Elliot K. Fishman M.D.
Johns Hopkins Hospital

Click here to view this module as a video lecture.

“The happiness of your life depends upon the quality of your thoughts.”
Marcus Aurelius, Meditations

All too often, people ignore my advice by saying that “our industry is different, and what you have to teach me doesn’t hold true for us.” Let me assure you, however, that our industries are not so very different, and that we both share a primary goal of serving the customer. Your department may be composed of some of the best physicians in the world, and you may know more about medicine than some of your competitors, but that doesn’t necessarily matter. 
Schulze HH
former CEO Ritz Carlton

“In all of the organizations I have worked, the best leaders and executives have been able to create work cultures that inspire both clients and their companies’ employees, and they have had the strength as leaders to drive the difficult changes needed to create those positive work cultures. Over the years, having seen both successful and unsuccessful businesses, I have become a strong believer that in order for your company to be successful, your employees must be happy, they must truly believe in their company and products, and they must be willing to put their clients first.” 
Kaplowitz M
CEO MEC Corp

“Another important lesson I have learned is that there is always something “stupid” or “dumb” happening all the time in any organization—we just don’t recognize it unless it becomes a big enough problem. As you get higher in the organization, you see fewer and fewer of the problems, and frankly, the interconnections and relationships in a big company are so numerous and complex that no leader can completely understand or grasp them in any real way.” “Finally, having an organization in which everyone feels empowered to suggest ideas and make contributions is critical if you hope to innovate”.
Ed Catmull
President of Pixar and Disney Animation Studios

”With the recent acceleration in technological change, it is imperative that companies be nimble and react quickly to embrace transformational changes. In the end, all of us want to serve our guests or our patients with the utmost care, and we need to anticipate their needs in order to accomplish that. With the rapidly changing landscape in digital technology, both the hospitality and the health care industries need to take bold steps to make technology an integral part of why our guests or patients choose us.” 
The Incipient Digital Revolution in Hospitality and Health Care: Digital Is Hospitable
Brian King, Elliot K. Fishman, Karen M. Horton, Steven P. Rowe 
JACR (2018)

“Leadership is a vague term, but it is readily apparent to everyone when it is absent. There always comes a time when there is a true test for an organization, and you then know who is a true leader. Leadership styles range from Attila the Hun to a consensus maker like Gandhi, and each style can be successful or a failure depending on the individual environment.”
Learning About Leadership by Making Mistakes
Brody WR, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Jul 27.

“Management guru Peter Drucker once said something like “the three most charismatic leaders in the 20th century were Hitler, Stalin, and Mao. Their problem was not bad charisma, it was bad mission.” Admittedly, I don’t have the perfect answer to this dilemma, but I will say that my experiences have taught me one lesson: never hire second best. If you can’t find the optimal candidate just restart your search.”
Learning About Leadership by Making Mistakes
Brody WR, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Jul 27.

“Taking the time to listen to your people is critical, especially for someone like me, who is used to making quick decisions. Soon after taking my first leadership position, I quickly realized that I needed to be the last person who spoke at a meeting, rather than the first. An effective leader needs to hear both sides of an issue before making a proper decision.”
Learning About Leadership by Making Mistakes
Brody WR, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Jul 27.

“The perfect leader is a person who is needed by the company more than he or she needs the company’s job. Be willing to make unpopular decisions that might even cost you your job if that is the right thing to do.”
Learning About Leadership by Making Mistakes
Brody WR, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Jul 27.

“Having the integrity to do the right thing, no matter what the personal consequences, is what ultimately differentiates the very best of leaders.”
Learning About Leadership by Making Mistakes
Brody WR, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Jul 27.

“The success of gender-diverse teams isn’t true just in companies but also on boards. When there is a higher representation of women on boards, companies have more meetings, have higher attendance rates, experience greater participation in decision making, engage in tougher monitoring, and are more likely to replace CEOs when stock performs poorly.”
The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121

“With 70% of consumer spending decisions being made by women (and an even higher percentage when it comes to health care decisions) and two-thirds of all the wealth in the United States being controlled by women by 2030, if you don’t have women participating in strategy and product decision making, one could argue that you are leaving money on the table”.
The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth .
Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121

“Although these data and experience are clearly focused on venture capital and business, many of these findings and lessons may apply equally to other sectors, including health care and radiology, where, as in venture capital, pattern recognition may be both the key to success and a significant risk.”
The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth .
Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121

“Creating a radiology workplace that is attractive to women will be a major step forward in the recruitment process. As Ms Abramson states, if we can recruit and retain a more diverse workforce, we will be rewarded with more successful departments with greater ability to realize our full potential.”
The Cost of Unconscious Bias and Pattern Recognition
Jenny Abramson, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
.Journal of the American College of Radiology , Volume 14 , Issue 8 , 1119 - 1121

“1. Do work that matters, that is hard, and that we are uniquely able to do: Make sure that the problem you are working on matters to other people and is thus commercially viable work that can be funded. Remember, however, that unless you swing for the fences your company will almost certainly lose. If you don’t take risks in business, how can you hope to beat all those other incredible companies in the marketplace? The conservative move is the one that will put you out of business!”
“From Gaming Machines to Thinking Machines . . . ”
Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.

“2. Do work that brings us incredible joy: Realize that profits may not be there when you start. Use the pride and satisfaction in the work itself as a way to overcome those inevitable initial setbacks and obstacles.”
“From Gaming Machines to Thinking Machines . . . ”
Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.

“3. Believe in your vision knowing that the best customers may not, at first: It is a truism that several of our most successful innovations were products that consumers claimed to have no interest in prior to our developing them! Success as an innovator sometimes requires the foresight to see ahead of the customer’s current wants and desires.”
“From Gaming Machines to Thinking Machines . . . ”
Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.

“4. Although Jen-Hsun Huang’s development of a multibillion-dollar company may seem light-years away from the demands of running a local radiology practice, his advice to take “joy in your work” and “care about craftsmanship” is valid for any industry. Though it is easy to simply “mail it in” and provide a mediocre product, maintaining your long-term viability in a competitive industry requires caring a great deal about the quality of your product or service. Certainly, as in Silicon Valley, many radiology practices have encountered failure because they failed to realize that it is quality work that underpins financial success.”
“From Gaming Machines to Thinking Machines . . . ”
Huang JH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2016 Aug;13(8):1008-9.

“To be successful, we need curiosity and the willingness to reach out to people from other disciplines who know things we do not know and are smarter than us. I subscribe to the 50- 50 rule: at least half of what I read is in fields unrelated to my own work.”
From Academia to Government toIndustry: A Strange Journey and Its Lessons 
Elias Zerhouni, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
Am Coll Radiol. 2018 Jan;15(1 Pt A):112-113

“Leadership requires heart, spine, and brains, as well as dominating one’s fear. When I first came to the United States, I had big dreams; I knew I could not put a full life in a small dream box. The ability of this country to attract the best is what makes America great.”
From Academia to Government toIndustry: A Strange Journey and Its Lessons 
Elias Zerhouni, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
Am Coll Radiol. 2018 Jan;15(1 Pt A):112-113

“For radiology to flourish in the world of precision medicine, our specialty must reach out and collaborate with other disciplines. Remaining sheltered in our imaging silo could hamper success. For example, the development of deep learning as applied to medical imaging depends on radiologists’ working closely with computer scientists to identify the most promising applications and algorithms as well as with our colleagues in oncology and surgery to identify key clinical questions we need to address.”
From Academia to Government toIndustry: A Strange Journey and Its Lessons 
Elias Zerhouni, Elliot K. Fishman, Karen M. Horton, Sheila Sheth 
Am Coll Radiol. 2018 Jan;15(1 Pt A):112-113

“In medicine and radiology, we are overly focused on the short-term: to care for an individual patient, to get through a clinical day, or to survive the challenges of the fiscal year. We need to “dream big” and set long-term, 5-year or 10-year plans to pursue projects that we feel passionate about and that we have the commitment to follow through.”
More From Moore's Law: The Journey to Toy Story and Implications for Radiology.
Smith AR, Lugo-Fagundo E, Fishman EK, Rowe SP, Chu LC. 
J Am Coll Radiol. 2022 Apr;19(4):592-593. 

“A number of years ago, we were approached by a Japanese company to make the first digital movie at Lucas- film based on the story of the monkey character in The Journey to the West. After running the numbers, however, I knew that given Moore’s law (now broadly understood to mean that technological progress results in the doubling of computer speed every 2 years), the technology was just not ready. We needed 5 more years before we could make their request a reality. To understand Moore’s law and computer graphics, we first need to understand the pixel, and to do that, we need to travel back to 19th- century France.”
More From Moore's Law: The Journey to Toy Story and Implications for Radiology.
Smith AR, Lugo-Fagundo E, Fishman EK, Rowe SP, Chu LC. 
J Am Coll Radiol. 2022 Apr;19(4):592-593. 

“Even worse, although I had established an open-door policy, I was told that the production staff had felt hesitant to voice their concerns because they didn’t want to be seen as “going over the head” of their coworkers. From that time on, my policy at Pixar has been that anyone can voice an opinion to anyone else without worrying about consequences or reprimand.”
From Toy Story to CT Scans: Lessons From Pixar for Radiology
Catmull E, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Sep;12(9):978-9.

Dr Catmull’s admonition about “hidden” aspects of an organization is very important. Radiologists may have a good sense of what is happening in departmental reading rooms, as the majority of radiologists in a department perform at least some clinical work. However, “other” facets of the department, including many patient-centric aspects of radiology, such as scheduling an appointment, patient parking, checking in with the receptionist in the waiting room, having an intravenous line placed by a nurse, or requesting one’s scan results, are all somewhat obscure in the minds of most radiologists but are critical in the “patient experience”.
From Toy Story to CT Scans: Lessons From Pixar for Radiology
Catmull E, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Sep;12(9):978-9.

“In all of the organizations I have worked, the best leaders and executives have been able to create work cultures that inspire both clients and their companies’ employees, and they have had the strength as leaders to drive the difficult changes needed to create those positive work cultures. Over the years, having seen both successful and unsuccessful businesses, I have become a strong believer that in order for your company to be successful, your employees must be happy, they must truly believe in their company and products, and they must be willing to put their clients first.” 
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8

The success of any company starts with caring about your people, products, and clients, and of these three, I would argue that focusing on the happiness of your own employees may actually be most important for the long-term sustainability of your business. Without happy employees, it is difficult to maintain happy clients, no matter how good your product may be.
Improving Patient Care Through Inspiring Happiness.
Kaplowitz M, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Nov;12(11):1227-8

“Specifically, the current customers of a successful business are usually happy with the service they are receiving, are unlikely to perceive or understand changes in the marketplace that may be coming in the near future, and are unlikely to be happy with any abrupt changes brought about by the incumbent business. On the other hand, new entrants into the market, unencumbered by the expectations of any current customers, are much more likely to make the dramatic changes needed to respond to a constantly changing market.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman
J Am Coll Radiol. 2017 Jun;14(6):848-849

“Being a leader in a time of change requires that you define your “North Star,” or the fundamental aspects and goals of your business, and then work backward to figure out the best step forward. Every decision you make should bring you closer to that North Star. Once you make a decision, have the courage to “own” that decision: be confident and knowledgeable. Be able to articulate your message. Although being confident in your decisions is important, continuously “stress-test” the reality of your decisions and be prepared to change course if things are not working.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman
J Am Coll Radiol. 2017 Jun;14(6):848-849

“One aspect of Mr Grossman’s talk we found particularly important was his stressing the idea that making necessary changes sometime means temporarily ignoring the short-term complaints of your customers, many of whom “like things the way they are.” That is particularly true in our field, in which changes in our practice pattern may affect not only our patients but also our many referring physicians. Perhaps in this time of rapid change in our industry, when changes may be required of us on a constant basis, consistently maintaining communication with our referring physicians and patients about the rationale behind our decisions might be critical as we go forward.”
Media Leadership: Change Management
Keith A. Grossman, Elliot K. Fishman, Karen M. Horton, Siva P. Raman
J Am Coll Radiol. 2017 Jun;14(6):848-849

“If you don’t understand how to optimize service for your customers, all the medical knowledge in the world will not be sufficient for your business to succeed.”
The pursuit of excellence: from hotels to hospitals.
Schulze HH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Jan;12(1):17-8

“In my experience, there are 3 things customers expect from any business: (1) timely service, (2) a good product, and (3) people who treat me well and are nice to me (i.e., caring service).”
The pursuit of excellence: from hotels to hospitals.
Schulze HH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Jan;12(1):17-8

“Let’s assume for a moment that your department and institution have a good product—you are great physicians and nurses, and patients can expect good outcomes if they choose your hospital. Unfortunately, the general public may not always have enough medical knowledge to recognize that you’re doing a good job—it is timely service and the way in which people interact with them that come to define their perceptions of you and their care.”
The pursuit of excellence: from hotels to hospitals.
Schulze HH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Jan;12(1):17-8

We’ve found that a wait any longer than a couple of minutes is enough to create a negative perception of your organization in the customer’s mind. Unfortunately, long wait times seem to be common at many hospitals. Why? The last people who should be kept waiting are sick patients, who are scared and anxious.
The pursuit of excellence: from hotels to hospitals.
Schulze HH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Jan;12(1):17-8

“I hire my employees as human beings to join us and be apart of us. I want them to be a part of the vision and dream of our company, and I want them to gain happiness from being part of a team that creates excellence.”
The pursuit of excellence: from hotels to hospitals.
Schulze HH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Jan;12(1):17-8

“Just as important, I have discovered over the years that the success of the team and individual employees is highly contingent on having your organization filled with leaders rather than managers. Leaders give no excuses—they exude positivity, optimism, and drive, and that filters down to every member of the organization. Managers, on the other hand, are concerned with covering up their own lack of drive and ambition with excuses.”
The pursuit of excellence: from hotels to hospitals.
Schulze HH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Jan;12(1):17-8

“Finding leaders is not that easy, but I have managed to gradually fill up my organization with leaders, rather than managers, and that has contributed toward my employees’ being happy and being placed in positions where they can succeed. Hiring the right people is the key to success and should be a top priority.”
The pursuit of excellence: from hotels to hospitals.
Schulze HH, Fishman EK, Horton KM, Raman SP.
J Am Coll Radiol. 2015 Jan;12(1):17-8