Prof.SergeyMorozovMD,MPH,PhD

EuSoMII President

Howtoidentifyradiologyproductivity

bottlenecks?

PIER @ ECR’17 – March 3 – Vienna

1. Toreviewthemetrics ofsharedradiologyworkflowinthedomainsofefficiency,qualityandsafety – what?

2. Todemonstratevariousmethodsandtechniquesfortotalproductivityimprovement– how?

3. Todelineateteamrolesinproductivityimprovementcycle– who?

Agenda

Radiologydepartment==Systemthinking

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Theactivitieschainofradiology

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Improvingaprocessdoesnotmeantoobtainbetteroutcomes.

Achainofactivitiesthatanindustryperformstodeliveravaluableproductorserviceiscalleda"valuechain"

fromBolandGW,GSRQS2015

Referrer Scheduling Protocol

ProcedureReportingDistribution

§ Customizedservice§ Patientsafety§ Throughput

§ ImagingTechnology

§ Anatomic§ Functional

§ Datamining§ Oncology-standard

templates§ Decisionsupport§ Secondopinion

§ Route§ Urgent§ Feedback

§ Appropriateness§ Utilization§ DecisionSupport§ Examtimeandlocation§ Pre-procedureprocess

Actionablereport

StrategicgoalsofRadiology

1. Selectioncriteria2. Equipment3. Patientrouting

Access1. Numberofsites2. Numberofspecialists3. Satisfaction

Quality&Safety

1. Standards2. Peer-review3.Training

Costs1. Reimbursementrates2. Additionalbudget

AccessCosts

Details StandardsMethods1. Imagingprotocol2. Reportingtemplate3. Terminology

1. Schedulinginterval2. Reportturnaroundtime3. Requirednumberofspecialists

”ASIS”1. Access – X2. Quality - Y3. Early Dx – Z4. Costs - M

”TOBE”1. Access – 2X2. Quality - 3Y3. Early Dx – 2Z4. Costs - M

StrategyTactics

Operations

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ACTIONPLAN

EarlyDx

EarlyDx

Quality&Safety

Recipeforfailure

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Engagemultiple

interconnectedparts

Startwithacomplexsystem

Payirrespectiveoflevelofquality

Adoptacultureofindividualism

Resiststandardization

Operate24/7

“Bottlenecktheory”

§ Equipment§ Process§ People

§ Materials§ Environment§ Management

§ Strategy§ Resources§ Motivation§ Datacollection

andanalysis(esp.manual)

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Howtotacklethebottlenecks?

§ Standardizingtheprocesses§ Increasingqualificationofemployees§ Minimizingdowntime,setupandchangeovertime

§ Eliminatingnon-valueactivities=calculatecostsatthepointofcare

§ Provideaconstantbufferstockupstream=suppliesandconsumables

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Administrativefunctions

Losttime:- Oversizedtime

slots- Waitingfor

emergentpatients

Patientpreparation

Sideactivities

Waste‘Muda’

Preparations Scan

Totalobservation

time

Admin.fx Patientwait

Effectivetime

Patientprep.

Contrastinjection

Patientdeparture

Scan

“MotionStudy”ofCTtechnician

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Thebestmethodfortackling‘bottlenecks’

§ Time-drivenactivity-basedcosting(TDABC)through§ betterresourceutilization§ matchingofpersonnelskillstotasks§ locatingcareinthemostcost-effectivetypeoffacility

§ Resultsin25%savingsofcosts

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Thebiggestproblemwithhealthcareisn’twithinsuranceorpolitics.It’sthatwe’remeasuringthewrongthingsthewrongway.

byRobertS.KaplanandMichaelE.Porter

Outcome27%

Mostcommon:Peer-reviewmetrics

Qualitymetrics

Narayan,A.,Cinelli,C.,Carrillo,J.A.,Nagy,P.,Coresh,J.,Riese,V.G.,&Durand,D.J.(2015).QualityMeasurementsinRadiology:ASystematicReviewoftheLiteratureandSurveyofRadiologyBenefitManagementGroups.JournaloftheAmericanCollegeofRadiology,12(11),1173-1181.

1861 papersreviewed

75uniquequalitymetricscategorized

Structure46%

Mostcommon:Facilityaccreditation

Process27%

Mostcommon:Appropriateness

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IdealPhysicianMeasures

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§ Cascade from organizational goals § Selected and supported by physicians § Be attributable to individual physicians§ Comparative and transparent § Align to electronic data collection

BalancedScorecard-Outpatient

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WatsonClinicinLakeland,USA,2006

Themeasurementphaseoftheproject:§ PatientbacklogforCTwasatfour

days.§ Roomschedulevariedbyupto40

percentaday.§ Patientthroughputwasattwo

perhourperCT.§ Halfoftheexamswerestarting

15minuteslateorlater.

CTProjectResults§ CTbacklogreducedtooneday§ 90percentofexamsstartontime§ 40percentincreaseinCTcapacity§ Dashboardimplemented§ Increasedoutpatientvolumes

to3.3patients/hour§ Financialpotential~$674,000

overoneyear

Leantechniques(valuestreammapping)andSixSigmaDMAIC(Define,Measure,Analyze,Improve,Control)foranalyzingandadjustingprocesses.

Acomprehensivedashboardtomonitoreightoperationalandfinancialmetricsonamonthlybasis.

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§ AssessmentUnitUrgentCTScansperformedandreportedwithin4hours

§ AssessmentUnitRoutineCTScansperformedandreportedwithin24hours

§ AssessmentUnitRoutineUltrasoundScansperformedandreportedwithin24hours

§ AssessmentUnitRequestsreceivedsameday§ CTScansperformedwithin24hoursofreceipt

ofrequest§ MRIScansperformedwithin24hoursof

receiptofrequest

§ EDUrgentCTScansperformedandreportedwithin1hour

§ EDCTScansperformedandreportedwithin3hours

§ X-RaysScansperformedwithin24hoursofthereceiptofrequest

§ NuclearMedicineScansperformedwithin2daysofreceiptofrequest

§ CTReportsissuedonsamedayasscan§ MRIReportsissuedonsamedayasscan

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Patients’satisfactionmeasurements

HOWTOGETA5STARRATINGASANUBERDRIVER

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Reportsandratings

Healthcarefacility

123456789

101112131415

For

CMO

Head of radiology department

Healthcare Department

Oneofresults:Avg. report turnaround time decrease by80%(from 53 to 8 hours)

TATCTQIV’15 TATCTQI’16 CHANGE

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Ratings’roleinmanagement

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Heads of departments and CMOshavesporting/competing interest

Achievingexcellent results

Whilehealthcareorganizationshaveneverbeenagainstimprovingoutcomes,theircentralfocushasbeenongrowingvolumesandmaintainingmargins

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M.Porter,HBS

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https://hbr.org/2016/11/4-steps-to-sustaining-improvement-in-health-care

Aradiologyservicemightbeagoodinitialcandidateforthepilotunitforengagingandstandardizingtheworkoffrontlinemanagers=techniciansandnurses.

HBR.4StepstoSustainingImprovementinHealthCare

Kedar S.Mate,JeffreyRakover,November09,2016

“Doingmorewithless”=efficiency

Elton Mayo (1880-1949):- Human relations movement- The Hawthorne Effect- Importance of human interaction and

morale for productivity

William Worrall Mayo(1819–1911)

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Strategicradiologychallenge

§ Clinical operational metrics § diagnosis-relateddelaysoftreatment§ timetobegintreatment

§ Outcome measurements § patients’andclinicians’satisfaction§ grossmarginofservices§ involvementindisease-specificclinicalteams§ bettertreatmentbecauseofaccuratediagnostics

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Doctors-executives

§ Operationsmanagementandexecution§ Manycliniciansfailtoappropriatelydistinguishbetweenurgenttasksandimportant,non-urgenttasks- prioritize

§ Peopleleadership§ Learnhowtogivenegativefeedback

§ Settinganddefiningstrategy§ CIO:“Chief- it'snotourbusiness– officer”© Shahar Waiser,Gett

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https://hbr.org/2015/04/the-skills-doctors-need-to-be-effective-executives

Take-homepoints

§ Definethepurposeof process or improvement§ Measure significant quality metrics§ Make metrics actionable§ Apply IT platform afterestablishingthe

processes§ Selectanddeveloppeople - “quality pioneers”

and change managers

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