RSNA President to rads: Get on the quality improvement bandwagon
CHICAGO— Quality improvement is one of the most vital priorities for radiology today and will be a key factor in determining the future of the profession, according to Gary J. Becker, MD, president of the Radiological Society of North America (RSNA) during his opening address of the RSNA scientific sessions. "Quality Counts" is the theme of this year’s conference.

He explained that the “habit of measurement,” which is necessary to improve quality, does not yet exist in radiology.

Becker, a professor in vascular and interventional radiology at the University of Arizona College of Medicine in Tucson, suggested that radiology has a few “wrinkles” to work out before the widespread adoption of quality improvement measures, including:
  1. Ignorance of quality improvement principles;
  2. Pre-conceived notions and attitudes; and
  3. Lack of a culture that is geared toward improvement.
“These factors prevent our engagement in the very activities that should be central to our practices,” he said. “The demand for individual physician transparency and accountability from patients, families, insurers, hospitals, quality groups, accrediting organizations, regulators and government is sure to grow.”

In reiterating the conference’s message of Quality Counts, Becker offered three themes for individuals to use as a background when adopting quality improvement measures:

  • Quality matters;
  • Quality Improvement is a quantitative applied science;
  • Quality Radiology of the Future.

“As we enter the era of personalized medicine and value-based purchasing, delivery of the highest quality and most efficient care will depend upon quantitative imaging and informatics,” he said.

The U.S. has awakened to medical errors and grown intolerant of waste, and Americans have grown weary of fragmented healthcare delivery, Becker explained, adding that the “nation deserves better from us.”

In citing a recent RAND study, he commented that about half of the recommended care to Americans meets evidence-based quality standards, which he said is “upsetting” because in 2009, 2.5 trillion, or 17.6 percent of the GDP, was spent on healthcare. Becker said that the waste in the U.S. healthcare system is projected at $3 out of every $10 spent.

“If radiologists and all physicians wish to avoid ceding all medical regulations to government and other external stakeholders, we must earn the public’s trust. To maintain a portion of our privilege to self regulate, we will have to deliver quality, affordable care; engage in physician performance assessment and improvement; and demonstrate our outcomes through public reporting,” Becker stated.

Becker reiterated that quality improvement is a quantitative applied science: “What you do not measure, you cannot know; and what you do not know, you cannot improve,” he said. “Measuring how well we do in practice is the basis for improvement.”

He said that all of the quality improvement aims can be whittled down to four goals: safety; process improvement; professional performance assessment and improvement; and satisfaction.

In general, the “measurement tools for quality improvement are not very high-tech,” and include record review, surveys, direct observation and some automated methods, Becker lamented. “Our collective action in quality and safety has been too slow and ineffective.”

Barriers to participation in quality improvement activities are often attitudinal, Becker explains, and manifest themselves in the following statements and ideologies:
  • Unfamiliarity with methodology or lack of knowledge;
  • Autonomy: “I do what works for me";
  • Beliefs about personal practice quality;
  • Viewed as extra;
  • Cost: “Just another unfunded mandate”; and
  • Insecurity.

“While measure is extremely important, it isn’t everything. Measurement only begins the process, as it needs to be followed by analysis, improvement planning and implementation and re-measurements,” Becker said. “It’s what we do with measurements that counts,” adding that clinical data registries are a good means of assessing quality.

Finally, he concluded that delivery of the highest quality, most efficient care or P4 Medicine [personalized, pre-emptive, predictive and participatory] is “highly dependent on quantitative imaging and informatics.”