Planning sets framework for evolving medical practice

In a previous column on technology assessment, it was noted that PACS installations completed during the early years of the technology typically yielded low value. The key reason was that technology adoption was not accompanied by behavior modification. Physicians continued to print film rather than make diagnoses from soft-copy images. Why wasn't this situation avoided? Why didn't the manufacturers work with the customers to train and prepare them to use the new technology properly ( "Successful technology implementation makes medical imaging tick")?

Today these problems have been largely resolved. For example, the RSNA meeting provides many opportunities to use PACS workstations, which helps customers modify their behavior and achieve the best results via the new technology. But this is some 20 years after the introduction of the technology.

To significantly increase the probability of successful integration when acquiring a PACS (or, for that matter, any equipment), the transition process must be carefully thought out. This process consists of a series of phases that allow a team to work toward and achieve success. The process may be implemented with a strategic thinking tool called the Growth Development Curve, which can serve as a guideline. Although customers ultimately have the answers, they may need the appropriate set of questions to find them. The Growth Development Curve provides the questions. Working the process as a team is key.

For equipment purchases, we will consider the following phases:

Phase one: Understanding the business. One of the most significant deficiencies I have found over the years is a lack of business understanding on the part of the customer. Some of the basic requirements of understanding the business include:

• evaluate and quantify current business operations;

• set functional goals for the system or technology under consideration;

• recognize the amount of effort that will be needed to communicate the anticipated changes to all parties involved;

• identify the team (defined as all individuals who will be affected by the incorporation of the acquisition and those who will be on the team to follow the process we are outlining);

• establish cross-discipline needs and opportunities; and

• establish an organizational structure.

Phase two: Technical process. Although the table shows each step as being completed prior to the start of the next step (an ideal approach if time permits), it may be possible to get a heads-up on future steps if the manpower is available. For the technology phase, it is suggested that team members:

• understand what is available in the market, to what extent each technology can satisfy the needs specified within phase one (at times, outside help may be advisable to evaluate the available technologies and to assess their ability to meet specific needs),

• understand who will be impacted by the new technology, and

• make sure those players are up to speed on the process for a clear understanding of the phase two timetable so that disruption is held to a minimum.

Phase three: Purchase process. The biggest challenge I have seen regarding the purchase process is that it is often attempted without doing an adequate job of phases one and two. It should be apparent that if those first phases are performed thoroughly, then the purchase process becomes relatively simple. A request for proposal will provide a vehicle for each responding manufacturer to provide further insight into the latest technologies and services. Site visits offer a chance to have peers demonstrate the pros and cons of what they have experienced.

Phase four: Installation and training. A detailed plan for staging the installation should be provided by the manufacturer in partnership with the in-house customer team. Delivery and storage of equipment, validation and acceptance, and a very thorough training program should be included. It is often advisable to have several members of the team train at other sites that have similar equipment prior to the start of the onsite training program.

Phase five: Monitor In this we return to the goals established in phase one and evaluate the system against those goals. Of course a debug period will take place prior to starting the clock to measure performance. A team including both customer and manufacturer is critical to this process, as they share in the achievement of the goals.

Mr. Schilling is an editorial advisor to Diagnostic Imaging and president of RBS Consulting in Los Altos Hills, CA. Comments can be addressed to ronald11341@aol.com.

The author thanks Dr. Ed Staab at Wake Forest University for originally suggesting the use of the Growth Development Curve for Transition Timelines.