In a joint effort by technologists and administrators, the department of radiology at Mayo Clinic in Scottsdale, Ariz., increased radiographers’ productivity by 11 percent, saving the department $170,000 per year, according to a study published in the October issue of Journal of the American College of Radiology.

“This is one of the few improvement projects that I’ve been a part of that was initiated and implemented on the grassroots level. The improvement project was designed and implemented by the technologists and supervisors themselves,” the study's senior author Daniel Johnson, MD, chairman of radiology at Mayo, told Health Imaging & IT.

The department sought a method to measure and ultimately improve the productivity of general radiographers in the department of radiology. After considering several options, including the common standard of calculating relative value units (RVUs), the department decided on a simple equation--productivity equals total time spent administering examinations divided by total time spent on duty--for individual technologists as well as the group as a whole.

“RVUs are not always right,” Johnson argued. “They don’t allow for variations between institutions. For example, a larger hospital that requires more walking time or a department that deals with sicker patients who need greater time and care earn poorer RVU scores. In the end, we chose to measure productivity in the way that was correct for us, and it worked.”

Securing buy-in
The project began with three months of observation, where technologists recorded the start and end times of all procedures. The average exam times for these three months served as the department’s baseline productivity, against which they would try to improve their efficiency. Initial productivity was measured at 50 percent, a surprisingly low number to both administrators and the radiographers themselves, the study’s authors reported.

The department then posted each of the 23 technologist’s productivity numbers (with each tech given a code corresponding to their productivity numbers, so that workers could compare themselves without generating personal conflicts), as well as the department’s overall productivity. “Initially it was a shock,” the study’s lead author, Michelle A. Wilt, RT, told Health Imaging & IT, “but now I can only see positive effects from posting the information.”

The technologists “did not find fault with the methodology of the study because they had helped create it,” the authors wrote. Technologists and supervisors held several meetings to discuss and improve the department’s productivity. The required times for three examinations were increased and several individuals voluntarily sat down with supervisors to discuss ways in which they could improve their own productivity. The authors emphasized that posting all of the radiographers’ productivity information generated substantial motivation, not antagonism.

“Individuals with low productivity scores also were surprised to learn that their peers were working harder than they anticipated, which encouraged some to increase their work pace,” the study found. Much of the “the improvement [in productivity] most likely was attributable to lower-performing individuals who voluntarily increased their workloads,” the authors suggested. Some of the measures that radiographers implemented to improve productivity included working at quicker paces, taking on larger numbers and alternative types of imaging procedures and cooperating as a department to find ways to increase efficiency and improve everyone’s productivity.

In the course of the study, three of 23 radiography positions were vacated. Initially, technologists complained that the vacancies left them overworked and overwhelmed. After seeing their productivity numbers, however, the radiographers themselves rejected the proposition to fill the open positions. “They didn’t want to see their productivity go down. They wanted to be on the high end of the curve,” Johnson pointed out. The major reason the project worked so well was that “technologists participated in the decision making process,” co-author Rafael Miranda claimed. “They voluntarily gave more work for themselves.”

From the baseline 50 percent productivity score, the department’s numbers rose steadily throughout the first few months of the study, to 56 percent, then 63 percent for two consecutive months, finally reaching a one-month peak at 70 percent. The department (staff and supervisors) agreed on a goal of 63 percent productivity, around which the department has hovered since the early months of the study in spring 2008.

“Even with the economy, we haven’t seen a dramatic dip. The radiographers are staying right around our goal of 63 percent,” Wilt commented.

“It has been a good project,” Miranda concluded, “opening up many workers’ eyes that they’re not as efficient as they thought they were.”

Similar methods, similar results
The authors emphasized the applicability of their productivity gains to other health centers: “We suspect that outpatient productivity would be higher than inpatient productivity.” While acknowledging the unpredictability of certain environmental and workflow factors, Johnson explained that “if other hospitals do the measures like we did, by calculating how long it takes them to complete the most common exams, then it will be relevant to those hospitals. Their numbers or methods may differ somewhat, but it should work for them,” Johnson explained.

In the views of the authors, the keys are first measuring the department’s productivity, then including workers at every step. “The project was a motivator for individuals as well as a measure of how well we’re using our human resources in the department,” said Johnson.

“Ultimately, the grassroots, the workers themselves, are where improvements are going to come, not from the leaders and supervisors. These guys know where the problems are. They know best how to solve them. I think that’s why this is such a neat project, we saw their productivity measures go up, and they’ve stayed up.”