CHALLENGES IN QUALITY MANAGEMENT OF

DIAGNOSTIC MEDICAL IMAGING

DEPARTMENTSArashk Fathi , BS , (RT), (MRI) , (CT)

Tehran University of Medical Sciences

CT & MRI Department Manager at Bu Ali

HospitalHead of Imaging Informatics Committee

Iranian Radiographic Sciences Association

What is Quality?

Quality is the extent to which the right procedure is done in the right way at the right time, and the correct interpretation is accurately and quickly communicated to the patient and referring physician.

- Hillman et al

 key components of quality

appropriateness of the examination  the procedure protocol accuracy of interpretation  communication of results  measuring and monitoring

performance improvement in quality, safety, and efficiency

Why Quality???

Radiology is coming under increasing scrutiny by payers and regulators.

Quality is becoming a critical issue for radiology.

Measuring and improving quality is essential not only to ensure optimum effectiveness of care and comply with increasing regulatory requirements, but also to combat current trends leading to commoditization of radiology services.

radiology is becoming more visible and central in healthcare delivery.

exponential growth in medical imaging

imaging is increasingly performed by non radiologists or by radiologists at remote locations who may not have access to the same information.

What is Key Challenge in Radiology?

A key challenge to implementing quality improvement programs is to develop methods to collect knowledge related to quality care and to deliver that knowledge to practitioners at the point of care.

Measurable Quality =

Improvable Quality

• What you can’t measure, you do not know.

• What you don’t know, you can’t improve.

• Without observation and measurement, there is no improvement.

 There are many dimensions to quality in radiology that need to be measured: examination appropriateness  procedure protocol accuracy of interpretation  communication of imaging result  measuring and monitoring performance

improvement in quality, safety, and efficiency

Key Performance Indicatorsfor Quality in Radiology

Quality generally consists of two related but distinct components: technical or outcome quality service delivery as perceived by the

customer

Figure 1.  Defining quality in radiology.

Johnson C D et al. Radiographic 2009;29:951-959

©2009 by Radiological Society of North America

Sequence of Events in the Radiology Care Process*

Main Categories

According to a survey of the members of the Society of Chairmen of Academic Radiology Departments (SCARD)in the US, the three main categories of quality management performance indicators used are: customer satisfaction patient access to appointments reporting time

customer satisfaction

In radiology, customers are not only patients but are also referring physicians and employees of the department, and their satisfaction is based on impressions formed at all points of contact with the institution.

Patient satisfaction

In particular, because patients lack the knowledge to assess technical quality, typically their quality judgment is based entirely on their subjective experiences throughout the process, necessitating the measurement and assurance of both quality components in a radiology department.

Quality is the extent to which the right procedure is done in the right way at the right time, and the correct interpretation is accurately and quickly communicated to the patient and referring physician.

- Hillman et al

appropriateness of the examination

Radiologists and referring physicians must be knowledgeable about which imaging procedure is appropriate for each clinical indication.

Computer representation of appropriateness guidelines.

Rubin D L Radiographics 2011;31:1511-1527

©2011 by Radiological Society of North America

 procedure protocol

In the definition of quality, the procedure protocol is represented by the term the right way.

correct protocol for the procedure must be selected and communicated to the technologist who will perform the study.

Procedure Protocol

Radiologic imaging modalities are complex, requiring that many different parameters be specified to customize the imaging procedure to the patient and clinical indication.

These parameters include use of contrast material, section thickness, acquisition protocols, and a variety of post processing steps.

Accuracy of interpretation

Accuracy of interpretation is represented by the term the correct interpretation. 

 Variation in interpretation is perhaps the weakest aspect of clinical imaging.

 “the number one killer disease in the U.S. is not cancer or heart disease

but variability in care”

Reporting

Organizing reporting workflow can lead to important benefits for imaging services. Reduce the report turnaround time Reduce errors Improve report quality

Decide on Reporting Technology

Situation Budget Preference Exam Volume

Communication of results

 is represented by the phrase accurately and quickly communicated.

Optimal communication of clinical information between the radiologist and referring physician is critical to patient care. This communication is bidirectional.

What we need from referring Physician?

the reason for the examination the patient history and the clinical suspicions

 measuring and monitoring

 Radiologists and institutions must measure and monitor indicators of quality, safety, and efficiency in their services to prove that imaging and their interventions are of high quality.

Potential Staff Problems

In common with most institutions, potential problems faced by radiologic staff fall into four general categories:

1. Poor supervisors treating them inconsistently and unevenly

2. Poor equipment 3. Poor environment 4.Workload exceeding staffing levels

Employees Related Challenges

To effectively manage employees and processes one needs sets of rules and guidelines to promote consistent action.

Too many rules choke innovation and stifle creativity – too few promote chaos and variability in quality and action.

departmental policies

Generally, these policies were about how the department should take care of employees and patients: Employee related: e.g., timekeeping

rules, conduct, dress code, leave policies, disciplinary actions, hiring requirements, etc.

Technical and quality: e.g., exam protocols, patient exam restrictions, image quality standards, certification requirements, radiation safety, etc.

Quality Assurance Committee

We must have both physician and a technologist Quality Assurance (QA) committees to develop and approve technical policies. Employee policies were developed by the department Senior Administrative committee.

Employees

Cost Reduction and Employees: By doing more case per

day , patient waiting list and response time is shorter, thereby contributing to a shorter length of stay. A shorter length of stay is the key to hospital financial success.

Employees

Dealing with Difficult Staff Members Having them be part of the solution

Continual Staff ProblemsContinual staff problems are often a result of one

or more of the following:

• Continual poor supervisors and managers;

• Expectations (behavioral and technical)

of staff not clearly set; and,

• Poor internal communication.

Employees

Staff Motivation Without a reward and recognition (R&R)

program it is not possible to achieve maximum staff motivation.

Having the success of the department drive the satisfaction of the staff is the ultimate goal.

Employees

Good Staff Morale in a Crisis Situation When staff feel they are being treated

‘fairly’ and with respect, morale remains relatively high.

Radiation Exposure Ranks Third on Medical Hazards

Top 10

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