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Challenges and Strategies in Radiology PQI


CHICAGO-Problems to anticipate and strategies to help with radiology practice quality improvement, presented at RSNA 2015.

Managing quality improvement within a radiology practice is a necessary part of any organization; often there are unforeseeable pitfalls that occur and prevent projects from being successful. David Larson, MD, MBA, from Stanford Medicine spoke from experience at RSNA 2015 in describing both the pitfalls within project design, as well as strategies that can solve both technical and adaptive problems.

 “Change has promise and risk. There are technical and adaptive challenges in any change effort that require problem solving abilities,” Larson said. In general, “most physicians tend to be poor problem solvers in complex environments and so we need strategies to problem solve within those environments.”

“Solving problems within complex environments often involves many interactions,” Larson said. “The impact of changes is often unpredictable, unseen, and far removed.” Because of this, such problem solving requires both “didactic and practical experience.”

Common Pitfalls in Project Design
Larson described many areas vulnerable to common mistakes in project design. They include:

Moving forward without leadership support and engagement

Applying a technical fix to an “adaptive” problem

Attempting to solve a problem without fully understanding it, trying to solve a problem at once, and poor problem-solving strategies in the team

Not involving all relevant parties or incorporating all relevant perspectives

Not sufficiently creating the tension for change

Not quantifying performance, objectives, or progress through SMART or other goal quantification measures

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Five Strategies to Solve Technical and Adaptive Problems
Many of these pitfalls are avoidable through quality improvement processes if the proper strategies are available. Mistakes will occur, according to Larson, and sometimes barriers are difficult to cross. With Larson’s own practice group at Stanford, the implementation of these five strategies has provided increased PQI success.

1. Leadership support is necessary. They set the vision for the group and control compensation. If the support is not present, you cannot move forward.

2. Creating a problem solving team that consists of a champion, sponsor, dedicated leader, participants who provide relevant expertise, and an expert QI coach. The team solves the problem as an “opportunity to improve.”

3. Managing an improvement project to keep things moving. Use an A3 consensus building communication document that summarizes the current phase of the project and functions in keeping people on the same page throughout the duration of the project.

4. Solve problems iteratively. Repeat processes and patterns as needed before moving ahead.  

5. Plan for sustainability by knowing what change needs to occur and creating change mechanisms that stick.

By “anticipating and strategically addressing problems,” Larson concluded that radiologists will not “get paralyzed, they will get started. You will make mistakes. The most important thing is to learn from those mistakes.”


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