Consistent Policies Help Radiology Practices

Late last night one of our technologists called me at home to ask a question about MRI safety. After I answered the question, which was one that was easily addressed in our current policies, I asked why they felt they needed to call about it. The answer was one I’ve heard before. Different radiologists in our group had told them different things about this, and they didn’t know there was a regular policy. With that in mind, I read with interest that a major national quality watch dog group was adding several radiological safety measures to their “serious reportable events” list this year.  That drove home the point that wherever possible the group should have a clear policy for common issues.

What’s the big deal? The lack of uniformity negatively impacts the quality of your care most importantly. It will cost patients time, and cost the practice time, possibly you personally. It also makes the practice appear haphazard and un-professional.

In the past, members of groups with whom I’ve worked have either rolled their eyes or overtly resisted having uniform policies for some things. Of course there are many sides to some issues. But there are also available consensus statements and national recommendations for many. Anecdotal experience and historical recollections of old policy should not trump widely held industry or local standards. It is expected that discussions about such issues will include healthy disagreement, discussion and clarification. Don’t avoid this. 

What are the other problems I’ve run into with this?

• Policies are often in place, but years old. How old are they? Have things changed? Are there newer policies?
• Often a single MD in a practice has taken responsibility for this and asked that his or her policies be applied when they are not uniformly agreed to. That person may or may not have investigated and created an accurate, shared consensus. How rigorous were they? How much consensus was there.
• A common situation is that techs are unaware of policies. Do you distribute the policies to all facility staff and make them readily available? Do you refer to them when questions are asked? Do your facilities provide this on a regular basis?
• Policies are not made because there is significant variation in practice patterns. Have you talked about the differences together?
• New members of the group may not know the policies. Do you provide this at orientation? As a new member do you ask for policies? 

So how do you overcome these issues? Have the group and facilities generate a list of what issues are common and need a policy. Designate two or three persons to search for national consensus statements or recent review articles, and ask that they summarize them. Designate a regular time, preferably annually, to review, discuss and, if needed, re-work those policies. It’s not a one-time process.

Once you’ve made the policies, it is not time to hide them away in a folder. Make sure everyone, techs and facilities, with whom you work has your policies and understands them. Have them sign off on those. Make sure they know whom and when to call to ask questions about them.

Variation in practice can be a challenge internally, even after the policies are made. How do you “sell” the new policies to your radiology colleagues so they apply them? Emphasize that uniformity of application is professional and improves quality. Understand that there are some uncertainties and special circumstances and give the radiologists an out. Tell them they can over-ride a policy, but make it clear they are over-riding agreed upon standards. This reduces confusion for the techs. To do this they need to document in writing their reasons for contravening a policy, and provide that to the tech. Give those who disagree a forum as well, by regularly reviewing the policy. Complaints often come when there is no opportunity for discussion. It is prudent to ask that all group members sign off that they know and reviewed the policy(s). That may seem draconian but I assure you that members of the practice are more likely to review them if they have to sign, and more likely to express disagreement or concerns if they do.

When a new radiologist joins the group, have a cogent policy book for them for clinical policies, and make sure they review it. When you, as a radiologist, join a practice, ask how those policies are determined. Does the practice devolve authority to someone, a “director of …” or is there some sort of consensus discussed and agreed to based on standards? How often is that updated? How is it shared with facilities with whom you work?  Who helps with this? Whether you know it or not you are signing on to such policies and may find that your practice patterns are in conflict. On a practice-wide basis, the lack of such a plan for policy making exposes the practice or corporation to risk. It results in unnecessary calls, confusion and questions amongst techs and facilities. Worse it may hurt quality of or slow patient care.