In the race to improve workflow in radiology, there are many factors to consider. Process improvements, facility redesigns and technology upgrades all play a part, but departments and practices need to make sure that, amid the rush, patients aren’t left behind.
Before any workflow improvement project begins, physicians and administrators need to understand precisely what they are trying to improve. While time in the scanner used to be a prime measure of turnaround, there’s too much not being captured by that metric, explains Robert Junk, founder and principal of RAD-Planning in Kansas City, Mo. Some facilities track turnaround from the image order to the point when referring physicians receive the results, but there again, many steps in that chain might be out of a practice’s hands.
Junk recommends tracking the time from patient arrival to when he or she walks out the door. This captures efficiency of check-in, patient prep, recovery and check out.
To put in perspective what’s at stake, consider an imaging facility that operates for 10 hours per day. If an exam takes 30 minutes, that’s 20 exams per day. If just five minutes could be trimmed from each scan, however, that would translate into an additional four patients every day and 1,248 additional patients per year.
To start shaving off minutes, St. Bernard’s Medical in Jonesboro, Ark., turned to Lean production, the process improvement principles first adopted in manufacturing that have been spreading throughout healthcare in recent years. The 465-bed hospital began their Lean journey in 2011 by bringing in a Lean consultant after seeing the gains made by other organizations at professional conferences.
“It really made sense and we thought ‘why aren’t we doing this here,’” says Rocky Horton, Lean facilitator at St. Bernard’s.
At the heart of the hospital’s Lean process is the creation of value streams for each department. These roadmaps are used to analyze the flow of materials, with the focus being elimination of waste. For example, an analysis of the pharmacy department revealed the process for preparing IVs often led to them being mixed unnecessarily and wasting both time and materials. By improving communication of what IVs were actually needed, St. Bernard’s realized $680,000 in annual savings, Horton says.
The hospital recently conducted a value stream of radiation oncology, with the goal of bringing patients in for their first visit within three days of referral. Horton says that after consulting with frontline staff and examining volumes, they recognized a need for two additional exam rooms and are investigating expansion.
When expanding an imaging facility or building a new center from the ground up, design choices can have an enormous impact on workflow. Junk says the biggest stumbling block for imaging construction projects is placing too much emphasis on the scan room and neglecting other areas, such as changing rooms and holding spaces. “The No. 1 bottleneck that we have found in reviewing imaging design is facilities don’t have adequate support spaces to optimize the flow at which the scanner is able to scan patients,” he says.
Support rooms are the cheapest to construct and well-planned facilities can streamline workflow more efficiently. Rather than prepping patients in a scan room, having a nearby space where technologists can prep the patient without tying up the scanner can speed turnaround times. Keeping waiting rooms easily accessible can cut down on the time it takes patients to travel to the prep and scan rooms. Creating separate spaces for inpatients and outpatients limits hang-ups stemming from the wide variety of protocols used to handle different types of patients.
Electronic scheduling and check-in kiosks are technologies that can be leveraged, though Junk advises practices to be cognizant of patient demographics. Older patients may not be adept at using a check-in kiosk, while younger patients may actually be more comfortable using the kiosk than speaking with a person.
Feedback and value
Lean process maps, construction schematics and turnaround times are all technical, left-brained ideas, and while they can ensure quality and safety, effective care delivery requires an added dimension.
“In the imaging profession, we’ve become so left-brained and task-oriented in moving patients through and giving them this service that we sometimes lose sight of what really matters most to the patient, and that’s this emotional connection,” says Bill Johnson, CRA, MBA, system director, patient experience, for Memorial Health System in Springfield, Ill.
Providers can be lulled into believing that a focus on improving turnaround times is being patient-centered, but Johnson says patients do not rate their experience based on an assessment of clinical delivery. About 60 percent of patients rate their satisfaction on how they are treated as a human being, he says. They already expect competency, safety and quality, and instead define quality of care as the quantity and quality of caring.
By monitoring patient satisfaction with surveys and post-visit calls, practices can modify the behaviors they exhibit during care delivery. Complaints often stem from poor communication or when a patient feels staff is disinterested, while compliments mainly focus on staff members who are kind and keep patients informed. These right-brained ideas about emotional connections don’t have to impede workflow, says Johnson. One Memorial Health System patient who received a breast biopsy commented that during the procedure, when she felt pain, the technologist held her hand and provided a calming effect without sacrificing technical efficiency.
“As we go from volume-driven revenue to outcome-driven revenue, the patient experience contributes a significant portion of revenue in the new reimbursement model,” says Johnson. “The patient experience has quickly become a renewed priority in any performance excellence model.”
Get started, but never finish
The emotions of patients aren’t the only ones worth considering during a workflow improvement project. Staff buy-in must be established early for a successful adjustment, and with so many demands on healthcare currently, another improvement project may not be well received initially. Horton says some staff at St. Bernard’s thought Lean would be a flavor of the month and eventually disappear, while others thought it heralded staff downsizing. “We had to quickly show them that we were bringing Lean in to keep these jobs, to save the medical center money in order not to lay off people.”
Sustainment is the ultimate goal, Horton says. Once workflow improvements are made, staff must maintain their responsibilities and administrators must continue to analyze and reflect. It is not about a single project. It is about the process of making work flow.