Ten core commandments shape management plans

Radiology departments are under continual pressure to deliver the highest quality service while still making efficiency gains. Fulfilling such demands can pose a significant difficulty for managers. Changes to established working practices are seldom popular, particularly if the benefits are not immediately apparent.

Prof. Philip Gishen, director of imaging at Imperial College NHS Trust, has now revealed the list of guiding principles used to tackle this dilemma at London's Hammersmith and Charing Cross hospitals. Any radiology managers seeking to achieve similar results could do worse than follow his 10 commandments.

The first of Gishen's must-do rules is to ensure that opportunities for private work are shared equitably among radiologists. If this extra work-and its associated financial reward-is divided fairly, then more radiologists will feel happy and motivated.

"I am certainly making sure that private work is shared among everybody. It is increasing their income, and so far, no one has complained," he told delegates at the 2007 Management in Radiology meeting, held in Oxford, U.K.

Second, department managers should look for radiologists with expertise in a particular organ, age group, or disease, or for interventional specialists. He recommends that a situation in which one practitioner has control of a single modality be avoided at all costs. Instead of employing a dedicated MRI radiologist, for example, managers should take on a cardiac radiology expert or a cancer imaging specialist.

Continuing with the theme of manpower, Gishen stressed the importance of dividing up routine, bread-and-butter tasks between all radiologists. Incentives rarely exist for reporting plain films or routine ultrasound examinations, but all examinations have to be covered.

Good scheduling is central to the smooth operation of imaging services, and the days when a radiologist would say: "I am reporting this afternoon," and then disappear are long gone, he said. For every hour of every day, the departmental time­table should indicate who is reporting cardiac films, who is looking at PET results, and who is scheduled for ultrasound work. Individual job plans should also ensure that radiologists carry out the 30 hours of clinically related work that they are contracted to do.

"The whole principle behind everything we did was to try and make it better for each individual radiologist," Gishen said. "If you make it better for each individual radiologist, you make it better for the department, and better for the patient."

His fourth commandment relates to the staffing of new services. If a department wants to start offering vertebroplasty, for instance, then the workload should be covered by a team, not just one radiologist. The availability of that service is not then compromised by one person's travel plans or ill health.

The fifth principle concerns on-call coverage. Interventional radiologists and neuroradiologists handle all out-of-hours duties at Hammersmith and Charing Cross Hospitals. These doctors are paid a premium to be available when on-call radiology registrars need expert assistance.

"We pay them 20% more than they would have been getting anyhow, and they love it. The other radiologists, they are not on call, and they have a good lifestyle. In the five years we have run this service, there has not been a complaint," Gishen said.

Daily workflow is another area where a radical approach may be required. The two biggest complaints leveled against radiologists by clinicians are difficulties in getting tests done, and then problems getting hold of the results. Gishen's no-nonsense solution is to abolish waiting times for imaging examinations and to eliminate reporting delays.

Good utilization of IT underpins the next three commandments. Once a department has embraced digital technology and films are no longer used, data acquisition and reporting can easily be performed in separate locations, he said. Implementation of PACS prevents hard-copy images being lost. Reporting with voice recognition software, rather than sending tapes to secretaries for typing, will help remove bottlenecks in the reporting workflow.

"All work done must be completed on the same day and made available to the hospital," Gishen said. "We are starting to measure ourselves in minutes, not days or hours."

He recommends that clinicians should indicate when they have read a report, and that they have understood all of the comments. Contact details for the reporting radiologist should be provided in case of queries.

The final commandment is that no radiologist should go to war with a colleague. Gishen would much prefer that radiologists speak freely with one another. Clinicians should also feel welcome to visit reporting rooms.

"Interruptions are essential. They are to be encouraged. I want each radiologist to develop a good relationship with a clinician. It's good, it's healthy, and that's what makes us radiologists," he said.
-By Paula Gould

TEN COMMANDMENTS FOR GOOD MANAGEMENT

Share private work equitably
Seek organ or disease specialists, not modality specialists
Split routine work fairly
Ensure new services are robust
Pay interventional radiologists and neuroradiologists to cover on-call duties
Eliminate waiting lists and reporting delays
Introduce modern working practices
Implement a PACS and use voice recognition software
Make verified reports available on the same day as the examination
No radiologist should go to war with a colleague