Crisis management is defined as the process by which an organization deals with a disruptive and unexpected event that threatens to harm the organization or its stakeholders.¹ We have long recognized the importance of planning for a crisis. Numerous business courses and reviews emphasize the need to be prepared for worst-case scenarios. Many practices and departments have spent time creating or reviewing procedures and processes for emergencies. Typically, we check the box and put the documents away. Life gets busy and other priorities take over. And then something like COVID-19 happens.

 

There were isolated warnings of such a pandemic — well-chronicled events such as the 1918 Spanish Flu, H1N1, Ebola, SARS, MERS, and others. Eerily, Bill Gates provided a prescient warning during a TED talk in 2015.² However, nothing could have prepared us for the medical, social, and economic impact of COVID-19. With a myriad of questions and decisions flooding any practice or department, having some guidelines for leaders provides a lifeline for the pathway forward. First and foremost, there are no right answers. Transparency through communication is a priority, especially when uncertainty is pervasive. Also, the natural tendency is to go into command and control mode. But the opposite is required — leading from the bottom up. One recent reference offered the following six steps for leading through crisis:

When focusing on our radiology staff, it may be useful to consider practice needs for three separate phases: shelter in place, re-opening, and post-pandemic. During the first phase, many practices and staff have focused on safety and security. Addressing mental health issues has become a significant and meaningful concern. The re-opening phase involved instituting new safety measures, ensuring hyper communication, and celebrating inspiring news. Post-pandemic, practices will need to focus on their core purpose — rather than legacy business models — to look for new or emerging opportunities.⁴

 

Radiology practices have been hit hard by the pandemic. According to a recent survey by IMV Medical Information Division, more than 90% of imaging centers in the country have experienced a major decline in the volume of procedures.⁵ The Harvey L. Neiman Health Policy Institute^® promptly evaluated the impact of the pandemic on imaging case volumes using real-world data from a large healthcare institution. The data  set included all patient service locations and imaging modality types. Analysis found an overall 28% decline in the total imaging volume over a seven-week-period during COVID-19, compared to 2019.⁶

 

Numerous medical and specialty radiology organizations have accumulated resources to address COVID-19. The ACR has established a Coronavirus Resource Center

(acr.org/COVID-19) with information on adjusting to the pandemic and sorting through the recovery phase. The ACR, the Radiology Leadership Institute® (RLI), and the JACR^® have hosted insightful interactive webinars with discussions on COVID-19 and managing in a crisis. The JACR established a frequently updated resource center with the latest radiology-related research and commentary as the pandemic unfolds. It is in times of crisis that one sees the importance of leadership — when people are called to step up and are tested as leaders. During the recent RLI Leadership Town Hall: Leading in Times of Crisis, several radiology leaders highlighted key elements of leadership, the challenges they’ve faced, and their success stories. During the JACR’s COVID-19 and Your Radiology Practice webinar, leaders from throughout the specialty — academic, private, urban, and rural — discussed how to respond to practice management challenges associated with the current pandemic, such as case triage for deferral, staff rotations versus physician redeployment, and revenue concerns (available at bit.ly/COVID-Practice). Participation in these town halls and webinars have been exceptionally high as members look for ideas and share experiences. Trainees are also concerned about the

job market and prospects for future positions as practices anticipate the longer-term impact on finances and referral patterns.

 

Crisis management is complicated by uncertainty. The ACR is committed to providing you with at least a measure of clarity in these challenging times.The organization and our practices will learn from this crisis. Our collective resilience will serve us well — not only to survive but to emerge with commitment, strength, and innovation.