Patient-Centered Radiology: Lessons from Disney (and Stanford and Hoag)

Traditionally, many radiologists have worked behind the scenes, not directly with patients. Their reports and opinions serve as input to the diagnoses and treatment plans a patient gets from oncologists, orthopedists, emergency-medicine specialists, primary-care physicians and others doing retail care.

“If I had a nickel for every time a woman said, ‘The breast surgeon read my mammogram,’ I’d be a very rich woman right now,” quipped Mary Mahoney, MD, director of breast imaging at the University of Cincinnati Medical Center.

But the field can’t stay hidden if it wants to survive in its current form, she and others are convinced. Radiology can either become more personal or become a commodity, as Mahoney put it.

Some practices are already well on their way to personalizing the field. Radiologists representing two forward-thinking practices joined Mahoney during a Nov. 29 RSNA 2011 session exploring patient-centered radiology. While there are major barriers to radiologists becoming familiar faces to patients (diagnostic workload and an incomplete knowledge of a patient’s status among the biggest), there is also much a practice can do to keep patients happy and well-informed of the vital role radiologists play in health care.

Doing things differently doesn’t necessarily demand major changes to how a practice operates – although using speech recognition to speed up delivery of reports is something to consider, said Michael Brandt-Zawadzki, MD, a radiologist with the Hoag Neurosciences Institute in Newport Beach, Calif. Rather, he said, consider optimizing the services enveloping radiology care.

Invest in your waiting room. When you’re done and it feels like a lounge, call it that, he said.

Patients hate to wait. Set expectations, and set them pessimistically, he added. Follow the Disney approach, which is to tell those in lines that there’s a 40-minute wait when it’s in fact only 30 minutes, leaving them pleasantly surprised at the end of it. At Hoag, they bring in a greeter during peak volumes and make sure patients know how long they’ll be in in the lounge.

He described a radiology practice’s circle of care as including scheduling and registration, reception, caregiver interactions, results reporting and billing. In scheduling and registration, his practice uses enterprise-wide scheduling following the “one-call concept,” with one voice, one contact and a single line for scheduling. They monitor the speed of answers and analyze patterns of abandoned calls. When patients are inconvenienced, they kick into service-recovery mode, offering movie tickets or Starbucks cards.

“The entire circle needs to be managed and effectively monitored,” Brandt-Zawadzki said.

Volney Van Dalsem, MD, who leads Stanford Hospital’s outpatient radiology practice, is continuing the work of Gary Glazer, MD, a patient-centered radiology pioneer. Glazer, who died Oct. 16 of prostate cancer, envisioned nothing short of a “new model in patient experience,” and had largely realized it, Van Dalsem said. Stanford’s 10,000 square-foot outpatient radiology facility was created from the ground up with the patient in mind, and Glazer’s team polished the practice on many fronts, he added.

The physical facility is “spa-like,” as Van Dalsem put it, though “nobody’s going to get an avocado wrap. We’ve got sick patients who need to be welcomed and coveted and embraced.” In the lounge are custom-developed patient-education materials describing imaging technologies and procedures in lay-language. On flats-screen TVs, there’s a video loop talking about imaging modalities and treatments specific to Stanford. Lounge computer users are welcome to play Angry Birds, but the welcome screen is set to the Stanford Health Library, he said.

For scheduling, the practice established its own call center and “dramatically increased personnel.” As at Hoag, they track metrics such as time on hold and dropped calls.

“If we see a spike, we try to figure out what the problem is and fix it,” Van Dalsem said.

As for patient-radiologist interaction, Stanford doesn’t report results directly to patients. But the practice did experiment with having radiologists swing by patients before exams to introduce themselves, thank them for choosing Stanford imaging, and tell them that physicians ordering the scans will have their results within 24 hours.

Patients loved it, Van Dalsem said, but the practice has gotten to so busy that the radiologists can’t take the time to do it anymore. So now there’s a video presentation with the Stanford radiology-department chairman saying the same things, he said.

“We’ve been victims of our own success,” he said. “We can’t keep up with the patients.”