RSNA: Cooperation, dialogue among keys to quality in radiology practice

CHICAGO—Despite operating in a complex system, the ability for radiologists to engage in cooperation and positive collective behaviors is the first step in achieving quality and meaning in radiology practice, according to a presentation on Dec. 2 at the Radiological Society of North America’s (RSNA) annual meeting.

Presenter David B. Larson, MD, MBA, of the Stanford School of Medicine, began his presentation by establishing quality as “consistently doing something well.”

“Quality is like breath,” he said. “Everyone assumes their own is outstanding. But is it, really?”

Radiology, he argued, has changed over the years. The older, more traditional practice, was simpler with fewer people in the mix.

“We interacted with each other a lot, we were involved and if there were issues to discuss, we would have those discussions,” he said.

Larson noted that the system has grown over the years and now includes a multitude of decisions, decision makers, feedback and protocols. “Under this construct, the built-in quality control mechanisms are gone.”

Larson describes a radiologist’s belief that they cannot impact or change the flawed current system “organizationally induced helplessness.”

“The system was designed to be mediocre,” he said. “And radiologists, despite doing their best to provide good work, feel like they cannot change the system. It’s a wonder more things don’t slip through the cracks—it’s a tribute to the quality of providers in this chaotic system that it doesn’t happen more.”

The key to quality in radiology, Larson argued, lies in defining purpose in radiology.

“We save lives and improve lives with information,” he said. “We are in the business of information and our primary concern should be our customers.”

A radiologist’s customers, he reasoned, are patients and their families, but also referring clinicians.

“We have to think beyond terms of simply creating a report,” Larson urged. "If we think along those lines alone, we’re going to be commoditized.”

Additionally, Larson thinks collaboration with other providers and technologists, freely sharing ideas and dialogue with others in the industry, is a good place to begin when looking to improve quality, an idea he called “collective behaviors and attitudes.”

“In general if you want to create excellence in care, you need to have shared mission and values across the field,” he said. “Lack of accountability, petty rivalries, inability and unwillingness to get along creates an unsafe environment for patients. If you want to get started in quality, this is the place to begin.”