Riding the Improvement Wave in Radiology

If your department or hospital is currently embroiled in meeting regulatory benchmarks and abiding by new regulations, chances are you're actively involved in some type of improvement project.

Maybe you're in the initial stages of thinking about what a good improvement project could be. Perhaps you've tried a few things that haven't worked. Or, maybe your group or facility has already found success and you want to keep it rolling.

Whatever the case, you stand to benefit from riding the improvement wave, according to Jake Mickelsen, Improvement Program Director at Stanford Medicine, and Dorothy Cordova, Quality Program Manager at Stanford Healthcare. They discussed a method that can help you capture your improvement goals at the 2017 AHRA annual meeting.

"Improvement has been a lot like surfing, and it continues to be this way. We want to catch a wave. It feels good, and it brings in results. But, sometimes you have small failures occur, and you wipe out in improvement," Cordova said. "It's the way you learn and identify the right things to do as an organization."

If you work strategically, they said, you can succeed.

Pinpoint Your Goal: This is always your first step. Do you want to improve a quality outcome, boost patient satisfaction, or save money? Before you do anything else, identify your need.

Unavoidable Problems: Be sure you elevate your problem spots to the point where they're a topic of conversation for leadership. Workgroups, leadership checklists, and project huddles won't be effective if they aren't regularly talking about the weakness you're trying to overcome.

Empower Your Frontline: Engage your frontline providers. They're best positioned to know where your problem spots are, and they can be your most valuable resource when brainstorming solutions, Cordova said. Give them a voice in deciding which problems to tackle first and  how to best address them. Make a concerted effort, she said, not to take over initiatives by imposing your thoughts on how to make changes.

Provide Consistent Support: Once your frontline is engaged, don’t leave them to wrestle with improvement efforts alone. Enlist the help from others in your organization who have worked on these types of initiatives before to be mentors. In addition, schedule frequent meetings -perhaps weekly  - to discuss any project progress and areas that might be strengthened.

"If we support people in a tangible way, they can do fantastic things," Mickelsen said. "These are individuals who can accomplish a lot with the support of leadership."

In today's health care environment, much credence is given to innovative solutions. Those programs or strategies are always exciting, Cordova said, but don't be afraid to adopt systems that are already working elsewhere. You don't have to create something wholly unique to your institution to be effective. Don't hesitate to tailor an existing program to fit your needs.

Stanford's Experience
Over the past year, radiology personnel at Stanford Medicine and Stanford Healthcare have shown it's possible to make significant improvement progress. The key, Mickelsen said, is having an overarching improvement system.

At the beginning of the current fiscal year - Sept. 1, 2016 - Stanford launched an effort to design and complete 52 improvement projects within 52 weeks. As of press time, 46 were complete with six more in progress. Each project, proposed by an individual frontline provider, addresses an area ripe for improvement.

The program design is simple, and it empowers frontline employees to feel they have the ability to bring about change. Each employee is paired with a colleague-coach who has more improvement experience. Together, over eight weeks, they design each program, clearly identify targets, determine how to measure problems, implement interventions, and sustain the ones that work. They also met routinely with program directors for additional guidance.

So far, he said, these projects have saved more than 3,600 staff hours, increased revenue by $9 million, saved $300,000 in supply costs, improved patient satisfaction scores by 8 points, and reduced near-miss errors by 60 for the year so far.

Cordova recognized Stanford's effort is audacious, but, she said, any facility or department can be successful at improvement even with bumps along the way.

"This is all possible, so don't be discouraged," she said. "It can be a lot of fun."