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1 Zoran Bojic, MHSc, PMP, CSSBB, CLA, ASQ-CMQOE Ellen Charkot, M.R.T. (R.), BHA Dr. Manohar Shroff, MD, DABR®, FRCPC Department of Diagnostic Imaging November 2014 RSNA 2014

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Page 1: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

1

Zoran Bojic, MHSc, PMP, CSSBB, CLA, ASQ-CMQOE

Ellen Charkot, M.R.T. (R.), BHA

Dr. Manohar Shroff, MD, DABR®, FRCPC

Department of Diagnostic Imaging

November 2014

RSNA 2014

Page 2: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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� Radiologists

� Technologists / RNs

� Support Staff

� U of T

� Michener

� Mohawk

� 9 Imaging Modalities

� RIS / PACS

� Voice Recognition

� 130,000 Exams / Year

Page 3: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

3

Legal and Regulatory

Compliance

Information

Management

Document

Management

Procurement

Management

Performance

Measurement

Human

Resources

Utilization

Management

Work

Environment

Education and

Training

Knowledge

Management

Risk

Management

Leadership and

Organization

Process

Management

Innovation

Management

Radiation

Safety

Operational

Controls

Service

Excellence

Technology and

Equipment

Continual

Improvement

Quality Management System Elements

Page 4: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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Process

Outcomes

Structure

Balancing

+

Page 5: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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� Affinity Diagram

� Benchmarking

� Bottleneck Analysis

� Brainstorming

� Cause and Effect Diagram

� Check Sheet

� Cognitive Walkthrough

� Control Charts

� DMAIC Problem Solving

� Fault Tree Analysis

� Five Whys

� Flowchart

� Force Field Analysis

� Gantt Chart

� Heuristic Evaluation

� Histogram

� Impact/Effort Matrix

� Interviewing

� Kano Analysis

� Mind Mapping

� Multivoting

� Nominal Group Technique

� Paired Comparisons

� Pareto Chart

� PDSA Cycle

� Project Charter

� Project Schedule

� Relationship Diagram

� Risk Response Plan

� Run Chart

� Scatter Diagram

� SIPOC Diagram

� Six Thinking Hats

� Solution Selection Matrix

� Spider Chart

� Stakeholder Analysis

� Usability Testing

� CTQ Requirements

� Kaizen

� Value Stream Mapping

� Standardized Work

� Error proofing

� 5S / Visual Management

� Kanban

� Single-Piece Flow

� Pull System

� Level Loading

� Spaghetti Diagram

� Rapid Changeover

� A3 Problem Solving

� Root Cause Analysis

� FMEA

� Stopping the Line

� Just-in-Time

� TPM

� MSA

� Design of Experiments

Page 6: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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Page 7: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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Improved

collaboration

Diminished

organizational silos

Consensus on key

priorities

Consistent execution of

projects

Effective allocation of

resources

Improved

communication

Increased capacity

for innovation

Enhanced organizational

capability

Systematic risk

management

Effective problem

solving

Better decision

making

Effective change

management

High return on

investment

Increased staff

engagement

Program

Management

Benefits

Page 8: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

8

Pa

tie

nt

Sa

tisf

act

ion

Sta

ff E

ng

ag

em

en

t

Ed

uca

tio

n a

nd

Tra

inin

g

Faci

lity

De

sig

n

Mu

lti-

Mo

da

lity

Do

se

Me

asu

rem

en

t

Mo

dif

ied

MR

Se

qu

en

ces

Re

sea

rch

Pa

rtn

ers

hip

Re

sea

rch

Infr

ast

ruct

ure

Re

gio

na

l R

ep

osi

tory

of

DI

Ima

ge

s

Eq

uip

me

nt

Re

pla

cem

en

t

Ele

ctro

nic

Co

mm

un

ica

tio

n B

oa

rd

Pe

er

Re

vie

w S

oft

wa

re

Project Group 3

Service Excellence

Project Group 5

Advanced Technology

Project Group 4

Innovation and Research

Strategic Goals

Fall

Pre

ve

nti

on

MR

I S

cre

en

ing

Pro

cess

Ra

dia

tio

n D

ose

Re

du

ctio

n

Inte

rve

nti

on

al

Sa

fety

Ch

eck

list

Project Group 1

Patient Safety

Sta

rt o

n T

ime

MR

I Le

an

Pro

ject

Ro

om

Tu

rno

ve

r

Sta

nd

ard

ize

d B

oo

kin

g

Pro

cess

Project Group 2

Access to Services

Diagnostic

Imaging

Integrated Program

Management

Page 9: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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Interpersonal

Dimensions

Communication

Appointment

Wait Time

Wait Time

After Arrival

Discharge

Instructions

Explanation

of the Exam

Preparation for

the ExamQuality of Care

Environment /

Facilities

Privacy and

Confidentiality

Activities for

Children

Parking, Food and

Directions

Factors

Impacting

Patient

Experience

Page 10: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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IMPACT

EFFORT

HIGH

HIGH

LOW

LOW

���� Safety rounds

���� Focus groups

���� Daily huddle

���� Staff Coaching

���� Mentoring program

���� Customized surveys

���� Benchmarking

���� In-person interviews

���� Telephone survey

���� Website survey

���� Comment cards

���� Mystery shoppers

���� Engage volunteers

���� Ongoing communication

���� Simulation

���� Timely status updates

���� In-service sessions

���� Online education modules

���� Regular reviews of survey results

���� List of patient suggestions

���� Strengthen complaint process

���� Staff feedback in real time

���� Daily newspapers

���� Washroom cleanliness

���� Waiting room comfort

���� Q&S Leadership Walkarounds

���� New quality indicators

���� New staff orientation manual

���� TV program selection

���� DI website content

���� Information pamphlets

���� Exam Information translation

���� Pain management

ID Task Name

1 Provide timely status updates and improve

communication with patients and families

who are in the waiting room

2 Proactively reach out to patients and their families , lis ten

to their concerns and continue to keep them informed

while they are in the waiting room

3 Promptly explain reasons for delay and provide

estimates for their remaining waiting tim e

4 Review and prioritize suggestions for im provements

provided by patients and families

5 Provide staff education and increase

awareness about service excellence

6 Organize in-service session on service excellence for

all s taff

7 Encourage staff to complete the online service

excellence module

8 Ins titute regular review and communication of the NRC

Picker survey results

9 Strengthen the process for reviewing patient complaints

10 Provide coaching and timely feedback to staff who

interact with patients and families

11 Review the waiting area to ensure it is se t

up in a way that is comfortable for the

child as we ll as for parents/ guardians

12 Dis tribute daily newspapers to the waiting room s

13 Remove obsolete newspapers to prevent cluttering

14 Organize daily checks to ensure cleanliness of the

washrooms and waiting areas

Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

Page 11: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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Service

Excellence

PDSA

PDSA

PDSA

PDSA

PDSA

Page 12: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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ID Project / InitiativeQ & S

Excellence

Enable

PeopleInnovate

Financial

HealthInfrastructure

Enhance

Systems

1 GTA West DI Repository (DI-r) X X X X

2 MRI Appointment Wait Times X X X X

3 CT Appointment Wait Times X X X X

4 Radiation Dose Reduction X X X X

5 Service Excellence X X

6 Quality Management Education X X

7 DI Q&S Leadership Walkarounds X X

8 2013 Accreditation X X

9 Report Turnaround Times (RTT) X X

10 IGT Equipment Replacement X X X X X

11 Simulation-Based Learning of CVL Insertion X X X

12 Innovative Procedures X X X

13 MRI Safety X X

14 Increasing OHIP Revenues X

15 Staff Engagement X X

16 International Benchmarking Project X X X

Diagnostic Imaging

2013/14 Strategic PrioritiesStrategic Directions

Page 13: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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Appendicitis

US

+ -

+

TP

69

FP

9

-

FN

5

TN

94

Sn=sensitivity, Sp=specificity, PPV=positive predictive value, NPV=negative predictive value, Acc=accuracy

Sn= TP/TP+FN ---------------- 93.2%

Sp= TN/FP+TN ---------------- 91.2%

PPV= TP/TP+FP --------------- 88.4%

NPV= TN/FN+TN ------------- 94.9%

Acc= TP+TN/ALL ------------- 92.1%

Negative appendectomy rate= 2/73 = 2.7 %

66% of US requested ���� Normal

34.4% ���� Positive for appendicitis

Timeframe: 3 months; 206 consecutive requests; 105 daytime; 101 after hours; Follow up in 177

Page 14: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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0

2

4

6

8

10

12

14Weeks

Policies Emergency Equipment

Screening Zoning Education

Safe MR Practices

Page 15: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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Fire in MRI Suite - Emergency Procedure

Fire alarm is generated in a specified room in MRI Suite. Sprinklers are primed and

Fire Department is dispatched.

Hospital Emergency Response Team enters MRI Suite to investigate the area. Initial investigation for evidence of fire involves

looking through the window without entering the MRI magnet room.

Is there suspicion

of fire in the MRI magnet room

No

No need to enter the MRI

magnet room.

Yes

Properly screened individuals take the MR Safe fire extinguisher located outside the MRI magnet room and enter the MRI magnet room to check for evidence of

fire.

Is there an actual fire in the MRI magnet room?

No

No further action required

in the MRI magnet room. Lock the MRI magnet

room door.

Yes

Plant Operations in consultation with

Respiratory Therapy will assess the need to shut off oxygen source.

Has the fire been successfully extinguished?

No

Quench the magnet using the quench button. It may take 1-2 minutes for the

magnetic field to dissipate.

Fire fighters enter the MRI magnet room and extinguish the fire using

non ferrous equipment

Upon arrival, Protection Services informs Fire Department that the fire alarm originates from

MRI Suite

MRI technologist contacts the MRI system manufacturer to send MRI Field

Engineer ASAP

MRI technologist notifies On-Call MRI personnel of the system status

MRI Field Engineer completes service of MRI equipment

Resume normal operations

Attempt to extinguish the fire using MR

safe fire extinquisher

Properly screened fire fighters enter the MRI magnet room with

non ferrous equipment and confirm that the fire has been

extinquished

Yes

CONTACT LIST

Plant Operations: 7111

Protection Services: 7122

Locating: 7500

MRI Tech On-Call: 416-589-8514

DI Manager On-Call: 416-237-3795

WARNING:MAGNET IS ALWAYS ON

Anyone entering MRI magnet room must

be properly screened as per MRI

Screening of Non-Patients policy

Befere entering MRI magnet room,

remove all personal objects and contents of pockets such as cell phones, keys,

coins, etc.

Firefighters must not go beyond the sign

posted on the MRI magnet room door:

DANGER: MAGNET IS ALWAYS ON unless directed by authorized personnel.

AFTER HOURS

� Page MRI technologist On-Call and DI Manager On-Call to Locating

� Locating transfers calls to Protection Services at the site of fire in MRI Suite

� Protection Services Supervisor obtains the key and unlocks the MRI magnet

room.

Aug 25, 2014

Flood in MRI Suite - Emergency Procedure

Flood identified in MRI Suite

Plant Operations and Environmental

Services/Housekeeping proceed with appropriate corrective measures

as per hospital Flood Response

procedure.

Note: All areas outside MRI magnet room are accessible without exposure

to magnetic field

Resume normal operations

Plant Operations staff determine

source and extent of the flood.

Contact:

Plant Operations

Protection Services

Environmental Services/

Housekeeping

IF AFTER HOURS also contact:

CHS Admin On-Call

MRI technologist On-Call

DI Manager On-Call

In collaboration with MRI technologist,

Plant Operations and Environmental Services/Housekeeping proceed with

appropriate corrective measures as per

hospital Flood Response procedure.

USE MRI SAFE EQUIPMENT ONLY

WARNING:MAGNET IS ALWAYS ON

Anyone entering MRI magnet room must be properly screened

as per MRI Screening of Non-

Patients policy

Befere entering MRI magnet room,

remove all personal objects and contents of pockets such as cell

phones, keys, coins, etc.

MRI technologist contacts the MRI

system manufacturer to determine if

MR Field Engineer is required to

service MRI equipment.

Service required?

No

Yes

If required, Plant Operations will:

� Close water shut off valve

� Turn off all operating cabinets

and computers

� Tarp equipment

Arrange for MR Field Engineer to service MRI equipment

ASAP, and notify On-Call

Radiologist

Complete service of MRI equipment as required

If the water reaches the magnet, MRI

technologist or authorized individual

shuts down electrical power to the

magnet.

If it is necessary to stand in water to reach the power switch, call MR Field

Engineer to shut down power.

CONTACT LIST

Plant Operations: 7111

Protection Services: 7122

Environmental Services/Housekeeping: 416-530-7254

Locating: 7500

MRI Tech On-Call: 416-589-8514

DI Manager On-Call: 416-237-3795

LOCATIONS

Clinical MRI

Water shut off valve:

Room S750A (access through rooms

S747 – S747D – S750

Circuit breaker: Room S792CDIU

Water shut off valve: Room 4150B

Power button: MRI Control Room

Research MRI

Water shut off valve: Room S720A

(access through room S720)1.5T and 3.0T Power Buttons: MRI

Control Room

Equipment Room 1.5T: S725E

Equipment Room 3.0T: S721C (access

through room S721)

Redirect traffic as required

Does flood

extend into MRI magnet

room?

Yes No

Do not shut down power to the magnet and/or equipment

room without authorization

from MRI technologist

July 20, 2014

Magnetic field is still present

even after shutting down

electrical power to the magnet.

Page 16: Department of Diagnostic Imaging RSNA 2014 · Department of Diagnostic Imaging November 2014 RSNA 2014. 2 Radiologists ... Flowchart Force Field Analysis Gantt Chart Heuristic Evaluation

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