What separates an exceptional radiology department from one that maintains the status quo? Are there attributes that top-quality radiology departments consistently demonstrate that separate them from a standard radiology department? One of the key attributes of excellence is continuous quality improvement or, in the words of the luxury car manufacturer, relentless pursuit of perfection.

At Dartmouth Hitchcock Medical Center (DHMC), continuous quality improvement (QI) is pervasive, championed by the leadership, celebrated by the staff, and the source of benefits for everyone. DHMC’s Management Services Office monitors the ongoing quality improvement activities throughout the institution, offering assistance, support, and, if required, a facilitator to move processes along. Currently there are more than 100 quality improvement projects in various stages of development at the hospital.

Twice each year, on a day we call Quality Day, DHMC hosts a day-long series of lectures on quality and process improvement. These activities are open to everyone in the institution, and they vary in scope from quality improvement workshops run by nationally known figures to focused lectures on quality and process improvement. The day is topped off in an auditorium filled with scores of displays showing recently completed or ongoing quality improvement projects, and anyone working on a quality or process improvement project is given the opportunity to show the details of their effort. One or more of the QI team members who worked on the project host each display. This has proven to be a wonderful way for people to show what they have been doing and for others to learn how successful QI programs have been run.

The radiology department, a frequent participant in the DHMC Quality Day, also practices quality improvement on a continuous basis. While there are many ongoing quality improvement projects, this year the department has focused its attention on six key activities:

  • Decrease report turnaround time
  • Increase patient satisfaction
  • Increase referring physician satisfaction
  • Decrease waiting time for patients
  • Decrease lost or missing studies from the reading areas
  • Increase employee satisfaction with their work

Our approach is for the key managers of the radiology department to look annually at the opportunities for improvement and select those that will have the greatest impact on our operation. The process starts with a brainstorming effort, during which all opportunities for improvement are listed, discussed, and grouped by major category, such as report turnaround time. Then the managers reach consensus on which key five or six quality improvements will be focused on in the coming year. Once consensus is reached, each manager accepts responsibility for one of the quality improvement efforts. The management group collectively accepted the responsibility for improving employee satisfaction.

During the weekly manager’s meeting, the progress on each manager’s quality improvement initiative is reviewed, progress is reported, enhancements or changes are suggested, and improvement targets for the next meeting are set. Both the process and the benefits are continuous.

As an example of one of the quality improvement projects, the effort to reduce report turnaround time became the responsibility of the radiology business manager, who administrates reception, transcription, and billing. Recognizing that the key to virtually any quality improvement program is the ability to measure the components of the process accurately, he collaborated with the department’s information systems manager in developing statistical reports of the different components of the results reporting process.

This included the time from:

  • dictation to transcription
  • transcription time
  • report availability to authentication
  • authentication to distribution

As each component of the process was evaluated, it became clear that the opportunities for improvement were to be found in small incremental changes rather than one sweeping change that would quickly improve turnaround time.

The new changes coupled with previous improvements were made in several areas:

Standardization. In collaboration with the chairman, the business manager met with several key radiologists to develop a standardized report format for high-volume studies that would lend themselves to standardization.

Transcription in Radiology. The hours of the transcriptionists were modified to accommodate both their availability and the work flow. Plans were developed to modify the work areas for the transcriptionists for general comfort (such as airflow and lighting) and to minimize repetitive motion discomfort, which slows the work pace or leads to increased sick time.

Transcription Outside Radiology. An out-of-state transcription company was contracted with to handle peak period work flow. This enabled the department to continue operation at a steady pace regardless of the availability of radiology’s transcriptionists, which fluctuates during vacation, unpredictable sick leave, and when positions become vacant.

Radiologists’ Reminders. The chairman’s administrative assistant reminds all radiologists of the number of reports awaiting authentication twice each day. This serves as a welcome reminder for busy radiologists.

The department purchased modems for any radiologist with a home PC so that reports dictated and transcribed late in the day could be signed in the evening at home.

Referring Clinician Access to Results. Referring clinicians were invited to register for the department’s password-protected, secure telephone system to enable them to listen to reports prior to transcription. More than 1,000 clinicians took advantage of this opportunity, and approximately 60 clinicians use this system each day.

Automatic Faxing of Results. Referring clinicians with fax machines have the ability to sign up to receive a faxed copy of the results immediately following the radiologist’s authentication: approximately 1,100 clinicians receive results by fax.

Since these improvements were implemented, the radiology results reporting process has improved dramatically. This provided increased satisfaction for the referring clinicians who receive reports promptly and for the radiologists who are able to sign reports shortly after interpretation. The department’s transcriptionists, relieved of the pressure to maintain the heavy workload, appear to be healthier. This is reflected in reduced sick time and a 20% improvement in productivity.

This process for quality and process improvement has demonstrated that improvements can be made effectively in small steps. These small steps lead to huge improvements in quality along with increased customer and employee satisfaction.

Additional information on radiology administration is available at Dartmouth Hitchcock Medical Center’s Radiology Department Web page.

Monte G. Clinton is administrative director, Department of Diagnostic Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, and a member of the Decisions in Axis Imaging News editorial advisory board.

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