CHALLENGES IN QUALITY MANAGEMENT OF
DIAGNOSTIC MEDICAL IMAGING
DEPARTMENTSArashk Fathi , BS , (RT), (MRI) , (CT)
Tehran University of Medical Sciences
CT & MRI Department Manager at Bu Ali
HospitalHead of Imaging Informatics Committee
Iranian Radiographic Sciences Association
What is Quality?
Quality is the extent to which the right procedure is done in the right way at the right time, and the correct interpretation is accurately and quickly communicated to the patient and referring physician.
- Hillman et al
key components of quality
appropriateness of the examination the procedure protocol accuracy of interpretation communication of results measuring and monitoring
performance improvement in quality, safety, and efficiency
Why Quality???
Radiology is coming under increasing scrutiny by payers and regulators.
Quality is becoming a critical issue for radiology.
Measuring and improving quality is essential not only to ensure optimum effectiveness of care and comply with increasing regulatory requirements, but also to combat current trends leading to commoditization of radiology services.
radiology is becoming more visible and central in healthcare delivery.
exponential growth in medical imaging
imaging is increasingly performed by non radiologists or by radiologists at remote locations who may not have access to the same information.
What is Key Challenge in Radiology?
A key challenge to implementing quality improvement programs is to develop methods to collect knowledge related to quality care and to deliver that knowledge to practitioners at the point of care.
Measurable Quality =
Improvable Quality
• What you can’t measure, you do not know.
• What you don’t know, you can’t improve.
• Without observation and measurement, there is no improvement.
There are many dimensions to quality in radiology that need to be measured: examination appropriateness procedure protocol accuracy of interpretation communication of imaging result measuring and monitoring performance
improvement in quality, safety, and efficiency
Key Performance Indicatorsfor Quality in Radiology
Quality generally consists of two related but distinct components: technical or outcome quality service delivery as perceived by the
customer
Figure 1. Defining quality in radiology.
Johnson C D et al. Radiographic 2009;29:951-959
©2009 by Radiological Society of North America
Sequence of Events in the Radiology Care Process*
Main Categories
According to a survey of the members of the Society of Chairmen of Academic Radiology Departments (SCARD)in the US, the three main categories of quality management performance indicators used are: customer satisfaction patient access to appointments reporting time
customer satisfaction
In radiology, customers are not only patients but are also referring physicians and employees of the department, and their satisfaction is based on impressions formed at all points of contact with the institution.
Patient satisfaction
In particular, because patients lack the knowledge to assess technical quality, typically their quality judgment is based entirely on their subjective experiences throughout the process, necessitating the measurement and assurance of both quality components in a radiology department.
Quality is the extent to which the right procedure is done in the right way at the right time, and the correct interpretation is accurately and quickly communicated to the patient and referring physician.
- Hillman et al
appropriateness of the examination
Radiologists and referring physicians must be knowledgeable about which imaging procedure is appropriate for each clinical indication.
Computer representation of appropriateness guidelines.
Rubin D L Radiographics 2011;31:1511-1527
©2011 by Radiological Society of North America
procedure protocol
In the definition of quality, the procedure protocol is represented by the term the right way.
correct protocol for the procedure must be selected and communicated to the technologist who will perform the study.
Procedure Protocol
Radiologic imaging modalities are complex, requiring that many different parameters be specified to customize the imaging procedure to the patient and clinical indication.
These parameters include use of contrast material, section thickness, acquisition protocols, and a variety of post processing steps.
Accuracy of interpretation
Accuracy of interpretation is represented by the term the correct interpretation.
Variation in interpretation is perhaps the weakest aspect of clinical imaging.
“the number one killer disease in the U.S. is not cancer or heart disease
but variability in care”
Reporting
Organizing reporting workflow can lead to important benefits for imaging services. Reduce the report turnaround time Reduce errors Improve report quality
Decide on Reporting Technology
Situation Budget Preference Exam Volume
Communication of results
is represented by the phrase accurately and quickly communicated.
Optimal communication of clinical information between the radiologist and referring physician is critical to patient care. This communication is bidirectional.
What we need from referring Physician?
the reason for the examination the patient history and the clinical suspicions
measuring and monitoring
Radiologists and institutions must measure and monitor indicators of quality, safety, and efficiency in their services to prove that imaging and their interventions are of high quality.
Potential Staff Problems
In common with most institutions, potential problems faced by radiologic staff fall into four general categories:
1. Poor supervisors treating them inconsistently and unevenly
2. Poor equipment 3. Poor environment 4.Workload exceeding staffing levels
Employees Related Challenges
To effectively manage employees and processes one needs sets of rules and guidelines to promote consistent action.
Too many rules choke innovation and stifle creativity – too few promote chaos and variability in quality and action.
departmental policies
Generally, these policies were about how the department should take care of employees and patients: Employee related: e.g., timekeeping
rules, conduct, dress code, leave policies, disciplinary actions, hiring requirements, etc.
Technical and quality: e.g., exam protocols, patient exam restrictions, image quality standards, certification requirements, radiation safety, etc.
Quality Assurance Committee
We must have both physician and a technologist Quality Assurance (QA) committees to develop and approve technical policies. Employee policies were developed by the department Senior Administrative committee.
Employees
Cost Reduction and Employees: By doing more case per
day , patient waiting list and response time is shorter, thereby contributing to a shorter length of stay. A shorter length of stay is the key to hospital financial success.
Employees
Dealing with Difficult Staff Members Having them be part of the solution
Continual Staff ProblemsContinual staff problems are often a result of one
or more of the following:
• Continual poor supervisors and managers;
• Expectations (behavioral and technical)
of staff not clearly set; and,
• Poor internal communication.
Employees
Staff Motivation Without a reward and recognition (R&R)
program it is not possible to achieve maximum staff motivation.
Having the success of the department drive the satisfaction of the staff is the ultimate goal.
Employees
Good Staff Morale in a Crisis Situation When staff feel they are being treated
‘fairly’ and with respect, morale remains relatively high.
Radiation Exposure Ranks Third on Medical Hazards
Top 10
THANK YOU FOR ATTENTION