ACR Bulletin

Covering topics relevant to the practice of radiology

Crisis Management

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Within an ever-changing radiology landscape, leaders must prepare, stay collected, and delegate.

Good leaders instill a sense of teamwork, dedication to the cause, experience, and commitment that sees everyone through challenging times while providing the best of care to our patients.

—Heather C. Sher, MD
January 01, 2019

Retired U.S. Army General Colin L. Powell once said, “The day soldiers stop bringing you their problems is the day you have stopped leading them. They have either lost confidence that you can help, or concluded you do not care. Either case is a failure of leadership.”

Crises can make or break a leader. For some leaders, it may feel like they are constantly navigating crises. Within an ever-changing radiology landscape, a crisis may present as an imposing merger or the threat of a cancelled contract. There are IT calamities and staffing shortages to deal with. Billing disasters and reimbursement pitfalls abound. Crises can come in financial, political, organizational, and legal forms — and many defy easy classification. In extreme cases, a natural disaster or terror attack could bring an influx of critical patients. Whatever the manifestation, a crisis is often unexpected, and swift action is always critical in the absence of a contingency plan. Surviving a crisis requires empathy, decisiveness, and nimble problem-solving.

The first step is to acknowledge that you have a problem and share what you know with staff as soon as possible, says Kimberly E. Applegate, MD, MS, FACR, division chief of pediatric radiology at the University of Kentucky in Lexington. “As the leader, you need to tell them, ‘We’re all in this together; we’re a team,’ and that together you’re going to find a solution,” she says.

Damaging rumors and misinformation spread quickly during a crisis, particularly when leaders don’t communicate information and next steps. A common misconception is that leaders should withhold bad news. “You don’t have to say the situation is horrible,” Applegate says. “But be transparent and don’t lie about what has happened.” “If there is a crisis, take your own pulse first,” says Carolyn C. Meltzer, MD, FACR, chair of the department of radiology and imaging sciences at Emory University School of Medicine. “As a leader, if you overreact, you can set off others — who will in turn assign blame and fuel worries about secondary issues.”

Leaders Prepare

It’s been said that the first step toward becoming a great leader during a crisis is, paradoxically, not having to lead in a crisis. Good leaders adopt a team mentality, lead by example, earn the trust and respect of the group, and identify opportunities amidst chaos. While no leader can foresee every hidden hazard, great leaders anticipate and actively manage with a crisis prevention mindset.

Good leaders have a disaster plan for seemingly common problems.

—Carolyn C. Meltzer, MD, FACR

Not communicating your plan in advance will aggravate a bad situation. “If a clear plan is not presented to staff before a crisis occurs, you’ll have a lot of background noise and people who aren’t really focused on solving the problem,” Cury says.

“Good leaders have a disaster plan for seemingly common problems,” Meltzer says. “What happens when the PACS goes down or an EHR isn’t available?” Radiologists must be ready to act, she says, and to work with others to coordinate preliminary reads and record findings.

Leaders Deliver

Many groups focus a great deal on planning, only to fall short when attempting to visualize a clear path during the crisis, says Cury. During a crisis, you may not see progress on a daily or even weekly basis, Cury notes. But part of execution is to assess your progress little by little and to focus on decisions that keep edging you toward positive outcomes. Whether you’re talking about revenue challenges, quality of care problems, or potential staffing shortages, you must maintain a balance while navigating the crisis, he points out. In a time of crisis, leaders must balance three pillars: quality, service, and efficiency. “Those amount to patient-centered care,” he says.

“Say you have an issue with staffing. If you focus only on productivity, pushing to read more cases and putting in longer hours, then you are potentially compromising quality,” Cury says. You have to be mindful of turnaround times, but jeopardizing quality and service won’t solve your problem, he says.

The focus on quality and safety can be particularly strong in stand-alone children’s hospitals, Applegate says. “Many quality and safety leaders in medicine come out of the pediatric community,” she points out, and that unique culture of shared decisionmaking can help maintain a balance in times of crisis. “Leaders must be mindful of — and keep staff focused on — the mission at hand. When things get frustrating, we have to remember that we’re here together to take care of patients.”

Crisis situations can sometimes come down to skill versus will. Applegate says: “If asked which I’d rather have in a leader during a crisis, I’d say the will to make (sometimes difficult or unpopular) decisions and implement a plan.” With any crisis — perceived or real — a willingness to act for the good of the community is more important than any learned skill set, she believes.

Leaders Share Hardships

Team members are more willing to take action when they see someone leading by example, and with a comforting confidence. “A good leader has to be able to control his or her own fear and anxiety during a crisis,” says Frank J. Lexa, MD, MBA, FACR, professor and vice chair of clinical affairs and operations in the department of medical imaging at the University of Arizona Medical Center, and chief medical officer of the Radiology Leadership Institute®. “It’s critical when bad things happen that the leader shares in the hardship, whether it’s a need for extra staff or a financial strain,” he says. “If the leader gets a bonus and everybody else gets a pay cut, that’s not leadership.”

Meltzer offers an example of a CEO who held multiple town hall meetings to discuss salary cuts. This type of leadership prepared staff for a pay reduction by giving them an opportunity to voice their concerns over how the reduction would occur.The group didn’t like the news, but communicating transparently prevented them from panicking and fleeing their positions. “It was a chance to let them know that maybe things weren’t as bad as they thought,” Meltzer says.

Crises are the test and measure of a leader, Lexa says. When leading your group through a trying merger or practice consolidation, for example, let staff know that the goal is to benefit everyone. “You can’t just say, ‘Good luck with that’ and hope for the best,” he says. “A strong leader tells the group, ‘Let’s not just put out the fires; let’s not just get through this. Let’s build something stronger and come out on the other side better than we were.’”

Leaders Evaluate

The noblest inspiration won’t mitigate bad outcomes when team members aren’t willing and committed to doing their individual parts. “Good leaders are constantly looking at how well people react during a crisis,” Lexa says. “You may notice some people stepping up, some people doing just fine, and some who just can’t handle it — or get worse.” Following a crisis, it may become clear that you need to reexamine your team, your contracts, or other aspects of your organization’s operations, Lexa says. Consider it an opportunity to make changes that allow you to perform even better during the next crisis.

Assess what happened once a crisis is resolved, Meltzer urges. Identify what you learned and ask the important questions. How can you better prepare? Were you transparent in your communication with the team? Who did their part and who could have done more? Staff and patients notice when something goes wrong. “People want follow-up,” she says, “and want to know that you have acted and that you’re prepared to act if something happens again.”

The next crisis is really more a question of “when” than “if.” If it presents in an extreme form, a leader’s resolve will truly be tested as lessons learned translate to lives saved.

Leaders Survive

The radiologists in a busy, level-one trauma center in downtown Fort Lauderdale have performed tirelessly through disaster situations, says Heather C. Sher, MD, a musculoskeletal radiologist. She has seen leaders emerge to care for patients during several major hurricanes since 2005, responding to victims of Hurricane Katrina, the Haiti earthquake in 2010, and Hurricane Irma in 2017.

Because of their relative frequency in South Florida, Sher says, “hurricanes are something we can prepare for with an appropriate action plan. And that’s a plan we evaluate each and every year.” Still, she says, Hurricane Katrina was one of the most stressful weeks of her career. “I was on in-house, overnight call during the entire week of the storm. I had no electricity at home for the entire week and was running out of gas on the way to the hospital as the week progressed.”

Her team learned from that experience, and now have one radiologist in-house at each facility within their health system during a storm. “The leader of our practice is in close touch with all of the radiologists in the group throughout a storm and delegates relief teams to come in as soon as possible once a storm has cleared. We spread the stress of the work out among all of the doctors in the practice.”

According to Sher, surviving a crisis requires planning, delegation, and clear lines of responsibility so that radiologists can perform at the top of their game when the community needs them most. She says, “Good leaders instill a sense of teamwork, dedication to the cause, experience, and commitment that sees everyone through challenging times while providing the best of care to our patients.”


1. Lexa FJ. Leading in a crisis, part 1. J Am Coll Radiol. 2009. 6(7) 521–522. Available at Accessed Nov. 1, 2018.

Author Chad Hudnall,  Senior writer, ACR Press