A Governance Framework for Diagnostic Quality in Hospital-Radiology Joint Ventures

Hospital-radiology joint ventures (JVs) are forming at an accelerating pace as health systems seek to recapture outpatient imaging volume and radiology groups pursue capital and operational partnerships. 3 decades of peer-reviewed literature show a reproducible risk: when financial incentives are not structurally separated from clinical authority, diagnostic quality degrades.

At an academic medical center governing a nascent hospital-radiology JV, we developed the Blueprint for Diagnostic Imaging Excellence by synthesizing principal-agent and stakeholder governance theory, three decades of JV quality literature, and Donabedian's quality framework into a deployable governance architecture.

The Blueprint assigns nondelegable clinical quality authority-accreditation, peer review, radiation safety, and artificial intelligence approval-to the radiology group while granting full operational authority to the JV partner, with a cochaired Joint Quality Committee as the interface. A 13-domain responsibility matrix, five contractually enforceable quality-protection provisions (including a volume-quality firewall and physics veto authority), a seven-trigger escalation protocol, and audit and accountability mechanisms operationalize the model; the Diagnostic Imaging Centers of Excellence pathway aligns quality with shared financial return.

The Blueprint offers academic departments, private groups, and hospital administrators a replicable governance template that structurally safeguards diagnostic quality and preserves clinical authority within JV arrangements.