Organizational decentralization brings both risks and advantages

Teleradiology and organizational decentralization can help eliminate growing imaging workloads, but workflow relief may come at the risk of professional continuity, radiologist commitment, and diagnostic quality, according to a new study from Norway.

The paper examines the advantages and disadvantages of decentralization of radiology practice (J Telemed Telecare 2006;12 Suppl 1:1-3). It defines decentralization as image interpretation performed at more organizational units than before implementation of PACS and teleradiology.

"Organizational decentralization can make radiology departments smaller and less stimulating and employees less committed," said I.H. Monrad Aas, Ph.D., of the Work Research Institute in Oslo. "Decentralization implies splitting professional communities."

Centralization (performing image interpretation in fewer units than before PACS/teleradiology), on the other hand, tends to strengthen professional communities, he said.

Decentralization can also reduce contact between radiologists and clinicians, which Aas says may affect the quality of healthcare.

"With decentralization, the close contact between radiologist and clinician may disappear, resulting in reduced quality diagnostics," he said.

Other disadvantages include lack of adequate patient information, which may be more difficult to obtain at the site of interpretation, according to Aas. Paradoxically, decentralization may also increase report turnaround.

"Splitting the workload across more sites may result in interpretation taking longer to complete," he said.

Organizational consequences of radiology decentralization have been topical issues since the emergence of teleradiology.

Aas also identified several advantages of decentralization, such as exploitation of workload capacity and professional competence, particularly at university hospitals where overnight radiology workload is often heavy. Receiving additional teleradiology work merely aggravates the situation.

"Workload may become more tolerant if some studies are transferred to other hospitals," Aas said.

Routine interpretations, for example, can be performed by radiologists on duty at smaller, less busy hospitals, whereas CT and MRI interpretations can be done by local specialized staff.

"Teleradiology provides an opportunity to completely reevaluate distribution of general healthcare and radiology functions among hospitals by reassessing which location should perform which radiology with which workforce," Aas said.

An episode of care may now consist of visits to different sites. Patients can be allocated to the site with the shortest waiting time, he said.