In general business terms, effectiveness can be described as actions that produce the results you want. Effectiveness is essential for growth. Efficiency is practices that produce consistent results in the quickest manner possible. Both are necessary for a successful medical imaging department when success is defined as providing valuable service to patients and referring physicians. Inefficiencies, however, creep in as local patient populations, equipment, personnel, and corporate philosophies change over time. It sounds daunting to restructure processes for improved efficiency, but with a step-by-step approach, the project is satisfying and benefits the entire organization.
Finding the efficiency gaps in a medical imaging department
Renowned management consultant Peter Drucker once said, "You can't manage what you can't measure."1 In medical imaging, that primarily distills to keeping expensive equipment booked, and maintaining smooth throughput.
The examination duration is one of the benchmark metrics of productivity in imaging. According to RadioGraphics, this is "the period during which the imaging of a patient is being recorded by a PACS, beginning with the first image in the first series and extending to include the last image of the last series as obtained from the PACS, "2 with PACS being a picture archiving and communication system.
Factors that delay examination duration include:
- Longer (possibly non-standard) imaging protocols
- Alleviation of patient discomfort
- Rejected/repeated exam2
Comparing examination durations for similar procedures among different technologists and varying times of day can identify points for improvement. This information can now be gathered automatically with specially designed software.
Table utilization, another measurement standard, is the total examination duration hours for a given period (such as a workweek), divided by available working hours for the equipment during the same period.2 When the quotient is not close to 100%, there may be a need to market the service more heavily or use the equipment more efficiently.
Interpatient time is equipment downtime between patients. Extended interpatient time is typically a result of:
- Delays in room preparation
- Awkward patient egress processes
- Device set-up time
- Slow patient positioning which may be a product of operator inexperience or patient health status
- No-show or late appointments
- Availability of necessary support staff2
This is an area where insight from the hands-on team is invaluable, and administrative modifications (such as scheduling improvements) can have a big impact.
Appointment interval time is the sum of interpatient time and examination duration. Appointment interval is the minutes allotted for one examination, measured as the distance between the start times of consecutive examinations.2 An understanding of this metric helps the organization identify the best times for outpatient scheduling, and lengthy exams. These adjustments to scheduling can reduce patient wait times.
Interseries time is the span between successive series for one patient. It is impacted by the time it takes the operator to select protocols and make equipment adjustments.2 Interseries time may be unavoidably protracted due to administration of contrast materials, coil placement, and patient repositioning, so it is important to take advantage of software efficiencies where possible.
For example, digital platforms that capture clinical data and automate scheduling, provide the benefit of real-time details to minimize delays inpatient care. Real-time communication tools that protect patient data with encryption also help to accelerate workflows and avoid medical record errors.
You can find procedure-specific standards in the American College of Radiology’s (ACR) Diagnostic Imaging 2018 – Quality Measures guide.3 Yet none of these lists are exhaustive, and benchmarks are just that – ideal standards. Achieving improved efficiency in your organization begins with a knowledgeable team willing to openly and non-judgmentally identify traits unique to your operations. Then, you can determine if standard benchmarks are appropriate efficiency measures for your situation, where modifications are necessary, and how to better track measurement data.
It takes a team
Lean quality initiatives call for a well-informed and diverse team. Mapping the value stream requires managerial, administrative, and financial perspectives. However, real transformation comes with staff involvement.
Close collaboration with information technologies (IT) personnel is imperative. As data gatekeeper, the IT department has the potential to improve data collection, providing information that is accurate and useful, and to launch workflow tools. However, data-driven practice management requires input from the clinical staff on what data is needed, what it means, and how it will be used.
Improvement in efficiency is not “once and done.” When new processes are implemented, allow a little time to work the bugs out. After a reasonable timeframe, begin a fresh data capture to plot new results against standards and pre-change numbers. Share the progress with the team (with appropriate accolades) and remain open to additional tweaks for further improvement.
John F. Kennedy, the 35th president of the United States, is credited with the aphorism, "a rising tide lifts all boats." His quote illustrated the idea that everyone benefits from improvement.4 While JFK may have been referring to the country’s economy, the concept certainly applies to a medical imaging department, as well. When the tide of efficiency rises, profitability and job satisfaction also crest.
- The Two Most Important Quotes In Business. Growthink, Inc. https://www.growthink.com/content/two-most-important-quotes-business October 8, 2019.
- Informatics in Radiology: Efficiency Metrics for Imaging Device Productivity. RadioGraphics. https://pubs.rsna.org/doi/full/10.1148/rg.312105714 October 8, 2019.
- Diagnostic Imaging 2018 – Quality Measures. American College of Radiology. https://www.acr.org/-/media/ACR/Files/Quality-Programs/2018-Draft-Measures-ACR-for-Public-Comment.pdf?la=en October 8, 2019.
- Origin of 'a rising tide lifts all boats.' English Language & Usage. https://english.stackexchange.com/questions/230520/origin-of-a-rising-tide-lifts-all-boats October 8, 2019.