Patient Facing for the Non-Patient Facing Radiologist

He was a four-time patient with a life-threatening condition who received all his CT scans at Houston Methodist Willowbrook Hospital. He was scared.

Fortunately, the radiology staff alleviated his anxiety and walked him through every diagnostic study.

"This patient told us it was comforting that our staff treated him like family during an uncertain time," said Dennis Indiero, Houston Methodist's director of diagnostic imaging. "He said he had an outstanding experience."

This reaction is one of hundreds Houston Methodist has received about its patient-centered program. Since 2016, the department's technologists reached out to patients before their exams to enhance their understanding of diagnostic studies.

Long discussed as the next wave of patient care in radiology, patient-centered programs are popping up nationwide. Now, the benefits are more than theoretical -- implemented programs show giving patients individualized attention vastly improves their experience with your department, practice, or facility.

In fact, said John Swan, MD, associate professor of radiology at Massachusetts General Hospital, radiology must shift more focus to the patient. Radiology isn't simply about getting good diagnostic images anymore - it's about contributing to the overall high quality of care hospitals provide.

"When you're caring for people, you have an obligation to look at all aspects of the patient experience," he said. "The patient experience isn't something that's meant to just be endured. It's a quality-of-life question."

What Patients Want
Before you can create an effective patient-centered program, you must know what your patients want to see from you. And, asking is the best way to find that out, Swan said.

In his pilot study, published in JACR, he surveyed 100 interventional radiology outpatients on 24 aspects undergoing diagnostic imaging. Patients revealed their four main concerns: easy interactions with faculty, doctors, and staff; accurate understanding of study duration; pain; and anxiety. This survey, called the Radiology Process Model, can identify what's most important to your patients, as well.

An effective patient-centered program must address your patients' concerns, he said.

"I want this model used in departments that are concerned about how their patients are responding to their policies and processes," he said. "It would be nice to see it used to solve existing problems."

Successful Programs
In 2015, Wesley Long Hospital Cone Health in Greensboro, NC, implemented the AIDET program to educate patients and alleviate concerns. Within the five-step program, technologists: acknowledge customers, introduce themselves and their skills, discuss the duration of the exam, explain what will happen, and thank patients for choosing Wesley Long.

Technologists completed 60 days of training, including learning - and personalizing - patient-education scripts and role playing. The program's goal, said Tonya Viars, BSMI, RTR, director of radiology, is helping patients feel like family rather than tasks.

After verifying the patient's identity, technologists answer questions. Most commonly, she said, patients inquire about a study's length and whether it will be painful. Some ask about radiation dose and appropriateness.

Since program launch, Viars said, the department's patient satisfaction scores have risen significantly. More than a year ago, scores were below 90 percent - for the past six months, they've been in the top decile.

Ultimately, she said, AIDET enhances how patients view their care. The focused attention makes them feel appreciated.

"You have to develop a culture around how the patient feels - not your efficiency or how you performed," she said. "It's about how the patient feels walking out the door."[[{"type":"media","view_mode":"media_crop","fid":"63403","attributes":{"alt":"Patient-centered radiology","class":"media-image media-image-right","id":"media_crop_1757972488282","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"8093","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"height: 170px; width: 170px; border-width: 0px; border-style: solid; margin: 1px; float: right;","title":"©Aha-Soft/Shutterstock.com","typeof":"foaf:Image"}}]]

Houston Methodist's program is equally successful. Technologists call the next day's patients to explain upcoming studies. The initiative developed, Indiero said, because the facility wanted to change how most patients arrived without understanding what was happening.

"We wanted to answer their questions before they arrived," he said. "If we can do that, then the situation isn't as scary for them."

Each afternoon, technologists call patients and walk them through the imaging process. They clear up misconceptions, Indiero said, such as how long an MRI might last or whether an exam will hurt. Initially, front office staff made the calls, but patients questions were often too complicated.

So far, patient feedback, via thank you cards provided at the end of each visit, has been good. The department received 250 positive responses in 2016 and 300, so far, in 2017. The program has also improved departmental workflow. Slowdowns are rare, Indiero said, because technologists can focus clinic time on taking images.

Challenges & Advice
Although patient focus has become a popular theme, changing your office culture is challenging, Swan said. Concentrating more on individual patients can mean additional work for employees and providers, so they might initially resist.

However, he said, as the ACR Imaging 3.0 campaign continues, acceptance of the patient-centered paradigm shift grows.

"The ACR is doing a great job," he said. "Radiologists are becoming more aware that focusing more on patients is what we need to do, and we need to do it well."

Training colleagues and employees to effectively address patient concerns can be equally difficult, Viars said. It happens slowly and requires a time commitment from everyone.

You can bolster your success, Indiero said. Most importantly, put yourself in the patient's shoes. What questions would you have? What would be most critical to you? Design your program to address those concerns.

"Everyone can provide coffee and a warm blanket. And, that's great," he said. "But, the other aspect is information. Patients want to know what's going to happen. We do what we do dozens of times daily, and we can unconsciously explain things in technical verbiage. We have to break that model and create a new one."

Individualize each patient experience as much as possible. It's also imperative, Viars said, to get buy-in from all involved - from front line staff to technologists to other providers.

Improving Patient Experience the ACR Way
Because focusing on patient experience is still relatively new, the ACR has developed resources to help you design programs within your institution. In 2015, the organization launched its Commission on Patient Experience, a group dedicated to helping radiologists design and implement more patient- and family-friendly environments.

Through developmental tools, metrics, and policies, the ACR aims to help you improve the patient experience design and test new initiatives. The Radiologist Tool-Kit for Patient- & Family-Centered Care offers online resources tailored for specific care settings - academic medical centers, children's hospitals, hospitals, private practices, and veteran's hospitals. They focus on patient engagement, colleague involvement, education, and program evaluation.

Using these resources, several clinics have developed patient-centered programs with positive results. For example, California's Radiology Associates developed a series of patient-engagement videos discussing procedures. They answer patient and family questions, as well as free up radiologists' time to devote to reading studies.

Cincinnati Children's Hospital created an extensive social media outreach campaign, including Twitter, Facebook, Instagram, and a blog. Providers share content about modalities and what patients can expect. To date, Cincinnati has more than 10,000 followers.

Additionally, Children's Hospital of Georgia transformed their imaging suite through patient and family input. The facility added an interactive touch-screen wall with more than 80 activities, such as popping balloons or picking apples. A Philips KittenScanner lets children perform a pretend CT on stuffed animals, and patients can change the waiting room lighting to their favorite color and select their favorite backgrounds sounds, including jungle noises.

Overall, Indiero said, in a specialty where patients rarely see you, patient-centered programs can help them feel like more than an anonymous image crossing your PACS.

"The idea of patient-centered radiology and patient focus struck a chord with us," Indiero said. "Everyone who walks through our door is the whole world to someone, and they need to be treated that way."