Building a Value Model: Education Series Pillar #4: Productivity

By: Jacqui Rose, AHRA President, and Director of Medical Imaging, Telecommunications, IT, & Lab, Premier Health – UVMC & MVHN

Pillar #4: Productivity

INTRODUCTION

Productivity is not simply a tool to save money; it is essential to allocating assets most efficiently.  Productivity is the culmination of asset management, staffing, training, and advising.  Pillars I-III, when managed well, create a very productive Imaging system.  Productivity tools are plentiful and range from sophisticated tools that incorporate Activity Based-Costing to simpler models based on volume and Relative Value Units (RVUs).  All instruments are very intricate to implement initially because variables borne from differences between departments will inhibit the ability to compare best practices and benchmarks until they have been mitigated.  It is crucial to develop these productivity standards with the Finance department to ensure that data is clean and clearly understood. 

Using a commercially available tool will enable comparison to other organizations by sharing best practices and creative solutions to achieve the established goal.  AHRA has provided an excellent explanation of productivity details and multiple tools in the Financial Management in Radiology textbook, available on the AHRA website and written by a host of knowledgeable members.  Chapter eight (8) is dedicated to a thorough evaluation of all components of productivity and tools.  According to this publication, productivity that is too high or too low may lead to staff dissatisfaction, lost volume, excess capacity, and poorly sized or equipped imaging centers.  Conversely, a good productivity tool will enhance operations in all these areas and optimize financial performance.

PRODUCTIVITY CONSIDERATIONS

Enhancing productivity involves thorough evaluation and optimization of all aspects of the asset, human, and system technology management.  Starting with the mission, vision, and strategic plan of the organization to guide the development of services and facility design, as well as future implementations and replacement plans.  After a clear vision of services is outlined, leadership should collaborate with the vendor of choice to explore equipment specifications that enable maximum efficiency and enriching services to exceed customer expectations.  The vendor partner is critical in facilitating efficient protocols that maximize quality in partnership with your Radiologists.  Staff training and competency are the next keys to optimizing equipment utilization, which should be preceded by hiring exceptional skills. 

ACCESS AND SCHEDULING

The optimization of the patient schedule and access to services, in collaboration with the EMR/Scheduling software provider, is critical to an efficiently run department.  Depending on the type of facility, you may need to incorporate timing for inpatient, outpatient, and emergency patients who often pose challenges to efficient use of assets.  However, aggressive management of patient schedules will reduce cancellations and no-show appointments and enable recapturing of time and market share—patient and provider access factors into the schedule and the team’s optimal performance.  Developing a collaborative plan for access via multiple avenues will open referral channels to capitalize on volume.  Inefficient or poorly managed patient schedules and access can lead to lost scan time, resulting in lost volume, revenue, and decreased staff and physician satisfaction.  Ultimately, loss of market share is tough to regain when services are again optimized.

SERVICE MANAGEMENT

Equipment maintenance and service are also integral to smooth, efficient operations.  Excessive downtime, poorly managed maintenance, and suboptimal quality can affect your operations to the point where referral sources lose trust in your services and take business elsewhere.  Management of equipment maintenance is significantly easier in larger departments with multiple units and more critical in smaller ones with single unit modalities.  The creation of well-planned maintenance schedules will decrease unplanned downtime and ensure that equipment is achieving optimal quality.

IT SYSTEMS AND ANALYTICS

Optimizing the image management systems, reporting systems, and data analytics will also enhance overall operations.  Disjointed or non-integrated systems can create massive inefficiencies that inhibit departmental procedures.  Proper guidance in the EMR will assist referring physicians in the correct ordering, which reduces rework by the technical staff to correct inaccurate orders.  Accurate and automated charge capture will assure financial viability, and reliable mechanisms to ensure results reporting in a timely and efficient manner are critical.  An Imaging team can have the best workflow possible. Still, if this final work product, the report, is not in the hands of the physician and patient promptly and accurately, nothing else will fix your referral problems. 

These supporting systems must be developed to eliminate inefficiencies by automating as much as possible.   Supportive staff processes must also be efficiently designed to enhance the department’s capabilities.  This will enable the technical staff to operate more efficiently and to the maximum level their license will allow.  Finally, creating custom dashboards helps monitor progress over time rather than focus on a point in time measures that can be deceiving and detrimental to progress.

SUMMARY

To summarize, every aspect of the design and workflow of a department impacts the productivity in Imaging.  Each component must be working at its optimal performance level to keep the total workflow smooth and efficient.  When issues occur that slow down the process, it can often be in another part of the system and not directly in the patient scanning process.  It is essential to work closely with vendors of all aspects, systems, and equipment with the whole chain of workflow to ensure each maximizes the performance of each.  Once this is achieved, the marketing team can grow volume based on achievable goals that will enhance the physician practice also.  So, much like the circle of life, each facet is fed and extends from the others in a process that is optimized in Imaging.

Vendor Connection

As an added summary to each article in our Value Model series, we will close with practical tips that you should consider if you’d like to put these ideas into immediate action.  We call this section the ‘Vendor Connection.’

By: Karen Holzberger, Senior Vice President & General Manager, Diagnostic Solutions, Nuance

It seems everyone is talking about productivity – maximizing it, building workflow efficiencies, and adding technologies in ways that enhance output and help us all do more with less. But the truth is this: you can be efficient and productive, and you can be ineffective all at the same time. But it is a challenge we can overcome. Efficiency comes in many forms; it is not just how fast you can get things done. It is about how effectively you are doing them the first encounter to create radiology departments and reading practices that have a genuine, positive impact on patient care and outcomes.

THE IMPORTANCE OF CONNECTEDNESS IN CREATING QUALITY OUTCOMES

A patient’s journey often begins with Imaging. Whether they start in the emergency department or with their primary care provider, radiology is often at the heart of connected patient care. But a good patient outcome does not happen because the image was taken. Good outcomes are possible when everything that occurs due to that image happens effectively, thoroughly, and quickly.

This connectedness empowers us to learn from each other, share our expertise, and collaborate in ways that can help avoid rework downstream. Again, how quickly you create the report is just part of the equation. It is about the patient and everything that happens once that report is available. When we can bring in real-time intelligence and decision support, streamline quality reviews, and enhance communications, we create more efficient workflows that ultimately drive us toward effectiveness.

CLOSING THE LOOP ON PATIENT-CENTERED CARE

Without a connected platform, there are too many opportunities for things to get lost. Consider a patient whose chest x-ray, performed to rule out pneumonia, reveals a tiny incidental finding – a lung nodule. Because the patient does not have pneumonia, she is sent home, only to return to the emergency department two years later with metastatic lung cancer.

These stories are far too familiar; they can be deadly and costly, but they are preventable. For example, a collaborative, automated approach to proactive patient follow-ups will use natural language processing and clinical analytics to intelligently detect and extract recommendations. That is, a follow up management solution can recognize a radiologist’s mention of “follow-up recommended” within the report, then help close the loop by proactively managing a patient’s adherence to these recommendations and help reduce the potential for missed or delayed diagnoses. It is an essential step toward creating quality outcomes and one that also allows radiology departments to achieve financial and operational performance objectives.

SUMMARY

Radiology plays a central role in healthcare; nearly every specialty relies on diagnostic imaging and radiology reports to create the best possible patient outcomes. With connected, integrated technology platform and clinical analytics at the heart of radiology, we can transform radiology services. That is, when every detail connects patients and providers, we can not only prioritize patient care, but we can also realize tremendous benefits: new revenue opportunities, enhanced opportunities for training and education, improved patient satisfaction, streamlined processes, and – yes – improved productivity.

Asset Management, Competition, Information Source, Productivity, Staffing, Training and Advising

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