99 Problems or Sometimes it’s OK to Eat the Low-hanging Fruit

Prioritizing in radiology.

It’s the nature of the health care beast, at least as long as I’ve been in the game-the number of issues, tasks, problems, etc. greatly exceeds the resources we’ve got at any given moment. Priorities have to be set.

No matter what stage of the game you’re at, from first-day intern to tip-top honcho at Monolithic Medcorp, Inc., it’s the same story. For most of us in the radiology trenches, this commonly translates to a burgeoning worklist and various other tasks which don’t directly add to our RVU tallies, somehow all expected to get done in a timely fashion.

There sometimes seems to be a certain logical way to go about it. At higher strata of the food chain, it often comes down to return on investment. That is, which problems, once solved, will pay off best for the resources thrown at them?

The thing I’ve noticed about this approach is that it runs the risk of never getting to the little issues. That is, there will always be big projects on the hoof to make the balance sheets prettier and the exec types happier (if they succeed, that is). Even if you listed all of the projects you’d eventually like to take on-say you came up with 20-long before you polished them all off, probably even before you reached #10, more would have added themselves to your list. By the time you did reach 20, the list might’ve grown to 50.

Yes, there’s a reason those little items are waaaay down the list of priorities. But putting them off for another day, or ignoring them entirely because you know you’ll never get to them, is a blunder that doesn’t need to happen. Because, dwelling in the priority nether-regions, there are a whole bunch of things that can often be fixed quickly and cheaply.

These little problems vex the subordinates in your organization on a routine basis. Maybe just because they find the problems annoying to deal with, maybe because they really believe that the little issues cost them in terms of productivity, efficiency, or quality of performance. And, maybe, because the employees have complained repeatedly, yet felt ignored by higher-ups who could nix the problems with little more than a wave of the policy writing pen.[[{"type":"media","view_mode":"media_crop","fid":"55697","attributes":{"alt":"Prioritizing","class":"media-image media-image-right","id":"media_crop_8977774102949","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"6981","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: 187px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Max-Griboedov/Shutterstock.com","typeof":"foaf:Image"}}]]

Such a higher-up, devoting perhaps one day per month to going around and cleaning house, could do a world of good for the workforce’s morale. To say nothing of the possibility of proving the worker bees right: Fixing longstanding minor-problem X did, indeed, translate to better numbers on the ledger.

It puts me in mind of when I used to work in a perpetually backlogged outpatient imaging center, and each morning I would walk in to a looming stack of studies that needed to be read, this one more overdue than the next. Yes, they all had to get done, so from a certain perspective it didn’t matter which ones I did first.

Yet I quickly found there was a way to go about it that suited me: Do the quickest stuff first (X-rays, etc.), and leave the complex scans with multiple comparisons for later on. First, because it made me feel better to have a shorter stack of cases (that didn’t feel quite as likely to cause serious injury if it tipped over on me halfway through the morning)…and second, because having fewer remaining cases meant that I’d have fewer office staff and referring clinicians hassling me for what remained.

In our line of work, going for the low hanging fruit has a certain bad rap, because it’s commonly associated with “cherry picking” easier cases and leaving the tougher stuff for colleagues. However, if you’re the one who’s going to be harvesting all of the produce anyway (or delegating the task to various personnel), all that you risk by shunning the quicker and simpler stuff is missing out on some easy victories.