Listen To Your Patients

December 14, 2017

Image quality and report turnaround time aren’t the only indicators of a successful radiology group.

It’s a struggle for radiology services to balance the complexities of running an efficient and high-quality imaging service, while ensuring that patients get the best experience.

Sometimes they are at odds. Some machines are slow. Appointment times book up far in advance. Staff members’ to-do lists never end. The flip side is that patients who are comfortable are more likely to remain calm and still during studies, improving the image quality, and not needing to redo the study. And patients who are happy with their experience are more likely to return when they need additional care, and tell their friends.

Philips recently published a study about the patient experience, surveying more than 600 American and German patients about their journey through the imaging process. While the results weren’t shocking, they’re still good reminders about what’s important to patients, how they perceive their treatment by medical staff, and their process in radiology’s care.

Jalal B. Andre, MD, said the study results were similar to what he sees in his practice. “They want faster turnaround time, and to have their time respected,” said Andre, director of neurological MRI at Harborview Medical Center in Seattle, and a University of Washington associate professor of radiology.

Patients as Customers
The patients’ opinion matters. Medical centers and providers have become more savvy from a business perspective in improving patient care and recognizing that patients are customers, and can choose to go elsewhere.

Historically, doctors placed less emphasis on the patient’s time versus their own, not on purpose, but due to the medical training and busyness of the job. Andre calls it the “conveyor belt approach,” partly driven by insurance demands. The model favors the doctor’s time over the patient’s. However, that’s shifting, as the internet allows patients to share information, giving them more power and choices than they had before. Sharing an experience on social media can sway other people. This is radically shifting how medical staff approach patients now.

“In order to thrive, we really do want to make sure patients want to come to us for their care. If we’re not showing them that compassion, and we’re not open to that patient experience, somebody else will, and they’ll fill that niche,” said Paula Gonyea, director of radiology at UVM Medical Center.

The Philips study showed that radiology offices need to keep their eyes on patient and family-centered care, said Gonyea, something her medical center already does. They have patient and family-centered care teams in all departments. In radiology, that team includes radiologists, managers, and technologists, and each modality has its own quality team. At each quality team meeting, they come up with one or two new things to welcome patients and families. “Welcoming is a big thing in our hospital right now, across the board,” she said.

The Softer Side
UVM includes patient advisors on their committees. These are patients who volunteer their time to share personal insights. During a recent hospital renovation project, they redid their waiting rooms and dressing rooms. Two patient advisors on the committee shared what they thought about when waiting for a test, like how to involve their families and make them more comfortable. They also wanted additional dressing rooms, with some redesigned to better accommodate wheelchairs. A lot of what they brought up was the softer side of medical care, Gonyea said.

She agreed with Philips’ study results, that patients want technologists and nurses giving extra care and presenting confidently that the patients are there for the right test for the right diagnosis. At UVM, that might mean the technologist addresses the patient by name, confirming that they are present for a CT scan for a specific diagnosis. Of course, the technologist will also ask about any additional concerns, and share the process for conducting the exam and sharing the results. They scan in the patient’s wrist band bar code to make sure the imaging study goes to the right medical records location.

While not all patients see radiologists as part of their visit, Gonyea said UVM is reviewing their workflow, to see if they can find ways for radiologists to interact with some patients to answer questions. They might try identifying patients who seem anxious when checking in, as good candidates to chat with a radiologist. Currently, a patient not scheduled to see a radiologist has to ask the technologist to see one. “We’re looking to be proactive to offer that,” she said.

Collecting Feedback
Timing is everything when getting patient feedback. Catch someone right after they came out of the scanner when they’ve had a negative experience, and you may get a different answer than when you wait an hour to ask. Wait a week or two, and the response may be completely different.

UVM has comment cards at the reception desks. When the patient checks in, the receptionist encourages them to take a card and hold on to it, dropping it off at the desk on the way out. The comment cards give instant feedback so UVM staff can more quickly track issues needing attention. From comments made on these cards, UVM increased the variety of magazines, learned that patients liked the new mammography waiting room music and the adult coloring pages and pencils offered. “When we make changes, we seem to get more comments,” Gonyea said.

While Gonyea doesn’t have statistics for how many patients fill them out, she said that at one point, they received hundreds of cards per month.

UVM also participates in Press Ganey surveys, mailed a week or two after the appointment. While helpful, those comments tend to be more vague, like the patients said they waited longer than expected, or that things were great.

There are other ways to collect patient responses too.

Imaging and Appointment Timing
The Philips survey asked patients for the one thing they would change about their imaging experience. The most common answers were that patients wanted their results faster, and didn’t want such a long gap between scheduling and the actual appointment. Fortunately, UVM hasn’t received many complaints about report turnaround time, but the latter issue is common.

“What every hospital struggles with is waiting time to get in for tests with limited equipment, and juggling those appointments,” she said. Most patients understand that there are a lot of people waiting for the same test. “There is only so much you can do,” she said. They work with patients who have coordinating appointments, to get their imaging done in time, and patients appreciate being added to a cancellation list for a possible earlier appointment.

The amount of time that imaging exams take was an issue for some in the Philips study. Radiology groups understand that too. Due to economic pressures, there’s a push for  greater patient through-put in the machines. However, scanners can only go so fast, said Andre. While CT scans may take a few minutes, MRI scans can take 90 minutes.

“Most developers think a 15-minute sequence is reasonable, whereas most clinicians think it has to be under five minutes,” he said. It’s critical for patients to hold still, as motion is a problem. Patient frustration with the long wait time is understandable and can’t always be resolved.

Patients in the survey also asked for more comfortable experiences, which can be difficult when the patient is in pain. Andre said he has been in the scanner many times as a volunteer, having pleasant experiences and often falling asleep. However, he had a wake-up call when in pain, he needed an emergent 45-minute MRI exam two years ago. “Every time the machine pulsed, I felt it go through my body in a way I hadn’t felt before. It hurt lying on the hard surface. The whole thing was a very different experience,” he said. He realized there was probably more they could do to make the patient comfortable, and that they historically haven’t done a good job putting themselves in their patients’ shoes.

Vendors are trying to improve the patient experience, through lighting, distraction, and entertainment options.

Culture and Communication
With long waits and uncomfortable scans, it’s more important than ever to communicate with the patient and share the status and what to expect. Hospital culture affects how staff members treat the patient experience.

“Patient experience plays a larger role in the discussion. People try to be active listeners in a place like Seattle, and that was new to me, versus what I’d experienced in the past,” said Andre. The good news is that the culture has changed since Andre’s training in New York Where there was less focus on the patient experience.