Introduction

For many years radiology enjoyed a period of tremendous growth. This advancement was largely due to the advent of new technology, which greatly expanded the diagnostic capabilities of imaging. In neuroradiology, pneumoencephalography became obsolete, and the new cross-sectional modalities of CT and MRI vastly increased the diagnostic armamentarium neuroradiologists use to diagnose central nervous system disorders. New nonimaging medical and surgical technologies also increased patient life expectancies, contributing to higher imaging volume in radiology in general, and in neuroradiology particularly. Between 1999 and 2004, imaging was the fastest growing physician service, and CT and MRI of the central nervous system grew proportionately with other imaging services.

Although the rapid rate of imaging growth dramatically expanded the role of neuroradiology in clinical practice, the expensive nature of neuroimaging was problematic from an economic and strategic planning viewpoint. Technologically sophisticated medical and imaging technologies are cost-intensive, and recently it has become evident that health care expenditures in the United States have increased to the point of potentially being unsustainable. United States health care spending was nearly $2.6 trillion in 2010, over 10 times the amount spent in 1980. To maintain United States competitiveness, increasing attention has been devoted to curbing the growth rate of health care expenditures, with a particular focus on imaging. These economic constraints make effective strategic planning for neuroradiologists essential.

Strategic planning for neuroradiology

Strategic planning for any organization can be loosely defined as envisioning a future for an organization and working backward to determine a plan of action designed to reach the desired goal. To do so requires several steps that can be conceptualized as vision, assessment, plan of action, and execution of the plan to achieve the desired goals. Although this methodology intuitively seems straightforward, the strategic planning process is, in fact, difficult. One of the primary reasons is that a desired future cannot be envisioned or achieved in a vacuum; organizations must take stock of the external forces continually influencing them, and at the same time accurately assess their own positive and negative attributes and their willingness and ability to respond to environmental change. Strategic planning also requires prediction and assessment of trends. In radiology in general, and in neuroradiology in particular, this is highly challenging. Commoditization, teleradiology, declining reimbursement, utilization management, political shifts, and technological uncertainty all make the construction of long-standing predictions in neuroradiology problematic ( Box 1 ). Not surprisingly, the rapidly evolving health care environment only reinforces the need for neuroradiology leadership organizations to have a cohesive and ongoing strategic planning framework in place.

Strategic planning for neuroradiology

Strategic planning for any organization can be loosely defined as envisioning a future for an organization and working backward to determine a plan of action designed to reach the desired goal. To do so requires several steps that can be conceptualized as vision, assessment, plan of action, and execution of the plan to achieve the desired goals. Although this methodology intuitively seems straightforward, the strategic planning process is, in fact, difficult. One of the primary reasons is that a desired future cannot be envisioned or achieved in a vacuum; organizations must take stock of the external forces continually influencing them, and at the same time accurately assess their own positive and negative attributes and their willingness and ability to respond to environmental change. Strategic planning also requires prediction and assessment of trends. In radiology in general, and in neuroradiology in particular, this is highly challenging. Commoditization, teleradiology, declining reimbursement, utilization management, political shifts, and technological uncertainty all make the construction of long-standing predictions in neuroradiology problematic ( Box 1 ). Not surprisingly, the rapidly evolving health care environment only reinforces the need for neuroradiology leadership organizations to have a cohesive and ongoing strategic planning framework in place.

Vision and mission statement

A neuroradiology division cannot develop a strategic plan without a vision and mission statement. The vision can be defined as a view of where the neuroradiology division would like to position itself both internally and in the external environment in the present and near future. The mission statement is a written expression of the vision. A good mission statement should be coherent, concise, and timeless, and should elucidate the purpose of the neuroradiology division and its priorities. The mission statement should be familiar to all employees of the neuroradiology division. Superficially, the priorities of a neuroradiology division may seem straightforward: to preserve human life through neuroimaging. However, a deeper examination of the neuroradiology division priorities suggests a more complicated picture, with varying levels of prioritization for the various neuroradiology practice settings. For example, an academic neuroradiology department that relies on a large number of research grants for its financial health may value cutting edge research and peer reviewed publications in addition to, and occasionally more than, a high volume of clinical work. Other less grant-funded academic neuroradiology divisions may place teaching ahead of research, and still other community practice neuroradiology divisions may prioritize clinical output over teaching and research. Box 2 provides examples of two different mission statements. Obviously, no correct and uniform set of goals exists for neuroradiology departments, but priorities of any particular neuroradiology division must be integrated into the mission statement of the neuroradiology department so that strategic decisions align with the overall goals of the neuroradiology section.

A poorly constructed or ambiguous mission statement can contribute to ineffective decisions that do not align with a neuroradiology group’s strategic plan. For example, if a neuroradiology division has research as a top priority, taking on a contract to interpret additional off-site neuroimaging studies with the goal of increasing clinical revenue may not be advantageous if it decreases research quality. Conversely, in a community setting, neuroradiologists might be ill-advised to allocate significant capital expenditures to hire a researcher in lieu of updating their MRI equipment if their mission statement specifies that using state-of-the-art MRI technology is their top priority.

Strategic planning frameworks

To plan an appropriate course of action based on a vision requires that organizations take inventory of their own attributes and examine the external environment in which they operate. To help organizations achieve self-awareness, formalized strategic planning frameworks have been developed. Two commonly used strategic planning frameworks are the strengths, weaknesses, opportunities, and threats (SWOT) framework, developed at Harvard University in the late fifties, and the Balanced Scorecard framework, also developed at Harvard in the early nineties. Both strategic planning frameworks are helpful in providing an overall structure to conceptualize strategic planning, yet both have some limitations. The strategic planning frameworks are not mutually exclusive and can be used to complement each other.