Promoting Patient-centered Care in Radiology

Regardless of your subspecialty, you’ve probably noticed over the last decade that you’re spending more time interacting with your patients than you used to. As health care models continue to grow and change, that trend is expected to continue and, perhaps, grow.

As radiologists, that means you should augment your skills for incorporating more patient- and family-friendly tactics into how you provide care. Industry experts at RSNA 2016 walked through their experiences in integrating a more patient-centered focus into their workflow.

“A patient’s experience is the sum of all their interactions, and it’s shaped by our organizational culture. It influences their perceptions across the continuum of care,” said Layne Mitchell, radiology administrator for Georgia Regents Health System. “Our job is to relay how that culture really is and to be patient with our patients so they can form those perceptions in a more accurate manner.”

Georgia Regents’ Experience
In recent years, Georgia Regents has redesigned both its mammography suite into a spa-like environment and its pediatric radiology area into a more kid-friendly zone. Both times, they brought patients to the table to be part of the decision-making process. In these discussions, Mitchell said, it’s important to be open to patient ideas and to avoid over-promising on what you know you can deliver.

The result has been improved patient experiences and satisfaction rates. But, these conversations also prompted the radiology department to make changes from within.

With the mammography suite, patient feedback taught their radiologists and technologist to slow down and take their time with each patient, so the department built a corner suite where providers can talk one-on-one to patients outside of the waiting room. Doing so helped relieve patient fears and got them more engaged with their care.

The department also empowered its staff to answer patient questions about clinic schedules, wait times, and other activities to minimize the time spent waiting for a clinic manager to respond to queries. They also created an open clinic environment where providers and staff alike felt free to speak up with concerns that affect the quality and safety of patient care.

Fostering a more patient-centered focus in the pediatric areas was a more visual endeavor, Mitchell said. The department worked with Phillips to change the clinic’s stainless steel appearance to one with vibrant colors. They also installed an interactive, touchable wall where children can pop balloons, play air hockey, or shoot off fireworks to take their minds off the studies they’re facing.

In addition, they also installed simulation scanners that children can play with to assuage any fears they might have about the diagnostic imaging equipment.

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The end goal of improving your patient- and family-centered focus is a positive one, but you will face challenges along the way, said Lynn Fordham, MD, pediatric imaging division chief at the University of North Carolina at Chapel Hill.

Ages and Behavior: Depending on your patient’s age, he or she will interact with you differently. Young children might want to touch some of your equipment. Letting them, as best you can, could help them feel more comfortable. As patients age, they’re better equipped to understand the abstract concepts associated with diagnostic imaging, but be sure you explain what will happen in developmentally-appropriate ways.

Family Structure: Be sensitive to the wide variety of families you might see – traditional, single-parent, same-sex, and multi-generational. In cases in which you aren’t sure, don’t be afraid to clarify who the patient is and who is responsible for him or her.

Language: Connect to services within your hospital or facility that can provide an interpreter for non-English speaking patients, if necessary. It’s the only way to ensure your patient has a good understanding of his or her care.

Know Your Audience: When explaining results, it can be helpful to have an idea about your patient’s occupation and education level. That will help you explain findings in ways they can best understand. For example, if you’re discussing a gastrointestinal blockage with a plumber, referring to pipes being clogged will be an easy metaphor to explain what’s going on, she said.

Reaction Time: You work under time constraints, but resist the urge to deliver your findings and move on to your next appointment. Give your patients time to react to any news you provide and to ask questions. Have them repeat what they heard back to you so you know they understand any findings or next steps.

Lessons Learned
Even with all the patient surveys and conversations that garner patient feedback, it can be hard for you to understand your patient’s perspective if you’ve never been in their shoes. If you see through their eyes, you could decide to change the way you practice, said Jennifer Kemp, MD, a private-practice body imager with Diversified Radiology of Colorado. The experience she had as a caregiver when her husband developed cancer was a game-changer.

“Was I clueless? I probably was more naïve than most radiologists are,” she said. “Being on the other side of medicine has helped me learn to be more empathetic.”

Here are her lessons:

1. Cancer is an emergency for patients. Don’t push your cancer follow-up studies to the bottom of the pile or leave them over the weekend. Your patients are waiting for these results to know whether they need more chemotherapy, if they’re cured, or if they need hospice. Give them answers as soon as you can.

2. Medicine is inherently uncertain, and that can be frustrating for patients who are looking for definite answers. As a radiologist, she said, you know findings can be indeterminate. So, if you can’t rule out certain diagnoses, say so. But, do try to give patients as much specificity as possible.

3. Patients are scared, and that fear often presents in many ways. They might be grouchy or mean. They could appear anxious or irrational. Do your best to remember their actions come out of worry, and try not to take it personally. Keeping your patients informed of what’s going on in the clinic, such as if there’s a delay that will push back their appointment, can also help them manage their emotions. Knowledge helps them feel empowered, she said.

4. Patients wait with bated breath to talk to you. They listen closely to what you say, so try to be as clear as possible when you explain your findings and what will happen next. In their minds, you’re the source of their next plan. Take a few extra minutes to make them part of an in-depth conversation about their care. It could make a big difference in the kind of day they have, Kemp said.

Regardless of the changes you make, though, Mitchell said, don’t ever think you’ve maximized the ways you can augment your patient’s experiences.

“Don’t rest on your heels, and never give up the idea that you have to constantly and continuously improve,” he said. “Stay involved with your patients. Have patient committees. Let them come to staff meetings and talk with staff members. Give them plenty of opportunities for feedback. Hopefully, it will ignite a passion in you to make every day special for every patient that walks through your door.”