this is true of not, any organization that allows itself to become an echo chamber is in for trouble. Such organizations need neither yes people nor naysayers. However, most do have a tendency to populate themselves with people who share the vision of a few leaders, unconsciously excluding diverse points of view from the conversation. They focus more on implementing than listening. One means of avoiding and recovering from such pitfalls is to actively seek out people with alternative points of view, who can raise important questions about unspoken assumptions. The payoff of better networking can be no less substantial for individual radiologists. For one thing, personal networking often plays a crucial role in finding a job. Once a position has been secured, networking can contribute mightily to enhanced performance in patient care, education, and research. Many of the most successful radiologists in each sphere are devoted networkers. Likewise, networking should be a major focus of every radiology leader. The vitality of the field depends on it.
REFERENCES 1. Uzzi B, Dunlap S. How to build your network. Harv Bus Rev 2005;83:53-60. 2. Steelcase. Case study: the Boeing Company. 737 programs and Renton Wash. site. Available at: http://360.steelcase.com/wpcontent/uploads/2011/02/Boeing.pdf. Accessed October 28, 2013.
Richard B. Gunderman, MD, PhD, and William D. Kerridge, MD, are from the Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana. Richard B. Gunderman, MD, PhD, Department of Radiology, Indiana University School of Medicine, 702 Barnhill Drive, Room 1053, Indianapolis, IN 46202-5200; e-mail: [email protected].
Networking Richard B. Gunderman, MD, PhD, William D. Kerridge, MD One of the more thought-provoking presentations at the July 2013 ACR Radiology Leadership Institute course held at the Kellogg School of Management at Northwestern University was offered by Kellogg faculty member Brian Uzzi. The topic was networking, a subject of particular importance to radiology leaders. Leader performance hinges in large part on effective networking, yet the topic is rarely addressed in medical schools or radiology residency programs. Uzzi illustrated the importance of the topic with reference to the US revolutionary-era midnight ride of Paul Revere, the purpose of which was to warn colonialists that the British were coming and summon militias. Another rider, William Dawes, left in the opposite direction, and in fact rode more miles and warned more people. Yet Dawes was considerably less effective at calling forth militias than Revere. Why? As Uzzi sees it, the crucial difference between Revere and Dawes was the fact that Revere was the far better networked of the two [1]. Most of the people Dawes notified resembled him and were thus part of the same echo chamber. They only told people like themselves and did not do a good job of reaching others. By contrast, Revere was networked with people in a variety of walks of life, who helped spread the message far beyond small circles of similar people. In contrast to Dawes, Revere was an “information broker.” In his Radiology Leadership Institute presentation and published work, Uzzi also describes the crucial role networking played in the early career of Bill Gates [1]. Gates’s mother served on the board of the United Way with IBM executive John Akers, and this connection provided a vital link between the hardware giant and a tiny startup software company called Microsoft. Because of this connection, Gates and his company had the
opportunity to land the contract for the operating software for IBM’s personal computers, subsequently known as MS-DOS. Uzzi argues that networking offers 3 crucial advantages. First, it gives well-connected people access to “private” information not accessible via official channels. With so much information available across the board on the internet, access to such private information provides even greater value than it did in the past. Those who have access to it can make better informed judgments and seize opportunities sooner than others who lack it. Second, networking provides access to diverse skill sets, an advantage that has become progressively more important as the field of radiology, the profession of medicine, and knowledge in general have become more and more specialized. Those who can bridge such knowledge domains often perceive and make connections that escape those who view matters from the perspective of a smaller number of disciplines or fields. Third, most effective organizations have tended to become more horizontally, as opposed to vertically, organized over the past several decades. The people at the top of the organizational chart do not necessarily exercise the most power, and information brokers can often exercise greater power by connecting different parts of the organization, as well as by connecting the organization with external constituencies. Uzzi offered several principles by which radiologists can determine how well networked they are. One is the self-similarity principle. Most of us have a natural tendency to interact with people who are like us and to avoid people from whom we differ in substantial ways. This is a self-defeating strategy, in part because people who simply echo one another’s sentiments are less likely to
ª 2014 American College of Radiology 1546-1440/13/$36.00 http://dx.doi.org/10.1016/j.jacr.2013.11.001
encounter new ideas and therefore operate at a competitive disadvantage when it comes to creativity. Another principle concerns proximity. We have a natural tendency to network with the people we spend the most time with, which often means that we network with others in our own section, department, school, hospital, and so on. Such people tend to have similar backgrounds, similar training, and similar ideas. Again, our networks end up seeming very homogeneous and narrowly circumscribed, depriving us of the kind of genuinely diverse perspectives that promote innovation. The final principle concerns shared activities. Simply put, it is important that we organize our work and our lives so that we regularly share activities with people who differ from us. This means seeking opportunities to interact with nonradiologists, nonphysicians, nonehealth care workers, people from other places and cultures, people of different ages, and so on. Great opportunities can include sports teams, book clubs, community service, and faith communities, among many others. What do such shared activities need to have in common? Generally, they need to evoke genuine passion and have something at stake in them, so that they have the potential to build relationships on the basis of trust. If we are not passionate about such activities, we are unlikely to stick with them, depriving us of the opportunity to develop such relationships with people who differ from us. The key is to come together with others around a common goal. Naturally, solo activities do not offer this benefit. Consider some practical examples beyond those offered by Uzzi. Some consultants and companies specialize in helping organizations diagnose their networks to spur collaboration and creativity. Through observation, surveys, and other diagnostic testing, 1
2 Opinion
it is possible to identify the information brokers within an organization. With this information in hand, it is possible to bring such people together regularly to better stimulate innovation and its adoption. Applying such an approach can help an organization turn a setback or even a disaster into an opportunity. For example, a major aircraft manufacturer lost one of its plants to a natural disaster. Employees had to be sent to other facilities. When several dozen engineers were temporarily placed on the production floor, they began to interact with workers in new ways and achieved marked increases in productivity. So impressed were the engineers that they eventually asked to remain there [2]. As radiologists think about networking, they need to ask themselves some fundamental questions. First, who are the information brokers within the radiology department, among different departments in the medical school and hospital, or between the medical center and the larger community? Perhaps even more important, who can become such information brokers, and what would it take to help them do an even better job of networking? Ironically, many radiology departments already resemble a hub on which the spokes of a variety of different specialists and departments converge, connecting key constituencies in health care. Radiology is in many respects extremely well positioned as a networker, in part because of its regular contact with a wide variety of disciplines and in part because of its long experience with increasingly important integrative resources such as IT. What might enhanced networking look like in a contemporary radiology department? Some institutions offer fine examples. Radiologists can
reposition their reading rooms in closer proximity to the patients and referring physicians they are serving. For example, emergency radiologists can be stationed in the emergency department, and musculoskeletal radiologists can position their reading rooms in the orthopedic clinic. In some cases, however, radiologists do just the opposite. Reading rooms are located at a distance from patients and referring physicians. Moreover, some radiologists are located in the midst of a veritable maze of hallways with poor signage, behind closed and even locked doors. Even when a referring physician manages to find one either by phone or in person, that radiologist sometimes proves less than helpful. Many have become invisible to patients and colleagues. Such practices undermine networking and thereby undermine the field of radiology and the radiologists who practice it. As we move into an era of bundled care, interdisciplinary collaboration, and accountable care organizations, it is becoming more important than ever that radiologists think outside the box, becoming not just imaging gatekeepers but true information brokers who bring valuable transdisciplinary perspectives to patients and enhance patient care systems. Similar challenges arise in other areas of radiology. For example, the ABR recently implemented a number of major changes in areas such as the board certification examinations and maintenance of certification. Such changes have provoked considerable consternation among key constituencies, such as radiology educators, program directors, trainees, and practicing radiologists, provoking what some associated with the board view as a surprising backlash.
How did this happen? Viewing the situation from the outside, it is difficult to know for certain, but it is possible that the ABR’s staff and board members found themselves unknowingly functioning as echo chambers, reinforcing one another’s enthusiasms without engaging those who would live with the changes day to day in sufficiently rich conversations around their impact. Whether this is true of not, any organization that allows itself to become an echo chamber is in for trouble. Such organizations need neither yes people nor naysayers. However, most do have a tendency to populate themselves with people who share the vision of a few leaders, unconsciously excluding diverse points of view from the conversation. They focus more on implementing than listening. One means of avoiding and recovering from such pitfalls is to actively seek out people with alternative points of view, who can raise important questions about unspoken assumptions. The payoff of better networking can be no less substantial for individual radiologists. For one thing, personal networking often plays a crucial role in finding a job. Once a position has been secured, networking can contribute mightily to enhanced performance in patient care, education, and research. Many of the most successful radiologists in each sphere are devoted networkers. Likewise, networking should be a major focus of every radiology leader. The vitality of the field depends on it.
REFERENCES 1. Uzzi B, Dunlap S. How to build your network. Harv Bus Rev 2005;83:53-60. 2. Steelcase. Case study: the Boeing Company. 737 programs and Renton Wash. site. Available at: http://360.steelcase.com/wpcontent/uploads/2011/02/Boeing.pdf. Accessed October 28, 2013.
Richard B. Gunderman, MD, PhD, and William D. Kerridge, MD, are from the Department of Radiology, Indiana University School of Medicine, Indianapolis, Indiana. Richard B. Gunderman, MD, PhD, Department of Radiology, Indiana University School of Medicine, 702 Barnhill Drive, Room 1053, Indianapolis, IN 46202-5200; e-mail: [email protected].
