Radiology department improves patient experience ranking through quality improvement program

Improving the patient experience during imaging visits is a necessary goal more and more radiology practices aspire to achieve.  

To do this, researchers from Brigham and Women’s Hospital, Boston, an affiliate of Harvard Medical School, found that implementing a quality improvement initiative in their radiology department can enhance overall patient experience, identify opportunities for improvement in the department and address the effectiveness of interventions aimed to address gaps in patient care, according to research published Jan. 22 in Radiology.  

“Studies in several radiology departments have cited various factors as important to patients including wait times, acknowledgment of concerns, friendliness of support staff, convenience of parking, and comfort of the waiting area,” Neena Kapoor, MD, with Brigham and Women's, and colleagues wrote. “However, it is unknown whether these factors are amenable to change or whether improving these factors can measurably improve patient experience.”  

Kapoor and her team conducted their study at a level 1 urban academic quaternary care hospital and at its tertiary care centers. The outpatient network at the hospital spans 183 practices with 1,200 physicians and performs more than 500,000 imaging examinations per year, according to the researchers.  

From May 2017 through April 2018, more than 26,000 electronic patient experience surveys and 22,213 patient comments were collected for review. Surveys were initially emailed to patients two days after their visit to the various radiology locations.  

Patients were excluded if they were experiencing homelessness, lived outside the U.S., were younger than 18 years old, had no e-mail address registered with the hospital, had received a survey for the same radiology site within the last 180 days or did not speak English or Spanish, the researchers noted.  

The following interventions were put into place during the study to improve patient experience:  

  • During the last week of April 2017, before the start of the survey, laminated identification badges were given to all radiology staff—including physicians, technologists, nurses and receptionists.  
  • In January 2018, a patient experience oversight committee was created with members of the radiology department's physician and administrative leadership and the hospital’s patient leadership team. The committee would meet each month and receive and review patient comments.  
  • In January 2018, categories of survey comments were translated into a “heat map grid." To better understand and organize patient comments, categories in heat map were color coded based on the percentage of negative comments (red, high percentage; green or orange, low percentage).  

The researchers found these programs did in fact improve the national percentile ranking of the radiology department and improved overall patient experience. By the end of the 12-month study, the overall raw score for the department increased from 92.8 to 93.6 and the national ranking improved from the 35th to 50th percentile.  

“Hospital-wide raw scores did not exhibit a positive month-to-month trend, suggesting that improvements in radiology performance were not attributable to overall trends within the hospital,” the researchers noted.  

Improvements in raw scores related to personnel were primarily responsible for the increase in overall raw score and rankings, the researchers noted. Additionally, the percentage of negative comments (15.6 percent) was highly correlated with lower monthly percentile ranking.  

“Negative comments from patient surveys may provide important opportunities for improvement, with changes in the percentage of negative comments among all patient comments being highly correlated with changes in a practice's national percentile rank in patient experience,” the researchers concluded. 

In an accompanying Radiology editorial, Jonathan Bruce Kruskal, MD, PhD, and Ammar Sarwar, MD, radiologists at Beth Israel Deaconess Medical Center in Boston, acknowledged that although the study revealed the significance of taking measures to improve patient experience in radiology departments, excluding patients who were experiencing homelessness or who didn't speak English or Spanish language was a major limitation.  

“Such patients represent the most marginalized populations precisely because of their inability to advocate for themselves,” Kruskal and Sarwar wrote. “Excluding them from a systematic assessment of patient experience increases marginalization and negates the principles of diversity and inclusion. Creating survey instruments and survey distribution methods designed for these populations represents a critical gap for future research.”  

The exclusion of patients or patient advocates from the committee overseeing the intervention was another limitation of this study, according to the authors. Nevertheless, they noted the study represents a systematic effort to increase patient-centered care in radiology.  

“Ultimately, as we increase the engagement between radiology department staff, their patients, and families, we will likely rediscover that most human suffering can be relieved with a little effort—starting with a human touch,” the authors wrote.