Jim Lipcamon

With no-show appointments averaging between 2%–5% in radiology departments, missed appointments are costly to an imaging department. You leave the day with a full schedule and by 2 PM the following day the schedule has more holes than a championship golf course.  

In an effort to get a better understanding of the no-show appointments, Twin Cities Community Hospital utilized lean daily management (LDM). Although we were following no-show rates for all modalities, two areas that were of particular interest were nuclear medicine and ultrasound because of associated isotope costs and OB ultrasound volume.

After gathering data for over one month, two significant findings were made; OB ultrasound appointments did have the highest no-show appointment rates and we uncovered a totally unexpected issue in nuclear medicine, which was related to inpatients. Since we use a nuclear pharmacy company to deliver isotopes, we were experiencing high stat delivery charges because the nuclear medicine technologist was not aware of the inpatient procedure before placing the order. The hospital is located in the Central California Coast and is approximately 200 miles from the nuclear pharmacy, which is located in North Los Angeles.

In further evaluating the data and the processes, we implemented the following which has proved beneficial:

• In doing daily reminder calls we have been able to determine some of the OB patients were admitted to the hospital for delivery. This has allowed those occupied appointments to be used by other outpatients. OB is a major service line at Twin Cities Community Hospital. 

• The labor and delivery unit is delivering a census report in the morning to centralized scheduling which uses it to cross reference outpatient appointments. Appointments occupied by patients on the labor and delivery unit are opened for outpatients.

• After 8 PM, the night shift technologist is to notify the nuclear medicine technologist of any inpatient nuclear medicine procedures so the doses can be ordered by 2 AM.  We have made the notification cutoff at midnight since we have only one nuclear medicine technologist.

• One issue that we discovered and not resolved is when the inpatient order is made for the next day in the electronic medical record, the patient name and procedure is not populating to the modality worklist.

We will continue to follow our no shows utilizing LDM to assess the process improvements we have made over the month of November.

Attention to no-show appointments is constantly at the forefront of a facilities agenda as demonstrated in a recent 

.  Insight is provided on the issues departments have with no shows. The authors reference a new study published by the 

done at Massachusetts General Hospital which analyzed over 54,000 appointments and found a no show rate of 6.5%. The article is informative and I highly recommend you read it.

Articles

No-show appointments are costly for radiology departments. 

Decreasing No-Show Rates in Radiology 

The “Sterile Cockpit Rule” is a Federal Aviation Administration (FAA) regulation that was implemented in 1981 after a series of accidents occurred when flight crews became distracted from unnecessary conversations during critical flight duties during takeoffs and landings. One such accident occurred in 1974 in Charlotte, NC, which resulted in 71 out of 82 lives being lost due to a pilot’s discussion on politics rather than focusing on the upcoming landing.

In another accident that occurred at Dallas-Fort Worth, a crash occurred that was linked to aircraft flaps not being down during takeoff. Fourteen lives were lost in this accident which was linked to nonessential conversation during the checklist procedure.

This FAA regulation states that flight crews are prohibited from activities or nonpertinent conversation during the critical phases of flight which encompasses taxi, takeoff, landing, and operations below 10,000 feet mean sea level. This regulation was recently expanded by the FAA to prohibit the use of personal tablets, smartphones, and laptops for personal use during the entire flight.

The health care industry has become a very complicated field with the same deadly opportunities for error due to distractions. Are there distractions while radiology nurses are drawing medications or taking medications out of drug dispensing systems, during the time out process, site marking for a biopsy or checking for medication allergies? Wrong site procedures and retained foreign objects continue to be an issue reported to the Joint Commission and state agencies. The Joint Commission cites inattention as a contributing factor to wrong site procedures.

Radiology is a minefield of opportunities for medical errors and the Sterile Cockpit philosophy can help improve patient safety when implemented in appropriate circumstances. This has been proven by the FAA through implementation of this regulation which has contributed to aviation safety by focusing on eliminating distractions during critical times of takeoffs and landings.

I recently e-mailed an article to my radiology staff on the FAA’s Sterile Cockpit regulation asking them for suggestions on circumstances other than those previously mentioned that this concept can be used and for engineering ideas on processes to implement it.

Adapting Use of The “Sterile Cockpit Rule” in Radiology

As leaders in our departments, we have a responsibility to ensure that we provide culturally competent, and patient- and family-centered care. The care we deliver in our departments must be provided with dignity and respect and to ensure safety and privacy for all patients and families who utilize our services. Until recently, patients who are lesbian, gay, bisexual, and transgender have been disregarded as health care consumers. LGBT individuals and their families reside in every county in the United States and they have an urgent need for access to welcoming, compassionate, and assuring health care provided by knowledgeable and sensitive health care providers. The Joint Commission felt that this is such an important issue, they developed a field guide: 

Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community

, 56% of the LGB patients experienced some type of discrimination in health care and 70% of transgender or gender nonconforming patients surveyed have experienced some type of discrimination in health care. 

 has demonstrated that LGBT individuals experience disparities in care and face other barriers to equitable care, such as refusal of care, delayed or substandard care, mistreatment, inequitable policies and practices, little or no inclusion in health outreach or education, and inappropriate restrictions or limits on visitation.

Here are a few items that the Joint Commission has on their Checklist to Advance Effective Communication, Cultural Competence, and Patient-and Family-Centered Care for the LGBT Community in appendix A of their field guide. Each of the bullets below have listed processes to accomplish each bullet. The processes are too numerous to list in this blog.  I highly recommend reading the Joint Commission field guide.

 Integrate unique LGBT patient needs into new policies or modify existing policies.

 Create a welcoming environment that is inclusive of LGBT patients and families

 Avoid assumptions about sexual orientation and gender identity

 Identify opportunities to collect LGBT-relevant data and information during the health care encounter

 Collect feedback from LGBT patients and families and the surrounding LGBT community.

 Most importantly, offer educational opportunities that address LGBT health issues

 Ensure equitable treatment and inclusion for LGBT employees

There are many resources to help advance our staff’s knowledge and sensitivity regarding interactions with the LGBT community and families. Below is a list of resources that have great information regarding this topic:

Advancing Effective Communication, Cultural Competence, and Patient-and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LBGT) Community and Field Guide

Healthcare Equality Index 2016 Promoting Equitable and Inclusive Care for Lesbian, Gay, Bisexual and Transgender Patients and Their Families 

Gay and Lesbian Medical Association (GLMAS)

My facility will be starting the journey towards advancing effective communication, cultural competence, and patient- and family-centered care for the LGBT community in 2017.  There will be a great deal of information to absorb, however, we will be better equipped to serve the health care needs of this overlooked community. 

Radiology practices and effective communication and patient-centered care for LGBT patients.

Communication, Patient-centered Care in Radiology for LGBT Community

As leaders in our imaging departments, one of our responsibilities is to help improve employee performance and mentor employees who aspire to be in leadership positions. The only way this can be done is through feedback.  A few months ago I was given an excellent handout by our CEO that I have found very helpful as a guide to providing feedback. The handout “The Ten Commandments of Feedback” is from 

 As we know, feedback can be positive or negative and is information provided about an individual’s performance or behavior. The way negative feedback is given is extremely important. As Frank A. Clark said “Criticism, like rain, should be gentle enough to nourish a man’s growth without destroying his roots.”  Here are ten commandments of feedback from the handbook that ideally will prevent an aggressive response or destroying an individual: 

1. Offer feedback on observed behavior, not on perceived attitudes.

2. Offer a description of what you saw and how you felt, rather than a judgement.

3. Focus on behavior which can be changed.

4. Choose which aspects are most important and limit yourself to those.

5. Ask questions rather than make statements.[[{"type":"media","view_mode":"media_crop","fid":"53401","attributes":{"alt":"Communication in radiology","class":"media-image media-image-right","id":"media_crop_387078881414","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6671","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 110px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©igor kisselev/Shutterstock.com","typeof":"foaf:Image"}}]]

7. Comment on the things that an individual did well, as well as areas for improvement.

8. Relate all your feedback to specific items of behavior: do not waffle about general feelings or impressions.

10. Before offering any feedback, consider its value for the receiver, if there is none, keep quiet. 

Here is a very important concept; BUT break any of the commandments of feedback, providing that you understand the rule and its purpose and that what you propose to do is going to achieve your ends more efficiently, with regard to the individual.

The goal any time you are providing constructive criticism is to send the message in a way that the individual’s defense mechanisms don’t kick in and your message is heard.   Hopefully, you will find these ten suggestions helpful in giving you a different perspective when offering negative feedback.

As an imaging leader, it is important to communicate feedback appropriately. 

Ten Commandments of Feedback

Editor's Note: An earlier version of this article did not attribute the Just Culture model appropriately. The Just Culture methodology was developed by David Marx and Outcome Engenuity. The article has been corrected.

 Nicholas Bakalar wrote that it is estimated that medical errors may cause over 250,000 deaths per year; a staggering number. In fact, if medical errors were considered a disease, they would be the third leading cause of death in the United States, behind only heart disease and cancer. In an effort to improve patient safety, organizations are introducing “Just Culture.” Just Culture encourages self-reporting so that systems that cause errors can be fixed; yet holds people accountable for behaviors. The Just Culture methodology was developed by David Marx and Outcome Engenuity.

Just Culture is the balance between human and system accountability and is a hot topic in patient safety and for the reduction of medical errors. In order for a facility to learn how to prevent medical errors from occurring, the reporting of events by staff is important and necessary. The goal of the Just Culture approach is to improve patient safety in an environment where people are able to report errors or near misses without fear, and create collaboration among employees to seek out solutions to safety issues.  In the Just Culture model there are three behaviors that lead to errors:

1. Human Error: Inadvertent action, slip, lapse, or mistake.

2. At-risk Behavior: Behavior that increases risk where risk is not recognized or believed to be justified.

3. Reckless Behavior: A behavior choice to consciously disregard a substantial and unjustifiable risk.  An example of this would be complete disregard of doing a time out during a CT-guided biopsy of a kidney to save time and the wrong kidney was biopsied.[[{"type":"media","view_mode":"media_crop","fid":"51504","attributes":{"alt":"Safety in radiology","class":"media-image media-image-right","id":"media_crop_5691410023970","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6346","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Vitezslav Valka/Shutterstock.com","typeof":"foaf:Image"}}]]

How should the manager or director handle these behaviors and hold staff accountable when the behavior occurs?

Human Error: Console staff who have made an honest mistake.  Look at making changes in the process and procedure. Evaluate training and design.

At-risk Behavior: Coach people to recognize the real risk. Focus on removing incentives for at-risk behaviors. Create incentives for healthy behaviors. Increase situational awareness.

Reckless Behavior: Punish the behavior choice to consciously disregard a substantial and unjustifiable risk of harm. Implement remedial and punitive action.

We realize how important safety is in the medical industry so how do we move to a Just Culture in which there is encouragement of reporting adverse events and near misses, yet still hold people and organizations accountable?  The organization must be able to distinguish between a system that might create risks, human error which may result in a bad outcome, and reckless behavior that intentionally disregards safety systems and puts lives or organizations at risk.  In addition, its critical to:

 Understand you cannot hide failure.  Remove secrecy and be transparent so the department can learn from medical errors.

 Shift from looking at errors as individual breakdowns to errors caused by system failures and evaluate the process.

 Create an environment that is not punitive.

 Get front line staff involved with system failures and collaborate with the appropriate departments.

The facility I work at has put a great deal of emphasis on Just Culture since the beginning of the year.   Just Culture reforms the understanding of accountability, the role of systems, and the role of human behavior, allowing facilities to distinguish human behaviors that help management attain a consistent way to establish a safe environment by managing the system and the behavior.

In addition, we are creating an environment of transparency and it is understood that you cannot hide failure and take the opportunity to learn from system failure and improve the processes that caused it.

A culture of patient safety and fewer medical errors.

Developing Just Culture in the Radiology Department

Although presenteeism is a topic that is not widely discussed, itis looming as the department’s next safety risk. I certainly have given this topic more attention in my department.  Presenteeism is the practice of employees coming to work sick. Employees are there, but not doing much because they do not feel well and are often distracted. The employee is not operating to their usual level of productivity. The total cost of presenteeism to U.S. employers has been increasing, with estimates for current losses ranging from $150 to $250 billion annually.   

Unfortunately, the highest rates of presenteeism are typically seen in health care in which employees work with people vulnerable to illness, and there is the potential to compromise patient safety. It has been estimated that as many as 80% of physicians go to work sick, and nurses who go to work sick are more likely to admit to higher rates of medication errors and a greater number of patient falls. Sick employees are not as alert mentally and their reaction times are slower. Just think of the instances you have had a severe cold. Were you as sharp mentally or quick in your movement? In addition, sick employees are putting the rest of the staff at risk for illness. Earlier this year, I had an employee come in sick on the weekend and consequently infected two other employees they worked with. The result was staffing issues the following week.

Without question, today’s workplace  emphasizes being “lean and mean,” which often results in employees coming to work sick.  What are the main reasons for employees coming to the radiology workplace sick?

 Burdening their co-workers with a heavier workload

 Saving sick leave to deal with their children’s health issues

To change the culture of presenteeism, radiology leaders must do the following:[[{"type":"media","view_mode":"media_crop","fid":"50140","attributes":{"alt":"Sick","class":"media-image media-image-right","id":"media_crop_8753624356356","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6101","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 215px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Pretty Vectors/Shutterstock.com","typeof":"foaf:Image"}}]]

 Must recognize that presenteeism is a problem in workplace.

 Send employees home! As basic as it seems, many leaders are reluctant to do this.

 Foster a culture that discourages workers from coming to work sick. Explain to them the effect of their illness on patient care, safety and outcomes.

 Evaluate absenteeism policies and their strength of disciplinary action. These policies create incentives for people to come to work sick. Remove the aggressiveness of these policies and move to more trust.

Presenteeism and absenteeism have been described as simulating an iceberg, absenteeism is the top of the iceberg because it’s visible. You know when people are not at work.  Presenteeism is the part of the iceberg silently lurking below the water, it is not always apparent and you cannot evaluate how much an illness is affecting an employee’s performance.

Presenteeism is an issue that has not been given much thought, yet can have significant effects on operations and patient safety. I have made an effort to be familiar with this topic and I have changed my outlook towards employees coming to work sick. I now encourage staff to stay home when sick and send them home if they inform me they are not feeling well.  Matter of fact, last week I sent an employee home sick immediately after having an employee calling in sick. Both of these employees did MRI. The move left me without MRI services for the morning, however, I knew there was no risk lurking below the water.

Dealing with employees that come to work sick.

Presenteeism in the Radiology Department

Competition for experienced, knowledgeable, and competent talent in the imaging industry is great.  Well-rounded staff can be a competitive advantage for any organization. Did you know that an employee is at greatest risk for leaving an organization during their first year of employment? In addition, the cost of employee turnover is costly. It is estimated that it costs an organization 150% of a position’s base salary to replace a newly vacated position.

Onboarding is a process that builds support for new employees by supporting that they be engaged, productive, and satisfied in their new work environment. Onboarding helps reduce turnover the first year, creates an environment that welcomes new employees, assists in creating opportunities for integrating the new employee into your imaging team, and builds positive working relationships within your organization.

During the onboarding process, radiology leaders are important participants. Every leader has areas for improvement and often the supervisor is the reason an employee leaves. Before hiring your next employee take to reflect and ask the following questions:

1. Are there any leadership qualities that need polishing?  Seek feedback for your supervisor, peers, and staff.

2. What is your communication style and how are your communication skills? Are you accessible? Do you lead by example?[[{"type":"media","view_mode":"media_crop","fid":"47191","attributes":{"alt":"recruiting","class":"media-image media-image-right","id":"media_crop_8510231216794","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5542","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 180px; width: 180px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Aha-Soft/Shutterstock.com","typeof":"foaf:Image"}}]]

3. Do you take the time to make new employees feel welcome on their first day? During the first 30 days?

4. As a leader, are you clear about your expectations and consistent in how you administer policies and procedures?

5. Do employees have the supplies they need to perform their job?  How can they facilitate work flow issues if they do not have the supplies they need?

6. Are you a good role model? How do you model the right behaviors and relationships?  How do you advocate the mission, vision, and values of your organization? Can you articulate how your work and the work of your team contribute to the mission of the organization? 

Radiology leadership is an integral part of the success of the onboarding process. Before hiring your next employee, take time to reflect on your role and responsibilities.

Before adding employees to your radiology practice, reflect.

 Radiology Leaders Important to Onboarding

At the end of each work day, I round on two-three inpatients who have been touched by the radiology department. I must say, this is one of the most enjoyable tasks of my day, to engage in a discussion with patients about the quality of the imaging services they received. Asking patients about their experience during a hospital stay drives higher levels of patient satisfaction and helps keep a pulse on the what the patients like and dislike. However, it is important to note that identifying patient issues and failing to resolve the issues makes patients more dissatisfied than they were before being asked. 

When I round on inpatients, I have five questions that I ask:

1. Was our radiologic technologist always kind and courteous?

2. Did the radiologic technologist explain the procedure to you?

3. We value your time, was your procedure done in a timely manner?

4. Did the radiologic technologist make you feel comfortable during the procedure?

5. Would you recommend this facility to family and friends?

I then finalize my rounding with “is there anything we could have done better?” [[{"type":"media","view_mode":"media_crop","fid":"45558","attributes":{"alt":"patient-centered radiology","class":"media-image media-image-right","id":"media_crop_4495302013585","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"5218","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 200px; width: 200px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Aha-Soft/Shutterstock.com","typeof":"foaf:Image"}}]]

It is amazing the response I get when doing my rounding! Patients are typically surprised but grateful that I stopped by to visit with them and ask about their patient experience. I get responses like “thank you for stopping by” or “I have been at other hospitals and they did not do this.” Patients who are in the health care field or have visitors in the room who are in the health care field are very appreciative of this practice. One cannot overestimate the value of personal attention! In addition, I take this opportunity to manage up the staff and physicians who are working on the unit I am rounding on.

Patients’ expectations of timely and convenient service can make a big difference in patient satisfaction, even inside the hospital. Creating a positive patient experience can help build loyalty to your facility and impact HCAP scores.

I have found the practice of patient rounding to be extremely gratifying and suggest you give it a try.

Improve satisfaction scores in the radiology department with a simple task.

Patient Rounding for a Positive Radiology Experience

In every imaging facility, whether in a hospital or an outpatient facility, there are specific tasks that may frustrate and slow you down. Ideally, a department wants to be as efficient as possible, and make it easier to care for patients, not just care for patients faster.

In addition, by 2020 there will be a significant overall payer mix shift which will affect a facility’s bottom line. Today's overall payer mix is about 55% Medicare/Medicaid and 45% commercial. By 2020, that mix is projected to be 70% Medicare/Medicaid and 30% commercial, this accounts for a 10%-15% reduction in reimbursement. As we are currently witnessing,   Medicare is bundling more payments and other Medicare initiatives could potentially put another 10%-15% of revenue at risk. To compensate for the projected revenue reduction, facilities will need to reduce cost 15%-25% by 2020.

In response to these challenges, it is important to identify wastes in the radiology department.

How does a facility start looking at ways to be more cost effective and efficient?  Start with the 7 wastes.

 Movement of patients, material, equipment, or supplies.

Moving samples, specimens, patients from one location to another

 Moving patients for tests and treatments

 Having more materials and supplies on hand than needed.

Do you have more than one month's supplies on hand?

Physical movement of the employee.[[{"type":"media","view_mode":"media_crop","fid":"44092","attributes":{"alt":"","class":"media-image media-image-right","id":"media_crop_7172343579939","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"4909","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 212px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"Â©Ryan Jorgenson-Jorgo/Shutterstock.com","typeof":"foaf:Image"}}]]

 Searching for patients, medications, or charts.

 Reaching, bending, or lifting to get frequently used items.

 Walking to several locations to find supplies or equipment.

 Idle time that occurs when you need to perform the next step.

 Waiting for a bed, room, or equipment to be available.

 Waiting for patients, test results, medications, or charts.

 Waiting for a transport,  support service, or delivery.

 Waiting for a phone call, discharge, admission, or instruction.

 Additional effort that does not provide value.

 Anything with the prefix "re" (re-do and re-work), such as copying down the same information multiple times or moving a patient from  bed to bed to bed.

 Producing more than is currently needed.

 Work that does not meet standards set by the customer. 

 Patient receiving the wrong test, medication, or procedure.

 Recording the wrong medication, allergy, dosage, or patient information.

 Finding an error/missing information in an instruction or record.

Use these seven wastes to identify areas which will make it easier for you to care for patients, improve quality, and lower costs in your facilities.   

1. Reilly R. Trends in Healthcare and the Changing Role of Radiology. 

Improve efficiency by identifying these wastes in the radiology department. 

7 Wastes in the Radiology Department

Recently I have seen and read numerous articles on the subject of emotional intelligence (EI). I have found the topic interesting and, if improved, EI can benefit you and the workplace. So what is EI? Emotional intelligence is the capacity to be aware of, control, and express one’s emotions, and to handle interpersonal relationships judiciously and empathically. EI is considered a key to both personal and professional success. In addition, hiring people with a strong EI can benefit your departments. In multiple studies, EI has proven to be a stronger predictor of workplace success than IQ. You ask why; because everyone wants to work with individuals who are easy to get along with, trusted, pleasant and supportive!

There are four fundamental components of emotional intelligence and they are:

1. Self-awareness: This is how aware you are and how accurately you can recognize your emotions. Most of us are so occupied with the hustle and bustle of our day that we rarely stop and think about how we are responding to situations and how we are coming across to our peers and staff. To be effective when interacting with staff and our peers we need to be in the present. To improve self-awareness it is recommended to take time each day for reflection.. In addition, reach out and solicit feedback from people who will be honest and whose ideas you value. 

2. Self-management: This is the ability to control your emotions. Self-management also includes your adaptability, self-control, achievement drive, initiative, and optimism. Do you react rather than respond and go with knee-jerk reactions? If so, you need to improve on engaging the rational part of your brain and select the best responses. This is difficult and takes practice as one acts against what is natural.

3. Social awareness: This is comprised of three components: empathy, organizational awareness, and service orientation. Are you empathic with others and try to understand their point of view and see things from their perspective? Organizational awareness refers to the ability to recognize the social and political dynamics in the workplace.  Service orientation is being in tune to the needs of our patients and meeting or exceeding those needs and expectations. 

4. Relationship management: How you develop others, serve as an inspirational and influential leader, are a catalyst for change, and manage conflict is part of relationship management. In addition, promoting teamwork with a collaborative approach is also part of this component of EI. Obviously, how we manage our relationships with the people (staff, peers, radiologist, administrative team) we work with is key to the success of our organizations and the departments we manage.

By being cognizant of the four components of EI and practicing their concepts we can improve interpersonal relationships, which can lead to improved staff and patient satisfaction.

The elements of emotional intelligence and how they apply to radiology.