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Administration of Medical Imaging

Department ( RSMI 481 )

Department of Radiological Sciences and Medical Imaging Faculty of applied Medical sciences

Salman Bin Abdulaziz University

Dr. AHMED YOUSEF

Chairman of The Department

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Course Description

• This course is designed to provide the student with general principles and

concepts of administration within health care organizations concentrating on

the medical imaging departments.

• Topics covered include health care delivery system, imaging service, ethical

issue in health care as well as administration functions and duties.

Objectives Of The Course

How does a hospital function?

What are the major components that make up a hospital?

Who are the personnel and staff that run the hospital?

What are their goals in the organization?

Where does the hospital fit into the larger medical care system?

Educational objectives

• To describe components of healthcare delivery system.

• To describe relationships and interdependencies of departments within a

hospital.

• To explain patient services available in the medical imaging department.

• Describe how the medical imaging department fits into the hospital world.

• To describe the healthcare team in medical imaging department and their

duties.

• To define the accreditation, certification, licensure and regulations.

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• To maintain the ethical and professional values of the radiographer.

• To communicate effectively with patients, their families and peers.

• To describe the skills and functions of medical imaging administrator.

• To explain and discuss the basic functions of management within a

radiology and medical imaging setting.

• To explore the qualities that characterizes exceptional leadership.

• To discuss the essential aspects of quality assurance in medical imaging

departments.

• Course schedule

• Evaluation

• Two mid term exam …………… 30

• Course project …………… 10

• Assignment & Activity …………… 10

• Final exam ……….…… 50

• Attendance

• It is the University’s administrative policy is that, attendance is required

for this course. Based on extenuating circumstances you may qualify for

emergency withdrawal but the premed program administration approval

must be obtained. If you fail to attend 75% and are unable to produce

official documentations you will be administratively prohibited to take the

final exam. IT IS YOUR RESPONSIBILITY!

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Health service

• Educational objectives:

• By the end of this lecture you will be able to:

❑ Define health.

❑ Discuss personal health service.

❑ List environmental health service.

❑ List public health service.

❑ Discuss factors that determine health needs of community.

• What is health ?

❑ Health is a state of complete physical, mental and social well-being and

not merely the absence of disease.

❑ Health status and disease status are a product of the process of continual

adjustment between the internal and external environment.

❑ The purpose of health services is to meet effectively the total health needs

of community.

Categories of health services

❑ Personal health services

❑ Non-personal health services

1- Environmental 2- public

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• Personal health services

Is achieved by:

1- Prevention

2- Diagnosis & treatment

3- Rehabilitation

• Environmental health service

1. Water supply

2. Pollution control

3. Sewage disposal

4. Food hygiene

• Public health services

1. Control of infectious diseases

2. Sanitation

3. Maternal and child health

4. Health education

5. Occupational health

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Health Care system

Educational objectives:

By the end of this lecture you will be able to:

❑ Explain system concept.

❑ Describe health care delivery system.

❑ Define hospital and its functions.

❑ Describe hospital classifications.

❑ Explain the purpose and mechanism of financial health system.

❑ Identify the responsibilities of health care facility and members of health

care team.

❑ Describe how medical imaging departments fit into the hospital world.

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What is Health Care System?

❑ The sum total of all the organizations, institutions and resources whose

primary purpose is to improve health.

❑ Chief function is to deliver health services.

❑ Every country has its own system.

❑ Ministry of health is the central part.

What is Hospital?

It is an integral part of a social and medical organization.

Its functions are to:

❑ Complete health care which is:

1- Prevention

2- Diagnosis

3- Treatment

4- Rehabilitation

❑ Training for new staff

❑ Medical Research

Hospital Classification

❑ General or specialist.

❑ Public or private

❑ Governmental, profit or nonprofit.

❑ Short term or long term.

❑ Primary care, secondary care or tertiary care.

❑ Others: number of beds, accreditation.

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Health Financing System

❑ The purposes of the financing system are :

▪ Adequate funding is available

▪ All individuals have access to health care.

❑ No single approach that will be most efficient for all nations.

❑ Mechanisms:

1. Tax-based financing.

2. Health insurance :

- Social (compulsory) - Private (voluntary)

Health Care Team

❑ Workers in health care system.

❑ Achievement of health and medical care require team work:

- Physicians - Nurses

- Paramedical - Supportive

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Medical Imaging Service

• Educational objectives:

• By the end of this lecture you will be able to:

❑ Discuss patient services available in the medical imaging department.

❑ Describe sitting and layout of medical imaging department.

❑ List rooms of medical imaging department.

❑ Describe specification of radiography rooms.

❑ Identify members of the department and their responsibilities.

❑ Explain what is meant by credentials.

❑ List duties and responsibilities of radiographer.

Outline

• Medical imaging services.

• Features of medical imaging department.

• Staff in medical imaging department.

• Position (job) description.

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Medical Imaging Services

*The medical imaging service in any hospital should be composed of the

following units:

❑ Radiography ( x-ray and fluoroscopy).

❑ Computed Tomography (C.T.)

❑ Magnetic Resonance Imaging (MRI).

❑ Diagnostic Medical Sonography ( US).

❑ Cardiovascular and Interventional technology.

❑ Nuclear Medicine.

❑ Radiotherapy.

❑ Quality Management.

Sitting of Radiology Department.

The setting of the radiology department should fulfill the following

requirements:

• Accessible to Outpatient Department (OPD)

• Lies preferably in the ground floor

• Not be sandwiched between other departments.

• Expandability and upgradeability.

• The Layout of radiology Department.

The layout of the radiology department should fulfill the following

requirements and rooms:

❑ Adequate reception and registration area ( near the entrance).

❑ Convenient patient flow.

❑ Adequate waiting area (separate cubicle).

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❑ Separate entrance for emergency cases.

❑ Provision of rooms for the technical functioning and auxiliary

requirements.

A) Rooms of Radiography unit .

▪ Chief radiologist.

▪ Radiologist offices.

▪ Radiography rooms ( number, group)

▪ Darkroom (CR, PACS).

▪ Film store.

▪ X-ray record.

▪ Staff locker and toilet.

▪ Viewing gallery and conference room.

▪ Contrast procedures ( Barium , IVU).

▪ Toilets

B) Rooms for C.T.

• C.T. machine room.

• Control room.

• Patient Preparation room.

• PACS and printer room.

• Reporting rooms.

C) Rooms for MRI.

• MRI machine room.

• Power supply and helium supply room.

• Control room.

• Patient Preparation room.

• PACS and printer room.

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• Reporting rooms.

D) Rooms for Sonography

• Sonography operating room.

• Patient Preparation room.

• Reporting rooms.

E) Nuclear Medicine unit rooms.

• Gamma Camera Rooms.

• Control rooms.

• Patient waiting room.

• Hot laboratory.

• Exercise room.

• Reporting room.

• Separate patient toilet.

• Staff toilet.

Staff for Imaging Department

❑ Radiologist.

❑ Radiographer.

❑ Nurse.

❑ Record clerk.

❑ Receptionist.

❑ Supportive.

Job description for radiographer.

❑ Defines the radiographer’s qualifications, duties and responsibilities.

❑ Credentials: registration (license) of individuals.

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• Saudi commission for health specialists.

• American Registry of radiologic technologists.

Radiographer’s Responsibilities

• Performs conventional radiographic procedures.

• Selects and operates radiographic equipment, imaging and/or associated

accessories to successfully perform procedures.

• Positions patient to best demonstrate anatomic area of interest.

• Adjust exposure factors.

• Select the proper size of image receptor and process exposed films.

• Evaluates radiograph for technical quality.

• Applies principles of radiation protection to minimize exposure to himself

as well as to the patient and other staff members.

• Assist the radiologist to perform fluoroscopic and interventional

procedures.

• Participate in the department’s quality assessment and improvement plan.

• Assumes responsibility for assigned area and report equipment

malfunction.

• Communicate effectively with patients, their family, physician and other

health care workers.

• Provides patient education and instruction.

• Practices aseptic techniques as necessary.

• Corroborates patient’s clinical history with procedure and ensuring

information is documented.

• Assumes responsibility for provision of physical and psychological needs

for patient during procedures.

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• Initiates basics life support when necessary.

• Documents and maintain patient's records.

• Performs venipunctures and administers contrast media and /or

medications (as allowed by the department protocol).

• Support colleagues and other health care staff members to provide quality

patient care.

• Adheres to the profession’s accepted code of ethics.

• Pursues continuing education.

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An introduction to Management

The manager’s Job

Educational objectives:

By the end of this lecture you will be able to:

❑ Define management

❑ Describe types of managers

❑ Briefly explain the four basic management functions

❑ Discuss fundamental managerial skills.

What is management?

❑ A set of functions directed at the efficient and effective utilization of

resources in the pursuit of organizational goals.

Classifications of managers

Can be classified according to:

1- Level of management :

* Top managers.

* Middle managers.

* First line managers.

2- Areas of management:

* Financial managers.

* Human resource managers

* Operations managers.

* Others

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Levels of management

❑ Top managers:

- Create goals, plans and polices.

- Representative to external environment.

❑ Middle managers:

o Implement plans and polices.

o Supervise activities of first line managers.

❑ First line managers

Basic management functions:.

▪ 1- Planning.

▪ 2- Organizing.

▪ 3- Leading.

▪ 4- Controlling.

1) Planning and Decision Making

❑ Planning:

▪ Ability to predict the future.

▪ Setting goals

▪ Determine policy and establish methodology to achieve these goals.

❑ Decision making:

▪ Selecting an action plane from a set of alternatives.

2) Organizing:

❑ Grouping activities and resources in a logical fashion.

▪ Dividing tasks

▪ Delegating authority over such tasks.

▪ Organizing charts

▪ Job description

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3) Leading.

It is the set of processes used to get members of organization to work together to

advance the interests of the organization by the following ways:

- Motivation.

- Close personal relationship.

- Communication.

4) Controlling

-It is the monitoring the organizational progress toward goal attainment.

-It is a measurements of work performed

- The Comparison of performance with predetermined goals and standards.

- Initiating the corrective actions to ensure that the performance meets the

standards.

Fundamental Managerial Skills.

The manager should have the following skills:

❑ Technical ( know well the technical steps and items within the system)

❑ Interpersonal ( good relationships with others and good communication

skills)

❑ Conceptional.

❑ Diagnostic (have the ability to initiate corrective action).

❑ Communication.

❑ Decision making.

❑ Time-management.

❑

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❑

❑

❑

❑

❑

❑

❑

❑

❑

❑ Organization’s Environment

1- External:

❑ General: economic, Technological, political- legal.

❑ Task: competitors, customers, supplier, regulator.

2- Internal:

❑ Owner

❑ Board of directors

❑ Employees

❑ Ethical and social Environment

❑ Individual ethics and believes ( what is right and what is wrong, what is

good and what is bad)

❑ Ethical behavior: conforms to generally accept social norms.

❑ Unethical behavior: does not conform to generally accepted norms.

❑ Managerial ethics: standard of behavior that guide individual managers in

their works.

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Professional Ethics

❑ Application of values and moral standards to activities within a profession.

❑ Code of ethics: a formal written statement of values and ethical standards

that guide a firm’s actions.

❑ American Registry of Radiologic Technologists ( AART, Aug, 2007)

Code of ethics: Importance

❑ Guide radiologic Technologists (RT) to evaluate their professional conduct as

it relates to patients, healthcare consumers, employers, colleagues, and

other members of the healthcare team.

❑ Assist RT in maintaining a high level of ethical conduct and in providing for

the protection, safety and comfort of patients.

Code of ethics

❑ The RT conducts her or himself in a professional manner, responds to

patient needs, and supports colleagues and associates in providing quality

patient care.

❑ The RT acts to advance the principal objective of the profession to provide

services to humanity with full respect for the dignity of mankind.

❑ The RT delivers patient care and service unrestricted by concerns of

personal attributes or nature of disease or illness, and without

discrimination on basis of sex, race, religion, or socio-economic status.

❑ The RT practices technology founded upon theoretical knowledge and

concepts, uses equipment and accessories consistent with the purposes

for which they were designed and employs procedures and techniques

appropriately.

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❑ The RT assesses situations; exercises care, discretion, and judgment;

assumes responsibility for professional decisions ; and acts in best interest

of patient.

❑ The RT acts as an agent through observation and communication to obtain

pertinent information for physician to aid in diagnosis and treatment of

patient and recognizes that interpretation and diagnosis are outside the

scope of practice for profession.

❑ The RT uses equipment and accessories employs techniques and

procedures, performs services in accordance with an accepted standard of

practice , and demonstrates expertise in minimizing radiation exposure to

the patient, self, and other members of the healthcare team.

❑ The RT practices ethical conduct appropriate to the profession and

protects the patient's right to quality radiologic technology care.

❑ The RT respects confidences entrusted in course of professional practice,

respects patient’s right to privacy , and reveals confidential information

only as required by law, or to protect welfare of individual or community.

❑ The RT continually strive to improve knowledge and skills by participating

in continuing education and professional activities, sharing knowledge

with colleagues, and invest in new aspects of professional practice.

Organization's culture

❑ The set of values bevies, behaviors, customs and attitudes that helps an

organization’s members understand what it stands for, how it does things

and what it considers important.

❑ A powerful force that can shape the firms overall effectiveness and long

term success

❑ The managers must understand the current culture and decide whether to

maintain or change it.

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Management Function

Kinds of goals

1-Strategic goals:

▪ A goal set by and for top managers.

2-Tactical goal:

▪ A goal set by and for middle managers.

3-Operational goal:

▪ A goal set by and for first line managers.

Objectives

❑ Specific: Determine exactly my objectives

❑ Measurable: Determine how would be a good job look like.

❑ Attainable: Is the objective feasible or not?

❑ Result-oriented: Is my objective meaningful?

❑ Time-limited: Is the objective traceable?

Planning

Kinds of plans

▪ Strategic plan: a general plan outlining decisions of resources allocation,

priorities and action steps necessary to reach strategic goals.

▪ Tactical plan: a plan aimed at achieving tactical goals that is developed to

implement parts of strategic plan.

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▪ Operational plan: focuses on carrying out tactical plans to achieve

operational goals.

The planning process:

SWOT analysis

▪ SWOT analysis: is a statistical method to identify the Strengths,

Weaknesses, Opportunities and Threats in the internal and external

environment for any organization.

▪ Using the SWOT analysis: the organization chooses strategies that support

its mission and:

▪ Increase its opportunities and strengths.

▪ Neutralize its threats.

▪ Avoid its weaknesses.

• Operational plans

1- Single use plan:

❑ Program: for a large set of activities

❑ Project: of less scope and complexity than program.

2- Standing plan:

❑ Policy: guidelines ( some direction)

❑ Procedures: sequence of steps describing how to carry out

the activity. ( less direction)

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❑ Method: as procedure ( no direction)

❑ Rules: define what to do and what not to do.

• Decision making

• It is defined as the process of choosing alternative from among a set of

alternatives.

• It is also an integral part of the all managerial activities but the most

central to the planning process (problem solving).

• Decision making

• Types of decisions:

1- Programmed 2- non-programmed

• Decision- making conditions:

1- Under certainty 2- under uncertainty

• Decision making process

1. Recognizing and defining the situation.

2. Identifying alternatives.

3. Evaluating alternatives.

4. Selecting the suitable alternative.

5. Implementing the chosen alternative.

6. Follow up and evaluating the results.

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Organizing

• Organizing Process:

❑ Purpose:

To make the best use of the organization’s resources to achieve organizational

goals.

❑ Organizational structure:

It is the structural elements of the organization and its relationships.

Organization structure:

- The formal decision-making framework by which job tasks are divided, grouped,

and coordinated.

- Built by top management.

- Represented in chart form.

- Informal organization.

Elements of organization structure:

1- Job specialization

2- Reporting relationship

3- Authority

4- Coordination

5- Organizational Mode

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Is hospital like other organization?

Directing and leading

Leadership:

Difference between leadership and management

leadership management Activity

Establishing

directions

Planning and budgeting Creating agendas

Aligning people Organizing and staffing Developing a

human network for

achieving agenda

Motivating and

inspiring

Controlling and problem

solving

Executing plans

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change Major results outcome

Leadership Behaviors:

Decision style model:

M

ot

iv

at

io

n:

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The Motivation Framework

What factors motivate people?

• Money ( and everything related to finance)

• self- confidence

• Higher level in the work category

• Higher educational level.

• Recognition

• Relationships

• How motivation occurs?

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Why some behaviors are maintained?

Popular

Motivati

onal

Strategi

es:

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Quality in medical imaging

TQM Historical Development

Ernest Codman

- In 1914, a surgeon named Ernest Codman developed one of the

earliest initiatives in health care quality.

- He challenged hospitals and physicians to take responsibility for the

outcomes of their patients.

- He called for a compilation and analysis of surgical outcomes.

- He recorded pertinent data (patient case numbers, preoperative

diagnoses, members of the operating team, procedures, and results)

on pocket-sized cards, which he then used to study outcomes.

Quality assurance and quality control

- Following Codman’s early efforts, the next 6 to 7 decades focused

primarily on QC and QA.

- The concept of quality in the term “quality assurance” expresses the

closeness with which the outcome of a given procedure approaches

some ideal, free from all errors and artifacts (Whole procedure).

- The term “quality control” is used in reference to the specific

measures taken to ensure that one particular aspect of the

procedure is satisfactory (Single step in the procedure).

Philip Crosby, Edwards Deming and Joseph Juran has shaped the

dimensions, practices and mechanism which underpin the concept.

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- It is noted that none of these three actually uses the TQM term.

Feigenbaum and Ishikawa are the greatest contributors to the

development of the term TQM.

Avedis Donabedian

- In the 1960s, Avedis Donabedian created the structure, the process,

and the outcome paradigm for assessing quality in health care.

- His work influenced practitioners to identify various methods to

enhance patient outcomes in the broad areas of structural, policy,

and organizational changes as well as process change and patient

preferences.

- His work also helped establish the systems approach to health care

quality and its studies.

TQM

- The Term TQM started to be used in the mid-1980s and only became

a recognized part of the quality-related language in the early 1990s,

became global at 1992. as TQM s.

Economic Control of Quality of Manufactured Product,

Deming recognized quality as a primary driver for business and

communicated these methods to Japanese engineers and executives,

which ultimately contributed to the tremendous successes in Japan in

the 1950s and for years thereafter.

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Deming’s best known contribution to American industry is a set of

management principles ( 14 principles ) that are applicable in large or

small organizations and in any business sector.

Deming’s Cycle

He planned his theory on the following circle:

Plan

Action execute

Check

Dimensions of quality health care

- Technical competence

- Access to service

- Effectiveness

- Interpersonal relations

- Continuity

- Safety

- Amenities

1- Technical competence

- It refers to the skills, capability and actual performance of health

providers, managers and the supporting staff.

- A lack of technical competence can range from minor deviations from

standard procedures to major errors that decrease effectiveness related

to patient safety.

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2- Access to Service

Health care services are unrestricted by geographic, economic, social,

cultural, organizational or linguistic barriers.

3- Effectiveness

- The quality of health service depends on the effectiveness of service

delivery norms and clinical guidelines (evidence based practice).

- The procedure when correctly applied should lead to desired results.

- The procedure must use the most appropriate technological facilities to

deliver the service.

4- Interpersonal relations

- It refers to the interaction between providers and clients, managers and

health care providers and the health team and the community.

- Good interpersonal relations establish trust and creditability through

demonstrations of respect and confidentiality.

5- Continuity

- The client receives the complete range of health services that he or she

needs without interruption, cessation or unnecessary repetition of the

procedure.

- The absence of continuity leads to decrease in the effectiveness, efficiency

and the quality of interpersonal relations.

6- Safety

- Minimizing the risk of injury, infection, harmful side effects or other

dangers related to the procedure.

- Safety involves the patient as well as the procedure.

7- Amenities

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- The components and features of the health service that enhance the

client's satisfaction and willingness to return to that facility upon his need.

- It is related to the physical appearance of the facility personnel and

material as well as comfort cleanliness and privacy.

How is quality of health care is measured?

- Measurement of indicators that reflecting few or all aspects of health care

(inputs, processes and outcomes).

- Qualitative and quantitative methods.

- Ongoing and periodic measurements.

-Information from a variety of data sources.

- Timely information ( feedback).