Management and Art
The day started off badly. Our voice-recognition transcription system wasn't working. Radiologists were screaming that they needed help. A project that required some quiet time to complete obviously was going to have to be put off again, a situation that was certain to irritate my boss. When managers have mornings like this (which unfortunately happens far more than we like) the temptation is to go into our office, close the door, and scream. I, however, have an alternative approach. I go to an art museum.
For the last 20 years I have been thinking about the relationship between management and visual art. My interest in the subject started with my reading of Robert Pirsig's book Zen and the Art of Motorcycle Maintenance. At first, I saw the connection as something interesting and perhaps warm and fuzzy. Now I see the appreciation of paintings as vital to long-term success in our profession. Allow me to explain.
We all know that to be a quality radiology administrator we must do more than be good at the basic tasks associated with our jobs. Nowadays we must be competent in human resources, information technology, digital imaging, facilities management, contracting, financial oversight and budgeting, project management, team building, and total quality management. We are also expected to be in compliance with the ever-changing regulations from federal and local governments and independent oversight organizations. Just surviving twelve months of balancing all of the competing demands we face should earn us a hefty raise. Instead we are asked to do more.
Remember the last time you went to a management seminar. I can say with confidence that it had a title something like "Management in the New Millennium” or Managing in Difficult Times. And I also can be 100% certain that in that training session the facilitator talked passionately about the need to think outside the box” and look at the big picture.”
I think the natural reaction of those of us who have been around for a while is to just lower our heads in disgust. After all, a person lecturing in front of a conference room cannot understand the pressures of working in a field where people's lives really do hang in the balance.
I'm afraid, however, that in this case the teacher is correct. We cannot keep doing things as we did them even five years ago. New technologies have forced us to re-evaluate our systems and processes. Changes in workforce demographics and financial reimbursement for our services mean that we must be more efficient with fewer resources. In fact, if we used all of our energy to maintain the status quo our future would be quite clear. We would have to seek employment in a field other than healthcare.
So in an environment such as this how do we not just survive but prosper in our profession? Well my solution is not one that you are going to see advertised in one of those slick course catalogs we receive so often in the mail. My answer, which involves recognizing the role that art can play in our work, requires some explanation. It is a proposition that encapsulates my own intellectual voyage with the writing of Robert Pirsig and the art of Edward Hopper.
An Understanding of Quality
I first read Zen and the Art of Motorcycle Maintenance when I was completing my clinical training as a nuclear medicine technology student. I instantly recognized the relevance of his ideas to my career. The author saw quality as a dichotomy. There was classic quality, the kind I tried to practice when performing a perfect liver/spleen scan. In my effort to always provide the radiologist with images having the greatest diagnostic information I tried to make sure that the patient was positioned properly and that the equipment settings were appropriate both for the test being performed and the physiology I was seeing on my persistence monitor.
Every field has attributes that can serve as examples of classic quality. One that I have used in the past to illustrate this point comes from architecture. In the design of buildings and homes classic equality equals the components of the structure and the way that they interact to produce the final product.
Pirsig understood that even if I produced the best liver/spleen scan ever recorded I would have reached only one-half of my potential as a quality technologist. The author describes the second element of his definition of what is good as romantic quality. Romantic quality, in his view, is reflected by the aesthetics of an object. In our example of architecture, romantic quality would be represented by the overall appearance of the structure. Romantic quality is a response to the question of whether what was built is pleasing to the eye.
However, in medicine I see romantic quality slightly differently. To me, romantic quality directly relates to our interaction with the patient. We can produce a textbook study but if we treat the person on the examination table poorly have we completed a quality test? Pirsig and I would answer with a resounding no.” Only if we demonstrate to the patient respect and compassion have we performed an exam that captures the romantic aspect of quality.
True quality, according to the author, is not classic quality or romantic quality but a combination of the two. We see this with technologists all the time. For instance, we do not consider radiolographers to be truly proficient at their job unless they can provide excellent images as the same time that they exhibit outstanding patient care skills.
Pirsig has made a significant contribution to the definition of what is good through his description of its two parts and his assertion that true quality contains ingredients of each. But the ultimate lesson of Zen and the Art of Motorcycle Maintenance is the author's explanation that producing quality is not like reading a cookbook. You cannot simply throw classic and romantic ingredients together and expect the outcome to be something valuable. An example will help to illustrate this point.
I have a new hobby. Last February I developed by own blog. A blog, for those who are not familiar with this term, is short for weblog. It is essentially a personal journal available on the worldwide web. Mine concerns itself mostly with politics and educational issues. You can take a look at it yourself at www.marklerner.blogspot.com . On my blog I even mentioned that I was working on this article.
When I set out to create my blog I was immediately presented with some decisions I needed to make. I had to figure out what the appearance or layout of the page should look like (romantic quality). In addition, every time I add a post I must make judgments about the content (technical quality). My blog could have the most beautiful template ever developed. Alternatively, I could add to my weblog ideas of which man has never dreamed. However, if the way that I combine the appearance and the words forces people to quickly surf the web for something else to read then I have not produced a quality product. The same issue arises if we again refer to architecture. A home can be constructed with a striking appearance and the finest materials but if the two don't complement each other then its design would be graded as a failure. As I point out in my article “Total Quality Management in the New Millennium,” we think if we start with quality parts we must end with a quality whole. Pirsig explained that it is the awareness of the quality whole that determines which parts are needed (Lerner 49).
The way I created my blog was to start with a notion of the result I was trying to obtain and then add the romantic and classic elements I thought would allow me to reach my goal. In reality this is the way we approach any search for quality. But then just how do we know what to include? How do we now answer the question of how to “think outside the box” and “see the big picture”? Pirsig's response is that we first have to reach a peace of mind.
As I also explain in my previous article, anything that promotes or interferes with the development of this peace of mind affects an individual's ability to reach quality in his endeavors. This realization has significant consequences for the culture of the organization in which we are employed, the relationship we have with our superiors and co-workers, and, most significantly, our own personal values and attitudes (Lerner 49).
The Vision of Quality
It may be simple to say that to see true quality we must first develop a peace of mind, but in real life this proves to be an extremely difficult attitude to achieve. It is here that I believe art can play a crucial role. I came to understand its importance over the same period that I was learning about Pirsig's philosophical ideas. What brought me to this awareness was that I became acquainted with the paintings of Edward Hopper.
Edward Hopper was born in 1882 in Nyack, New York. After completing high school he started taking classes at the New York School of Illustrating in Manhattan. In 1900 he transferred to the New York School of Art, where Robert Henri became his most influential teacher. He earned his living initially as an illustrator of magazines. Hopper next experimented in etching, and then in the 1920's switched to painting watercolors outdoors while visiting various sites in New England. It was during this period that his art began to receive favorable reviews by critics. He was now over 40 years old.
By the 1930's Edward Hopper was an established artist and museums actively acquired his work. The income allowed he and his wife to purchase a home in Truro on Cape Cod, and they spent the rest of their lives alternating between spending the warm weather months in Massachusetts and the winters in their small New York City apartment overlooking Washington Square Park in Greenwich Village.
Hopper now painted almost exclusively in oil. In 1933 the artist had his first retrospective at the Museum of Modern Art. The new museum had purchased Hopper's “House by the Railroad” to start it's permanent collection. The artist's most famous painting, “Nighthawks,” was completed in 1942 and was immediately obtained by the Art Institute of Chicago. In 1948 Hopper was featured on the cover of Time Magazine. The Whitney Museum of American Art hosted a wide-ranging retrospective in 1950, the same year that he was featured both in Life and Newsweek magazines. By this time the artist has been the recipient of multiple awards and honors, one of which was a gold metal from the National Institute of Arts. Hopper died in 1967. His wife Josephine passed away a year later and bequeathed all of his work to the Whitney. (Mecklenburg 154-165).
During his life, Edward Hopper said very little about his motivations as a painter and next to nothing about the scenes presented on his canvases. This reticence to offer guidance to both admirers and art critics has led to many interpretations of his art. My favorite quotation about his work is from Guy du Bois, a fellow painter and friend of Hopper. Please take notice of what I detect are classic (the telephone pole), romantic (warmth by color) and true quality (as summarized in the last sentence) aspects of his review of the painting “Road in Maine.”
To fully comprehend the importance of Hopper to the world of art it would be good to analyze a specific example of his work.
The above painting, “Early Sunday Morning” was completed in 1937, and is located at the Whitney Museum of Art in New York City. It depicts a scene of a deserted street with all of the stores closed. The absence of people and activity leads to a feeling of loneliness and alienation. We feel as if we are intruding, that somehow it is wrong to be looking at this street at all.
But then, as I have witnessed museum visitors do time and time again, we take a closer look at the painting. We notice details that are extremely similar to other city streets we have seen, like the barbershop poll and the building's apartments on the second floor. Our mind begins to wonder about who lives above the shops and what the street looks like when people have gathered to conduct business. The bright colors Hopper has included inject optimism into our original dismal frame of reference.
It is this contrasting impact of Hopper's art, this initial feeling of being pushed away and then being drawn back, that people describe as the power of his art. As admirers experience these emotions they often begin to question why they are driven to behave this way towards an inanimate object. They study the canvas for clues to their reactions. It is when viewers are undergoing this complex process that they begin to think about their own lives in relation to their current thoughts.
I am of course describing the practice of the act of contemplation. It is contemplation that we commonly rely upon as human beings to settle our internal conflicts. It is contemplation that allows us to reach a peace of mind. And it is contemplation, which can be triggered by something as simple as looking at a painting by a famous American artist, which can reveal true quality's classic and romantic constituents.
Technology was supposed to solve all of our problems. We have certainly seen an implosion of new technology introduced into the field of radiology together with a corresponding improvement in patient care. However, much of these tools came with the promise that they would make our professional lives easier and simpler. In fact, our jobs have become much more complex. In this age of increased complexity it is often extremely difficult to take time out of our daily lives to be creative about how our systems and processes can be improved. Even if we do grab an opportunity just to sit and think we are too tense and tired from everything that is going on around us to do anything but rest. But if we can get away for just a short time, maybe a few hours to enjoy some of the finer things around us, then we might just be able to get to a point where we can start performing the activities for which we were placed into our positions in the first place. With our skills, our experience, and some luck, we could actually begin to make things better. Perhaps an appreciation of Robert Pirsig's writing and Edward Hopper's art can provide us with the keys to that journey.
Lerner, Mark, “Total Quality Management in the New Millennium,” “Radiology Management,” May/June 2000, p 45 49.
Levin Gail, Edward Hopper An Intimate Biography, Alfred A. Knopf, New York, 1996.
Mecklenburg, Virginia, M., Edward Hopper The Watercolors, National Museum of American Art, Smithsonian Institution, W.W. Norton and Company, New York, 1999.
Pirsig, Robert, Zen and the Art of Motorcycle Maintenance, William Morrow and Company, New York, 1974.