The radiology department at Trinity Mother Frances pulls together to cut costs without sacrificing jobs—and scores big.

MVP: Coach, Motivator,
Barry L. Borel, Divisional Director

In spite of today’s tough economy, Barry L. Borel, divisional director of imaging for Trinity Mother Frances Hospitals and Clinics, Tyler, Tex, has an ambitious goal: to create a “world-class radiology department” on a par with the Mayo Clinic or the Cleveland Clinic. 

And that’s not just lip service. Since coming to Trinity Mother Frances 4 years ago, Borel and his team have used a combination of smart equipment purchases (such as the portable Fuji FCR GO machines and the Siemens Acuson S2000 ultrasound units) and savvy staffing to cut the aggregate turnaround time per exam from 129 hours to 13.69 hours.

Naturally, his department is not immune to the pinch of the economic slowdown. But rather than feeling resigned to the challenges ahead, Borel sees them as an opportunity for further improvement.

“I think my vice-president said it best, ‘We’re finally going to do things we should have been doing all along,'” he said. “When things are good, you tend to not look at every little detail. Boy, the minute things go bad, you start looking at everything. And so we’re looking, and we’re finding. And so far, it has not been incredibly painful.”

Like most hospitals around the country, Trinity Mother Frances has had to make some adjustments in keeping with the national economic downturn. Some positions have been eliminated, and plans to purchase an electronic medical records system have been put on hold. But in a hospital-wide meeting held in early 2009, hospital executives made it clear that they would do everything possible to avoid layoffs—and they asked every manager to encourage staff members to help come up with cost-saving measures.

Even before this meeting, Borel’s staff have been instrumental in developing ideas to cut costs without sacrificing the quality of care. He says that many of the department’s best savings ideas come from the techs themselves, and he makes sure to solicit their input. 

“It’s amazing how much waste we can wrangle out of the department when we actually ask the people who are doing the work day to day,” he said.

MVP: Most Saves!
Brad Whisenhunt, RT,
PACS Administrator and Radiology Manager

Strategy for Cutting Costs

Borel’s staff has come up with several cost-saving measures. For example, the department slashed $400,000 in annual agency fees by implementing an internal cross-training program. By encouraging diagnostic techs to seek open positions on the CT team, the department no longer has to rely on outside help during high-volume days.

The CT cross-training program was the brainchild of staff member Kristen Bracken, RT (R), (CT), who now serves as the team leader for the CT department. Currently, three of the 11 CT techs have come out of the diagnostic staff, and the department also offers cross-training in MR.

“Cross-training was an option given to me when I worked elsewhere,” she said. “So, I suggested giving that opportunity within the hospital, and they thought it was a great suggestion.”

Each CT trainee shadows Bracken for about a month, and then works alongside other experienced CT techs to get a feel for different approaches to the modality. After 3 to 4 months, the trainee is ready to become a full-fledged member of the CT team.

Hiring CT techs from within means they are already familiar with the hospital’s systems, policies, and procedures—which translates to greater savings for the department. “There’s always an increased cost in hiring from outside the company,” Bracken said. “Because that employee has to go through an orientation, they take a lot longer to train within the department.”

Cross-training techs is just one of the many ways that the Trinity Mother Frances radiology department works together to cut costs. Here are some others:

MVP: Original Strategies
Kristen Bracken, RT (R), (CT),
Team Leader for CT Department
  • Scheduling staggered shifts. During busy times, calling in for reinforcements can be a costly proposition for most radiology departments. Rather than locking staff in to traditional “block” scheduling—such as the 7 am to 3 pm shift—the CT staff at Trinity Mother Frances looked at data on the department’s hourly volumes to determine when staff are needed most. Staff now work staggered 8-, 10-, or 13-hour shifts that are designed to overlap during the busiest hours. “Keeping the most techs here during those high-volume times helps us decrease our call-backs, which helps us save money,” Bracken said. It also translates to more efficient care. “Our patients are able to get their procedures done quicker, more efficiently, and get the results faster,” she said.
  • Standardizing supplies. Sometimes, physicians order supplies that are redundant or not used very often—and end up collecting dust until their expiration dates. To avoid this problem, Borel’s department is working with the physicians in the radiology group to standardize common products such as biopsy needles and drains. “Instead of having 12 of the same type of product, only from different vendors, we’re going to streamline it down to two or three, so that our inventory levels go down and we’re not holding so much money in inventory,” Borel said. It is also an opportunity to price products. For example, the department is switching to a new catheter that is both longer lasting and less expensive than the brand it used previously.
  • Cutting down on contrast. When the CT department brought on two SOMATOM Sensation 64 machines from Siemens Medical Systems 3 years ago, the staff noticed that the faster scanners did not require as much contrast as they had used in the past. “In several of our angio procedures, we were able to cut costs by decreasing the amount of contrast used in those procedures,” Bracken said. “Even if we’re saving only 20 cc of contrast per patient—with our workload and our volumes the way they are, that adds up to a significant amount of contrast.” The CT department typically handles 80 to 120 procedures a day.
  • Creating criteria. Many cost-saving measures require interdepartmental communication. For example, when tracking the hospital’s use of a more expensive contrast agent, Borel’s team discovered that the cardiology department was using it in almost all of its patients. This led to an effort to educate all departments about when to use the contrast. “We got with the medical directors of each group and presented criteria to them,” Borel said. “And they helped us wean it down to where CT alone is using 50% less, angiography is using 30% less, and the cath lab is using about 30% to 35% less.” Within 4 months, the savings was already upward of $100,000.
  • Printing fewer pages. Although the department has greatly reduced the need to print out orders and other paperwork, sometimes the need for a physical copy is unavoidable. To conserve paper, one staff member figured out how to set the printers and copiers to double-sided mode. “Not having to buy so much paper has netted us a few hundred dollars each month,” Borel said.
  • Renegotiating contracts. The department uses a night-hawk service, and some of the radiologists were tasked with pricing the competition. After getting one or two quotes from competitors, the radiologists negotiated with their existing service. “They went to the current vendor and said, ‘What are you willing to do to keep our business?'” Borel said. “So, they lowered their prices.” The savings are projected to be about $30,000 a year.
  • Collecting all charges. Some procedures fall through the cracks, as far as billing is concerned—and finding those instances can help boost the bottom line. “We’re looking to make sure that we’re capturing all the charges that we can, and we find out a lot of that information from the working techs,” said Brad Whisenhunt, RT, PACS administrator and radiology manager. Thanks to staff reports on their daily activities, for example, the radiology department discovered that it was often not charging for urethrocystograms. In fiscal year 2006, only four of these procedures were recorded; but due to improved reporting, there were 210 on the books in 2008, and another 328 for the first 9 months of 2009. “The radiology portion of it is not terribly expensive, but every dollar helps,” Whisenhunt said.
Barry L. Borel, divisional director, Kristen Bracken, RT (R), (CT), and Brad Whisenhunt, RT, PACS administrator and radiology manager.

Building a Team

Soliciting input from staff to help cut costs can greatly benefit a radiology department—but that doesn’t mean it’s always easy to do. Often, staff are timid about making suggestions, for fear of jeopardizing their jobs if their supervisors don’t like what they hear. As Borel learned from experience, it takes a lot of effort to make staff feel comfortable enough with the management to come forward with ideas. “That was very painful for me and the leadership team, I assure you,” he said.

The first step is making staff feel that their input—and even constructive criticism—is valued. But building that trust between management and staff takes time. Ultimately, it comes down to management delivering results—and Borel credits this for bringing his department together.

“Seeing the results of the things they brought forward actually happening, taking place, and getting corrected was the biggest thing that brought the majority of them around to feeling like they were part of the team,” he said.

It is also important to create channels for staff to deliver feedback. In addition to regular team meetings within each modality, Borel developed what he calls the Radiology Action Committee (RAC). The RAC is made up of one representative from each modality, and the committee meets monthly to discuss issues that arise, suggestions for improvement, and other ideas for the department.

“This is all grass roots; there are no management people in that group,” Borel said. “They work on policies, they work on protocols; they work on whatever they feel needs to be changed. Then they run it up to us, and we take it where it needs to go.”

The RAC is designed to help every staff member have their say.

“Technologists tend to communicate better to their fellow technologists than they do to administration, simply because of that comfort zone,” Bracken said. “[With the RAC,] we’re able to bring things to the table that have been communicated to us from our coworkers, and take them up the chain of command to administration. That way, they’re always being heard.”

Of course, good communication is a two-way street. Whisenhunt notes that the managers make sure to keep employees informed about the department’s performance, goals, and budget, too, so that everyone is on the same page.

“They know how many procedures we’re doing this year versus last year, compared to what was budgeted,” he said. “We let them know the information so that when we talk to them about flexing their time, for example, they understand the reasoning behind it.”

When the economy turned sour last year, management asked employees to “flex” their time—meaning if they work an extra 30 minutes one day, rather than claiming it as overtime, they go home 30 minutes early the next day. Although employees were reluctant to accept the change at first, they were much more receptive when management made it clear that this measure could save jobs.

“The bottom line is that transparency and honesty go a lot further than trying to protect them by keeping things from them,” Borel said.

Despite the current economic challenges, Borel says his team’s goal to become a world-class radiology department is stronger than ever. And as the staff is pivotal to that goal, he makes sure they work together every step of the way.

Borel says to keep morale up, he speaks to the heart, reminding staff that their dedication is instrumental to the hospital’s success. “You know to do what’s best for the patient, for yourself, and for the organization,” he tells them. “If you can get all three of those things wired into your psyche, this organization will continue to thrive even during the tough times.”

Ann H. Carlson is a contributing writer for Axis Imaging News.