Managing to Succeed: Achieving Radiology Department Excellence
By Judy Zakutny
Radiology Today
Vol. 21 No. 2 P. 6

Health care organizations that seek to improve quality, safety, and patient experience—while managing costs—would do well to take a close look at the imaging department. The following are a few reasons why:

• More than 80% of all hospital and health system visits include at least one imaging test.1
• Estimates suggest that, overall, hospitals and health systems spend $65 billion each year on imaging.2
• The Centers for Medicare & Medicaid Services is moving forward with site-neutral payments, potentially cutting reimbursements further.3
• Beginning January 1, 2021, errors in reporting authorized use criteria consultation information will cause Medicare claims for imaging services to be denied.4
• Diagnostic imaging that uses CR rather than DR will be subject to a 7% payment reduction through 2022, which will increase to 10% in 2023.5

The Importance of Operational Excellence
Operational excellence in a hospital or health system’s imaging department is an important goal for two reasons. First, a focus on operational excellence enables imaging departments to identify and eliminate wasted resources. Whether it’s wasted time, supplies, equipment, or staff, reducing waste is an effective way to improve the way an imaging department works.

Second, operational excellence has the dual effect of reducing cost while improving quality, which drives value. By devoting attention to operational excellence, imaging departments can start a virtuous cycle of efficiencies, ultimately resulting in better care. This gives patients confidence in their treatment, which improves their experience; staff are proud to work in the department as well.

Envisioning Imaging Efficiency
What does an efficient imaging department look like? There are two key aspects to which imaging departments should pay attention: patient flow and technical operations. An efficiently operating imaging department has a smooth patient flow that does not have bottlenecks or long wait times. Optimal patient flow creates a positive patient experience and maximizes the department’s use of staff resources and equipment. On the technical operations side, a department’s efficiency is only as good as its tools. An efficient imaging department minimizes tech-related downtime and has high-functioning equipment.

Equally important is the relationship between efficiency and the department’s overall strategy. Operational efficiency initiatives must support the department’s strategic priorities to ensure that all team members are moving in the same direction.

As you begin to consider how your imaging department may benefit from operational improvements, it’s essential to take a holistic approach, from the provider’s order all the way through the radiologist’s final report. Your task is to maintain a balance between appropriate fiscal responsibility and excellent patient care. The most dangerous and expensive phrase is, “We’ve always done it that way.”

Seven Keys
Step 1: Look at the current state of the department. Even if you have the most detailed roadmap in the world, it’s useless if you can’t identify where you currently are. Similarly, in order to optimize your department’s operation, it is crucial to have a solid understanding of your current state. Knowing where you stand is imperative to driving sustainable change. The following are integral to this step:

• Collect the data. Establish a baseline of your current operational performance, including patient volume, staffing, revenue, and other important metrics. It’s also important to understand the impact that other areas you rely on, such as scheduling, have on your department.

• Talk with your personnel. Get information from the staff’s point of view because they are the people who best know how the department functions day to day.

• Engage employees in the process. Research shows that staff engagement correlates to patient satisfaction. Involving employees throughout the process helps build and maintain a culture of engaged employees, which is key to patient satisfaction and loyalty.

• Ask your patients for their perspective. Understanding how patients perceive your department’s performance enables you to meet their needs and improve their experience over time.

Step 2: Define the ideal state. Next, it’s time to brainstorm and contemplate what is possible. How should the department look? No map is helpful unless you know where you want to end up. As with step 1, it’s important to get views from multiple stakeholders so the picture that emerges takes advantage of diverse perspectives.

To create a powerful future target, cultivate metrics that will allow you to compare current and future performance. Relevant metrics will vary by department, but common choices include patient satisfaction, financial performance, staff productivity, and equipment utilization. It’s also important to benchmark against yourself—not others—to truly assess your progress.

Step 3: Identify barriers, issues, and bottlenecks. What is keeping your department from performing at maximum efficiency? Take a close look at the factors that are keeping the department in its current state and preventing it from rising to the ideal.

To succeed in this step, don’t assume you know the answer. Perform a root cause analysis to be sure you totally understand the problem so that you can design a sustainable, lasting solution.

Include staff and patient perspectives to gain a greater understanding of the problems the department faces. Incorporate lean process methodology into your everyday management. Stop and ask yourself, “Is it required? Does it add value?”

Step 4: Develop a plan of action. Chart your course to operational excellence by brainstorming solutions, prioritizing the projects that are likely to have the greatest impact, and putting an execution plan together. To create a plan that works, remember that staff engagement leads to increased performance, which is key to patient satisfaction and loyalty. Also, be mindful of the upstream and downstream effects of any changes, in order to eliminate the “silo syndrome.” Changes made by the imaging department may affect other departments. Keep this in mind, as collaboration between all personnel is crucial.

Step 5: Create a culture of continuous improvement. Now that improvement projects are up and running, it’s no time to rest on your laurels. The long-term success of operational excellence initiatives depends on a commitment from leadership to fostering a culture of continuous improvement. Each day, keep the following maxim in mind: There is always a better way to run your department. Whatever you’re doing today, aim for continued incremental improvement.

To get started, listen to all ideas; the importance of communication can’t be overstated. In addition, empower your staff by telling them why the project matters, what its impact will be, and how it will benefit them, the department, and the patients.

Step 6: Monitor and manage operations. Even after you make changes and are moving in the right direction, it’s necessary to maintain focus. Assess your operations on a regular basis, rather than falling into the trap of assuming that everything is working as efficiently as possible. Always look for better ways to run your department.

With virtually real-time data and reporting tools for management, you can make informed operations decisions and, most importantly, sustain positive changes. For example, examine equipment utilization to achieve maximum throughput and zero downtime. You should also do the following:

• monitor inventory—less inventory equals lower operational costs;
• manage overtime;
• track specific cycle times, such as average procedure times; and
• train staff to ensure that they have the skills they need to complete jobs efficiently with high quality.

Step 7: Design a fail-safe. Your department is running efficiently—congratulations! But what happens if an unexpected event throws a wrench in your carefully designed processes? In a clinical setting, variation happens quite often. That’s why it’s important to standardize processes to minimize interruptions. From IT system downtime to a hospital lockdown, unexpected events don’t need to become crises.

Develop a fail-safe plan that will allow you to remain efficient. Share it with your entire team. Spend time on the floor so that you can identify possible issues and address them quickly, before they have an adverse effect on efficiency.

Conclusion
Imaging departments face real challenges. With reimbursements going down, costs going up, and an ultracompetitive landscape, it’s smart to keep an open mind. Organizations that are receptive to new ideas are the ones that will move ahead.

One key to success is data, which can give you unparalleled visibility into your imaging department’s operations. After all, past success doesn’t guarantee future success.

— Judy Zakutny has more than 35 years of experience in the imaging and health care information technology industries. She has held positions as a technologist, lead technologist, manager, and system director. Zakutny is a retired radiologic technologist and has held advanced certifications in CT and MRI. She can be reached at jzakutny@accumen.com. Visit www.accumen.com for additional information.

References
1. Smith-Bindman R, Miglioretti DL, Johnson E, et al. Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996-2010. JAMA. 2012;307(22):2400-2409.

2. Hospitals and IDNs database. Definitive Healthcare website. https://www.definitivehc.com/platform/data/hospitals-and-idns  

3. Brady M. CMS moves forward with site-neutral payments, slashes 340B payments. Modern Healthcare website. https://www.modernhealthcare.com/payment/cms-moves-forward-site-neutral-payments-slashes-340b-payments. Published November 1, 2019.

4. CMS releases appropriate use criteria fact sheet for referring providers. American College of Radiology website. https://www.acr.org/Advocacy-and-Economics/Advocacy-News/Advocacy-News-Issues/In-the-February-2-2019-Issue/CMS-Releases-Appropriate-Use-Criteria-Fact-Sheet-for-Referring-Providers. Published January 28, 2019.

5. Regulatory changes affecting radiology reimbursement in 2018. Healthcare Administrative Partners website. https://info.hapusa.com/blog-0/regulatory-changes-affecting-radiology-reimbursement-in-2018. Published December 7, 2017.