Basic Imaging Management: Q&A with the Authors

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By AHRA Staff

November 2011–“Basic Imaging Management: A Reference Manual” was published this summer. It was written by AHRA members based on a first hand “start from scratch” experience. They were presented with a radiology leadership change at a small associated clinic/hospital and were asked to provide interim leadership support. There was a need to establish basic department infrastructure and formal documentation. From this experience, this publication was born.

Link recently spoke to the authors to help readers better understand their experiences and motivations for writing this publication.

Link:  Can you give us a little more background on the experience that was the foundation for this publication?

Sue Ramthun, Sue A. Rysted, and Kathleen J. Williams: Our initial focus was daily department operation oversight and locating employee, equipment, policy, and scheduling information, and associated documentation. When we couldn’t locate the expected information, we leveraged our knowledge and experience to start the policy, procedure and employee documents from scratch.

At this point we recognized the importance of having an information infrastructure and how we took it for granted in our own institution.

Link:  What kind of staffing issues did you encounter?

SR, SAR, and KJW: There were several:
•    High rate of technologist turnover
•    Performance management, corrective action, and termination
•    Lack of annual competencies and department policies
•    Staffing to workload (analysis and benchmarking)
•    Scheduling favoritism – the prior practice allowed some staff to work their preferred hours rather than when they were needed, some staff were excluded from evening or weekends

At first, employees were resentful about having outsiders brought in, but once some of the changes were implemented and all technologists were treated equally, we were made to feel welcome. Even the decrease of overtime and loss of extra money was received well and considered the right thing to do.

Link:  Can you tell us a little more about your experience with Joint Commission survey prep?

SR, SAR, and KJW: The facility was not Joint Commission accredited, but was planning to apply the next year. This news provided us with several focus points: 1) environment of care, 2) employee competency and documentation, 3) imaging patient care procedure alignment with continuity of care within the organization, and 4) equipment performance and maintenance.

Our first concern was the safety of the patients and ensuring the department was meeting regulatory standards. We decided to draft checklists to help guide our initial site evaluation. The checklists morphed into the documents included in the “Basic Imaging Management” manual.

Link:  What sort of IT or informatics issues needed to be addressed?

SR, SAR, and KJW: The radiology department operated as a digital practice with the exception of mammography. We evaluated the process flows and identified some issues with the orders input. We oversaw the installation of a bone mineral density unit and a CR mammography unit. A second radiography CR reader was also installed to increase department efficiencies. All of these equipment installations required vendor and IT collaboration.

As part of the project, all of the radiology exams would be interpreted by a group of radiologists located 40 miles away.  As we began sending image data from the facility to the interpretation location, we found that networking the CT and MR exam images was extremely slow due to the large amount of data. The networking had to be faster to provide a reasonable turnaround time to clinicians. After a thorough review of the situation, the decision was made to install two T3 internet connections from the facility to the interpreting site. The second T3 line was installed as a back-up in the event one line was out of commission. This was a very costly solution but was definitely needed to service the patients.

Link:  Financial management is a big area of focus for imaging administrators. What did you learn the most in this area of the business?

SR, SAR, and KJW: It is important to do your homework and analyze cost versus level of service provided. After review of the maintenance service contracts, we found the level of equipment preventive maintenance (PM) was at the recommendation of the vendor. They performed PM on a monthly basis, which was well beyond state regulations. Additionally, no one really knew what types of tests were performed during the PM monthly check. We learned the site had signed a five year maintenance contract and it could not be terminated unless the equipment was removed from service.

Another area of learning was staffing overtime. Historically, the radiographers worked a significant amount of overtime. By modifying employee schedules to match patient demand and altering overtime to be paid only after 40 hours worked, overtime was almost entirely eliminated.

Link:  Finally, how did you go about putting the manual together?

SR, SAR, and KJW: The first thing was recognition that the project would be overwhelming for a single person. Each of us had our areas of expertise as well as contacts for specific questions. We wished we had a reference manual such as this one and decided it would be a worthwhile publication. Our goal was to author a manual that would encompass all aspects of radiology in a simple format.

From start to finish the manual was a year and a half long project. We feel good about creating a unique publication that can be useful to many imaging managers. We also know that the manual isn’t perfect and look forward to user feedback we can include in future revisions.

You can purchase a copy of “Basic Imaging Management: A Reference Manual” on the AHRA website.

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