Most radiologists measure their impact one read at a time. Ben Wandtke decided to measure his by what happens after the report goes out.

Ben is a professor and vice chair of quality and safety in the Department of Imaging Sciences at the University of Rochester Medical Center, chief of diagnostic imaging at Thompson Hospital, and director of the University of Rochester's CT lung screening program. He chairs the American College of Radiology's Commission on Quality and Safety, rebuilt the ACR's Diagnostic Center of Excellence program, and serves as a physician lead for the ACR's Learning Network.

In this episode of The Operating System, Ben tells Andy how it started: four missed lung cancer diagnoses at a 110 bed community hospital, and a decision to stop letting incidental findings fall through the cracks. He built a Microsoft Access database in an afternoon with one person from IT and a quality nurse, and started tracking patients manually. That program now manages 18,000 patients a year, and the organizations Ben has worked with through the ACR Learning Network have pushed their follow up completion rates past 80 percent, a jump of 30 points or more from where they started, in a space where studies have shown as many as 30 to 70 percent of patients with a follow up recommendation never complete it.

We get into how he applied the same approach to lung cancer screening, growing one health system's volume from 200 patients a month to more than 1,000 while pushing screening rates into the 60 to 70 percent range, how he took a six week CT scheduling backlog down to four days in about two months without hiring a single new technologist, and the 6 and 12 program he built to keep his department improving on a fixed cycle instead of waiting for a crisis. We also talk about where he thinks radiology is headed next: using AI and EMR data to flag cardiovascular risk the same way mammography already flags breast cancer risk, and why he thinks earlier detection, not more treatment, is what actually bends the cost curve in healthcare.

Most healthcare improvement stories start with a mandate from the top. Jim McCarville built his career proving the opposite works better.

An industrial engineer by training, Jim has spent 40 years working inside more than 100 hospitals, first as a consultant, then as an executive. At Sarasota Memorial, he brought discrete event simulation into hospital design, testing floor plans and staffing models before a single wall went up. At Kronos, he spent a decade installing labor management systems into 100 hospitals, and learned quickly that the software was never really the point. At Catholic Health Initiatives, he ran productivity and clinical performance across a multi hospital division in some of the toughest markets in the country. And at St. Elizabeth Healthcare in Northern Kentucky, as VP of Quality Operations, he took roughly 400 leaders through applied lean training and rebuilt how the entire system looked at its own numbers.

In this episode of The Operating System, Jim walks Andy through the tools behind that track record. He breaks down how simulation settled a six month standoff between an architect and a radiology director over a costly room addition, and how the same discipline showed a cardiology team a better use for their most valuable real estate. He explains why a single line at Wendy's beats four lines at McDonald's, and how that same queuing logic helped cut a hospital's leave without being seen rate from nearly 5 percent down to under 2 percent, using nothing more than two recliner chairs and a different workflow.

Jim also gets into the huddle boards, employee idea programs, and lean principles that added up to more than 20 million dollars in savings over 12 years, and why he believes leadership, not budget or technology, is the real driver of high reliability care.

If you run a hospital or radiology department and want to know what separates the places that actually improve from the places that just talk about it, this conversation lays out the playbook.

Most radiology groups think growing market share means better equipment or more sub-specialists. Dr. Stephen Holtzman proved otherwise, and he has the numbers to back it up.

Stephen is an interventional radiologist, Founder and CEO of TurboRad, and former CEO of Radiology Associates of San Luis Obispo (RASLO), where he led a full lean transformation that grew practice revenue from $15 million to $25 million. A Dartmouth-trained master's in healthcare quality improvement, former president of the California Radiological Society, and the founder of two healthcare companies, Stephen's approach is built on one deceptively simple idea: apply the scientific method to running your business.

In this episode, Stephen walks through how he trained all 120 employees in lean principles, executed hundreds of rapid improvement events, and built an internal green belt and black belt program so effective that outside medical practices started paying to participate. He explains how a single process change, eliminating a patient intake form, opened up 30% capacity on X-ray in one afternoon. And he details how relentless focus on consistent, fast, high-quality radiology reports allowed RASLO to rank #1, #2, and #3 in ER report turnaround time across all 180 CommonSpirit Health hospitals, eventually taking over a competitor's book of business with four radiologists instead of the six the hospital insisted it required.

Stephen also shares how that operational foundation led directly to his two companies: The Holvan Group, a patient education video platform now used at UC Davis, MD Anderson, Emory, and Georgetown, and TurboRad, a radiologist reporting tool built on 15 years of lean refinement that is already logging 1,400 implemented improvement suggestions in its first year and doubling radiologist RVU output per hour.

If you are running an imaging center, leading a radiology department, or building healthcare technology, this is one of the clearest case studies on what lean actually looks like when it works at the highest level.

Follow Andy and Stephen:

Connect with Andy: 

LinkedIn: https://www.linkedin.com/in/andymilkowski/

Website: imorgan.net

Connect with Stephen: 

LinkedIn: https://www.linkedin.com/in/stephen-holtzman-0a008265

Website: https://www.turborad.com/ 

Most CIOs come up through IT. Lee Milligan came up through the ER.

After training at UCLA and working as an attending emergency physician, Lee taught himself to program, got pulled into his hospital's EHR selection process, and eventually became Senior Vice President and Chief Information Officer at Asante Health System in Oregon, a role he held for 22 years. He later joined SimonMed Imaging, one of the largest outpatient imaging providers in the United States, as CIO.

In this episode, Lee walks through the decisions and frameworks that shaped his career at the intersection of clinical care and healthcare technology. Topics include:

• CodeRunner: a single-page resuscitation tool he built inside Epic that is now part of the system's foundation, and why having a clinician build it changed what the tool was capable of
• IT project prioritization: why the most important conversation is not inside the IT department, but with the CEO and CFO about the gap between organizational ambition and execution capacity
• AI in radiology: how Lee reduced X-ray turnaround times at SimonMed by 36 hours in two weeks by asking radiologists one question about which modality they hated reading most
• Operational bottlenecks: how a fax machine was quietly throttling order volume at SimonMed, and how he fixed it
• The CIO role reframed: why the job is not about managing technology, but about motivating people to do the right things at the right times within the right constraints
  
  Lee now runs Asbury Health Tech Partners, where he advises hospitals, imaging centers, and investors on healthcare technology decisions.
  
  Connect with Lee Milligan:
  LinkedIn: linkedin.com/in/ldm007
  Website: asburyhealthtech.com
  
  Connect with Andy Milkowski:
  LinkedIn: linkedin.com/in/andymilkowski
  Website: imorgan.net

Chris Baxley has spent his career solving problems that most healthcare operators have decided to live with. He served in the US Army, earned his MBA at Vanderbilt, and worked through the 2008 financial crisis as a healthcare investment banker at JP Morgan. He then moved into operating roles at Healthways, Healthgrades, and Rad Partners, where he helped scale from a few hundred radiologists to over 4,000 and built partnerships with 17 of the 20 largest hospital systems in the country. He is now President and Chief Growth Officer at VitalEngine, a referral and collaboration platform working to fix one of healthcare's most stubborn operational failures.

In this episode, Chris breaks down why convenience, not clinical quality, is the dominant factor in how patients choose where to go for care, and what that means for imaging center operators competing for volume. He explains the mechanics behind Healthgrades' B2B model, the principles that made Rad Partners scale successfully, and why 35 to 50 percent of referrals across specialties never get completed. The conversation is a masterclass in understanding patient flow from the outside in, and in building the connective tissue between providers that most organizations have simply never prioritized.

• 00:00 Why Design Matters
• 00:38 Meet Chris Baxley
• 01:38 From Army to Healthcare
• 03:18 Vanderbilt MBA Path
• 04:22 Project Pyramid Origins
• 07:53 JP Morgan in 2008
• 10:49 Crisis Finance Lessons
• 14:23 Healthgrades Marketplace
• 22:26 Convenience Wins Patients
• 25:54 Scaling at Rad Partners
• 33:32 VitalEngine Referral Fix
• 39:38 Rapid Fire and Wrap

Chris Baxley is President and Chief Growth Officer at VitalEngine, a referral and collaboration platform built to fix one of healthcare's most stubborn operational failures. He previously held senior operating roles at Rad Partners (where he helped scale from a few hundred radiologists to over 4,000), Healthgrades (where he led large IDN strategy and built partnerships with 17 of the 20 largest US hospital systems), and Healthways. Earlier in his career, Chris served in the US Army and worked as a healthcare investment banker at JP Morgan through the 2008 financial crisis. He earned his MBA from Vanderbilt.

• LinkedIn: https://www.linkedin.com/in/chrisbaxley/
• Website: https://www.vitalengine.com

Most imaging leaders think they have a throughput problem. Michael Wendt says they have a drama problem. A 23-year Siemens Healthineers veteran who rose to Senior Vice President running North American sales and service, Michael now runs The Green Chair Group, helping radiology practices unlock productivity hidden inside their existing operations. In this episode, he walks through exactly how he helped one client increase patient volume by 50% without changing a single piece of equipment or adding one staff member. The secret is not scanning faster. It is eliminating unwanted variation across every step of the patient journey, from scheduling and jewelry removal to contrast prep and bathroom reminders, so the scanner keeps making that familiar knocking noise as long as possible each day.

00:00 Why telling your staff to see five more patients will backfire

02:00 Michael's 23-year journey from biomedical engineer to SVP at Siemens Healthineers

04:30 The Green Chair concept: never improve operations at the expense of patient care

06:30 Why dashboards report the news but don't make it

09:00 How one client achieved 50% more patient volume without new equipment or staff

12:00, Designing workflows intentionally: who does what, and when

15:00 The human side: making your team part of the solution

20:00 How poor image quality is its own source of unwanted variation

22:00 Using data without creating fear on the floor

25:00 How to prevent operations from slipping back to old habits

30:00 Rapid fire: the biggest misconception in MRI productivity and what truly great operations look like

Michael Wendt is the founder of The Green Chair Group, where he helps radiology practices unlock productivity hidden inside their existing operations. He spent 23 years at Siemens Healthineers, rising to Senior Vice President running North American sales and customer service across the company's imaging portfolio. Michael holds a PhD in biomedical engineering and has been inside more imaging operations than almost anyone alive.

• LinkedIn: https://www.linkedin.com/in/michaelwendtphd/
• Website: thegreenchairgroup.com
• Email: [email protected]

Operational excellence for radiology, imaging centers, and healthcare technology, hosted by Andy Milkowski of Imorgan.

Andy spent 20 years inside medical imaging, first selling ultrasound equipment at Siemens, now running Imorgan, where his team builds the AI middleware that pulls hours out of a radiologist's day. He started The Operating System because most healthcare leaders he respects don't have time for vendor decks, theory, or another panel of consultants saying the same things. They want to know what's actually working for the people doing the work at the highest level.