Optimize organizationby taking holistic view

April 1, 2009

Finding the ideal organizational solution for animaging department would be so much easierif we had a blueprint to follow.

Finding the ideal organizational solution for an imaging department would be so much easier if we had a blueprint to follow. I am not so arrogant as to suggest that I have such a blueprint. There are, however, a number of factors that I believe should inform our decision making when planning future imaging departments.

This is not about bricks and mortar. Few of us get the chance to design a department from scratch, starting from a green field site and following progress to completion. This is about patient flow, about delivering a high quality of service to clinicians and patients. Imaging departments play a pivotal role in hospital service delivery. We need to ensure that they make a positive contribution to the overall patient experience.

We all work within certain parameters that will vary among countries, regions, and institutions. National and local politics can dictate priorities. Many common themes also shape imaging services. As the baby-boom generation matures into a sizable elderly population, the need for imaging services to diagnose age-related disease is growing. Patients are more aware of the potential benefits of imaging and more likely to request “a scan.” Referring clinicians, who have become increasingly dependent on imaging, now expect the services to be provided immediately, at all times of day and night.

Advances in IT are helping imaging departments to meet rising expectations. Not every radiologist wants a PACS terminal on the kitchen table, however. Few would deny that they want to offer a patient-focused service, but this has to be managed properly. Short bursts of increased activity are no substitute for a sustainable service delivery plan.

Is this possible? Before we can make any improvements, we have to understand our services. As the physicist and quality improvement pioneer W. Edwards Deeming said, “In God we trust. All others bring data.” Elements of our service must be measurable so that we can monitor change and, crucially, check that change is for the better. Various methodologies already exist to do this. See, for example, those from the Institute of Healthcare Improvement (www.ihi.org).

So how should we proceed? Trend analysis of current services will require robust information gathering. We also need to do some “horizon scanning” within our own service. In other words, we need to talk with our referring clinicians about their future imaging requirements, perhaps for surgical robotics or coronary artery investigation. These future needs will influence referral patterns and expectations placed on radiologists.

For our part, we may plan new services, such as CT colonography or CT angiography. Different staffing profiles should be considered, including the need for expert knowledge and specialist skills, as should the relevance of enhanced IT support. Public health predictions- for example, on cancer and heart disease- can also help predict future demands for certain imaging services.

Having established the requirements for our program, we can create a vision for the desired future service, articulate it, and assess the gap between current provision and what is required. A detailed plan can then be formulated of how to get there, together with time scales for education and retraining. The lead-in time will inevitably be long, and it is important to recognize this. The plan may also need to be revisited and revised if problems arise with affordability or implementation.

This is not just about money and investment. It is about working smarter, not harder, to improve the flow of patients through our hospitals. Tried-and-tested methodologies for improving efficiency and flow are readily available (for example, from www.ihi.org), and they can be applied to suit local constraints and circumstances.

Significant systems change is an unsettling and uncomfortable process for some. It can create a perception of destabilization and move staff out of their comfort zones. Change needs leadership. The vision of the future needs to be articulated and the steps to that future laid out so individuals see their route through this. At a mechanical level, plans are constructed and ownership achieved by involving as many stakeholders as possible.

The cultural aspects of change are more complex.

The concept of cultural competence is a new one. It is likely we will recognize its importance in the coming years and train and educate staff to be aware of culture, with strategies and skills for dealing with it rather than ignoring this aspect of change management. We are at the beginning of that journey, however. Currently, executive sponsorship and both clinical and managerial leadership are vital. Working in partnership with an articulated and clear vision and plan is necessary. Communication is key. A culture of inclusion and no surprises are helpful.

Ultimately, service optimization is determined locally. There is no blueprint. We need to start by improving a single process, then we can change multiple processes, redesign networks, and rethink healthcare delivery. So the initial structural solution leads to system design and service transformation. Quality and patient safety cannot be achieved without an effective, efficient, and timely service. We have wonderful opportunities. By thinking on a broad canvas, we can-and will-transform imaging services.