Strategic Thinking Articles

Transformation -- How an Association Learned to Embrace Change

Transformation is evolution not revolution.  Changing an organization’s genetic code requires a shift in the members’ business environment, good research, willingness to suspend disbelief, courageous decisions, adherence to a compelling message and strong champions.  This is how the Society of Cardiovascular and Interventional Radiology (SCVIR) responded to its environmental shift and reinvented its profession and itself. 

            SCVIR is an organization of 4,000 professionals who utilize interventional techniques, mostly catheters, guided by radiological images to treat various diseases.  Typically, other physicians call in interventional radiologists on cases in the hospital.  Like many medical specialties, interventional radiologists are seeing others enter their niche as the economics and technologies of healthcare induce doctors to move beyond their traditional areas of practice.   This was particularly galling because interventional radiologists see themselves as the innovators in catheter technology.   Their gut reaction was to try to wall off the profession to keep others out.

            Debate over the future of the profession had raged for years without resolution.  When Paul Pomerantz, CAE, became SCVIR’s executive director, he wanted to move past the debate.  To do that, in 2001 he engaged The Forbes Group, a strategic and futures consulting firm in Fairfax, VA, to design a way to define a preferred future for interventional radiology and the association. 

            The Forbes Group suggested a multipronged approach that focused heavily on assessing the current and future markets for interventional techniques and benchmarking other professions, not necessarily in healthcare, to see how they had tackled similar problems so that SCVIR could learn from their successes and mistakes.  This research, plus a socioeconomic study being done by SCVIR staff, would form the knowledge base for determining the futures discussion.  This knowledge base would elevate the conversation above the anecdotal, get beyond personal passion and appeal to physicians’ belief in research to support decisions. 

Strategic Assessment

To get a handle on the professional climate, Amy L. Cole, Forbes’ executive vice president and COO, did a strategic assessment by conducting in-person interviews with nine members of the SCVIR senior staff and telephone interviews with fourteen SCVIR leaders and nine important external constituencies identified by the association.  The assessment focused on questions such as “What types of new applications for interventional radiology do you see in the future that are different from what you are doing today?”, “How does moving to these new applications affect the services provided by SCVIR?”, “Who else will be involved in these new applications and are they competitors, partners or both?”. 

Using the information gathered during the interviews, Cole designed an online e-poll where respondents were emailed a web address and asked to visit it to complete a questionnaire based on the results of the staff, leader and external interviews.  SCVIR provided The Forbes Group with a list of 2,200 working email addresses for members.  A total of 654 SCVIR members responded to the e-poll, just shy of a 30 percent response rate, good for a survey of this type. 

The findings set the stage for the discussions of the future of the profession and association to come.  They showed that future applications of interventional radiology went beyond the cardiovascular system.  There was strong support for becoming directly involved with patients instead of relying on referrals.  Not surprisingly, concern about turf and competitors was a common theme among all the constituencies interviewed and surveyed.  Leaders saw competition as inevitable.  Many said that rather than circling the wagons in a futile attempt to keep the specialty closed-off it would be more productive to become more open and collaborative.  Members, on the other hand, felt otherwise.  This dichotomy would have to be dealt with for SCVIR to make forward progress.

Customers’ Customer Analysisã

            Concurrently with the strategic assessment, Forbes Senior Vice President and Chief Economist Richard C. O’Sullivan conducted a Customers’ Customer Analysisã, a Forbes system that takes a business-oriented approach for looking beyond an association’s membership to markets. This study examined institutional and noninstitutional disease treatments that compliment and compete with radiological medicine in order to define a unique position for interventional radiology. 


             The very best an association can expect from its own customers is to react to changes sooner.  However, by studying its customers’ customers, an organization can anticipate emerging needs of its immediate customers or members.  The process looks like this:

Examine the trends that will change the kinds of customers the association’s members will face.


Identify new demands that these customers will place on the association’s members.


Identify the new skills, services, and partners the members will need to meet these new demands.


Recommend the new functions, products, and services that the association will need to help its members meet these new needs.


Define a new position and revenue models for the association based on the new mission.


The result of this approach is a proactive, market-driven solution that responds to the long-term needs of the members’ market rather than solely the short-term concerns facing today’s members. 


            For SCVIR, this analysis looked at interventional radiologists’ competitors, potential partners, the social forces influencing the future of the profession, healthcare reform proposals, innovation and spending trends, the decline in support for noninstitutional care, and consumer demands for a say in healthcare decisions. 

The analysis determined that “interventional radiologists, like most emerging professions, have taken the approach of “positioning by comparison.” By defining what interventional radiology is by its relationship to other professions, they have effectively allowed others to define their profession for them.  This is similar to the product management approach that other businesses, such as manufacturers, often take.  In the product management approach, a supplier examines what his product does and finds new applications for that product. 

  “While this is an effective way of expanding one’s customer base in the short-term, the approach is essentially one of a solution in search of a problem.  Businesses that adopt this strategy in the long term often lose track of the value that the product or service provides while focusing on mechanics of the product itself.  In other words, suppliers become so focused on how to use the product they lose focus on why the product was valued in the first place.  Clearly product-development strategies have advantages and value but they are a short-term approach.  In the end, suppliers who depend exclusively on product development become reactive to changes in the market and changes in their competitors rather than proactive drivers of change themselves. They also tend to focus on current competitors of the same product and overlook the next technological innovation.

       "To be more proactive, SCVIR and its members should examine their future from a broader view that encompasses, but is not confined to, existing professional definitions.  This is a business- development approach.  In the business-development context, the supplier focuses on the value that the original innovation brought to the market.  Had Western Union perceived itself as a provider of long-distance communications rather than the operator of a national telegraph network, it may not have refused to purchase the patents for the telephone for $100,000 when it had the chance.  SCVIR should ask what do its members really do.  Do they use catheters to deliver treatments or do they create noninvasive, interventional means of treating diseases?”


One of the most significant conclusions of the study found a voice in the late founder of interventional radiology – then called angiography.  According to the study, “one of the key reasons why interventional radiologists have been vulnerable to competitive challenges is that a technology, the catheter, has defined their profession rather than a unique body of knowledge regarding treatments or disease.  The founder of the profession, Dr. Charles Dotter wrote in 1968,  ‘Angiographers can play a key role in disease treatment if they are prepared and willing to serve as true clinicians and not just skilled catheter mechanics.  If my fellow angiographers prove unwilling or unable to accept or secure for their patients the clinical responsibilities attendant on [the technology] they face forfeiture of territorial rights based solely on imaging equipment others can obtain and skills that others can learn.’”


This juxtaposition of present analysis and powerful counsel from the past created a resonant story that dealt with the member-leader dichotomy and helped convince SCVIR members that being high tech but not technology specific and that competition, not protectionism, were the ways to the future.




Finally, in a process called industry benchmarking, Forbes Chief Economist O’Sullivan identified successful and failed strategies and tactics used by other professions that tried to establish a new identity following technological or market changes. He and SCVIR selected four professions for review: optometrists, dental hygienists, chief information officers, and orthopaedists.  O’Sullivan also reviewed other professions with similar problems or behaviors to determine the extent to which the analyses of these professions could be generalized.  Based on these examinations, several consistent messages emerged.

“Be as Distinctive as Possible – Those professions that made the most significant break from the past were those that enjoyed the greatest and the earliest success.  A corollary to this is to distance oneself from potential competitors.  “Define Your Profession by an Outcome Not an Input Professions that defined themselves based on what they did rather than why they did it tended to be overwhelmed by competing professions who made the distinction between purpose and practices.  Those professions that defined themselves according to a result or a purpose also proved to be more flexible over the long term and could credibly adopt new practices and technologies as they emerged. “Consistency Not Critical Mass Do not be lured by large numbers.  Going for size can dilute a profession with unqualified practitioners.  Consistency should also come before compromise.  Those professions willing to compromise their professional definition or standards to achieve immediate legislative victories found that political expedience is a false friend.  Eventually, the inconsistencies and contradictions in a patchwork of laws, titles, and practice scopes obscured the profession’s true value from the consumer and undermined its credibility. “Profound Change Creates Opportunity In each profession studied, a significant change in technology or market created new opportunities.  Healthcare reform will change who will pay for what and when. The result will be profound structural response.    SCVIR needs to be sure that its profile in these discussions goes well beyond assuring that interventional radiology continues to be a covered procedure.  SCVIR should impose itself on the entire debate around all noninvasive care to establish the foundation and justification for its new professional identity.”

 Into the Chrysalis


            To metamorphose from caterpillar to butterfly, the animal goes into a chrysalis stage where it is neither one nor the other but a liquid waiting to reform and be reborn.  In organizational transformation, there’s a similar evolutionary stage where questions about form and substance have yet to be answered. 


            Armed with its research, SCVIR leaders met to determine what would emerge.  While in the initial stages of the research, there was some skepticism, especially about how well the consultants understood the profession, those doubts were erased and then SCVIR President Dr. Curt Bakal and President Elect Dr. Michael Darcy became the champions of change. 


Because the interventional radiology profession and the association are so   interdependent and synergistic, leaders decided to define a preferred future for the profession that would lead to the strategic direction for SCVIR.  Forbes’s Executive Vice President Cole designed a day and a half session where a diverse group of SCVIR leaders  convened in small groups to address seven questions.


§         What critical issues must be addressed in the preferred future?


§         What is the purpose of the profession?


§         What services do we provide?


§         What is our unique position?


§         What will it take for IR to succeed?


§         What are the boundaries/constraints on our preferred future?


§        If we remain on our current path, where will we be in ten years?  How good would that be?


            The “butterfly” that emerged was this five-step preferred future.


By 2006, interventional radiology will


·        be seen as the leader in providing the most innovative, non-surgical, high-tech, cost-effective, image-guided diagnosis and treatment by the medical profession, industry, patients, and policy-makers


·        provide an office base for patient evaluation, counseling, and follow-up


·        be the hub for two-way referrals


·        recognize and face competition


·        have approximately 40% more full-time practitioners than in 2001


            To achieve this transformative preferred future, interventional radiology would have to make these shifts.




Procedure oriented

Clinically oriented

Primarily vascular

Diverse practice

Part-time practitioners

Full-time specialists

Secondary referral

Primary referral

No public awareness

High public awareness

Preventing competition

Tough competitor

Waiting for referrals

Practice builder

Part of diagnostic radiology

A unique component of radiology


     Each of the five preferred future elements was arrayed on a five-year timeline as a milestone to which planning objectives could be attached.  They were clear and unambiguous and became a mantra of Drs. Bakal and Darcy that brought other SCVIR leaders and the members along and persuaded leaders of radiology and medical education to consider the changes interventional radiologists believed were crucial to a successful future.  


The Emergence


To translate the preferred future into work, SCVIR crafted a strategic plan with four major prioritized goals. 

Goal 1: Achieve awareness of the profession

Goal 2: Advance patient care and access in public and payer policy

Goal 3: Advance practitioner’s skills in clinical arenas and practice development

Goal 4: Create and implement innovations in patient care and validate therapies


In order to develop specific objectives under each of these goals, SCVIR staff inventoried all of its 40 programs. Then they narrowed the list down to 18 key programs that utilized significant human and financial resources and evaluated them using a tool called Portfolio Analysis, which was developed for non-profit organizations by Dr. Ian MacMillan, a professor at the Wharton School of Business (available free by clicking , then products and services,  then toolbox).  The analysis helped determine the future of each program and resulted in ending a publication that saved $200,000 annually.


Since the development of the strategic plan in the summer of 2001, the association has accomplished several milestone objectives that have placed fulfillment of its vision in clear sight.


1.      It achieved recognition of interventional radiology as a distinct subspecialty by the American College of Radiology.   This means that it will have its own identity within the radiological community.


2.      It crafted a strategic plan for its research arm, which sets the pace for research and innovation in the profession.  Key aspects of this plan call for creation of an annual Innovations and Research in Interventional Radiology Conference in October 2002, a new innovations award, and development of a network to facilitate interventional radiology’s involvement in clinical trials.


3.      It developed an identity and branding strategy that is the result of extensive research among healthcare consumers and primary care physicians and that caused members to approve a name change to the Society of Interventional Radiology (SIR) with the tag line: Enhanced Care through Advanced Technology.  In addition, the Society has launched awareness programs geared at consumers and at family practitioners.


4.      It developed a new training curriculum for interventional radiology.


5.      It launched a new series of educational programs and resources to assist members in developing the clinical skills necessary to compete and released a practice development manual.  New courses planned for 2002 release will emphasize innovative therapies and training in non-invasive imaging. 


 The evolutionary transformation of SIR has been a combination of struggles, lessons learned, and challenges.  But because of the courage and foresight of the association’s members, leaders and staff, the metamorphosis has also proven to be rewarding and successful.  SIR is living proof that the future does not just happen – it is created.

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