MGH Department of Radiology - Quality Management and Education

A DECADE OF QUALITY MANAGEMENT AND EDUCATION
LOOKING AHEAD
QME TIME LINE: 1993 – 2002

A DECADE OF QUALITY MANAGEMENT AND EDUCATION

Ten years ago, Dr. James H. Thrall and Daniel I. Rosenthal conceived the idea of introducing a quality management program into the Department of Radiology. The primary motivations were a recognition of the enormous challenges facing the Department in improving operations and the limited availability of the already busy managers to tackle issues at a fundamental, systemic level. Bringing in specific expertise in work process redesign and operations improvement would provide both the manpower to accomplish the needed reforms, fresh insight into what could be done, and the means to implement the improved processes through staff education.

At the outset, Drs. Thrall and Rosenthal knew that they wanted to include someone with no hospital experience in the core of the quality management team. For this reason, they chose to hire an industrial engineer, believing that he would be able to look at things from a fresh perspective and would not already know “why things could not be done that way”. Adding to the engineering perspective, they built a team of people with a range of expertise, including those with MBA, MPH, and education degrees; expertise that was synergistic to the radiological experts.

From the beginning, the Quality Management and Education (QME) team tackled some fundamental systems, such as patient reception, patient scheduling, the film library, and the line management of the entire Department. The team started by assessing each work process in use at the time, identifying the stakeholders at each step and learning from them what their desired outcomes were. Then the QME team embarked on the iterative process of redesign or, in some cases, design of a new work process.

A large part of the reorganization process depended on the development of service metrics, finding out, for example, how much time each step took from the time lag for scheduling an appointment to the last step of the billing procedure. The guiding principal of service metrics is that the information gathered serves as a benchmark for improvement and makes it possible to know whether a new procedure is indeed a change for the better. The information also makes it possible to identify the bottlenecks and weak points of the work process.

As the Radiology Department began to see the impact of these improvements, the leadership realized that the Department was developing expertise of value to other radiology departments around the country and even around the world. The Radiology Consulting Group (RCG) was thus born. RCG not only benefits the many other radiology departments whose members attend courses in radiology management, it also benefits the members of the QME team. The interaction with those in other hospitals provides a window onto the practices in place outside MGH and is therefore a valuable learning experience in addition to providing an incentive to improve computer, presentation, and report writing skills.

Outside interactions also provide valuable feedback on the work that the QME team has accomplished. Within the MGH, the team members only see the things that need to be improved. The contact with those outside provides the gratifying experience that there is much that they have accomplished and they realize the impact that their work has benefited in benefiting many patients.

LOOKING AHEAD

As the first ten years of QME come to a close, it is not only a good time to look back over past accomplishments but also to look forward to what is ahead. QME has had an impact on the Radiology Department in many ways over the past decade, helping it to figure out how to take advantage of new technology, to use space efficiently, to train a highly competent workforce of technologists and administrators, and to develop service metrics. In many cases in the past, while working on one issue, the QME team recognized other related issues, leading to further opportunities to raise management and training to the next level. Essentially, QME’s work was largely reactive, dealing with problems that were apparent and seeking ways to improve existing protocols.

As it moves into the next decade, QME is becoming more proactive. The team is introducing the use of failure model effect analysis in order to prevent problems before they arise, by examining how things can go wrong. For example, if ferrous metal is brought into an MRI room, it poses a significant safety problem. By examining the likelihood of the many ways in which ferrous metal might be brought into the room and the likely effect of each type of potential incident, it becomes clear what can go wrong. Redundant preventative measures can then be developed and implemented, which can be put in place to ensure smooth operations and maximum patient safety. Patient safety will remain a top priority of both the Department and QME. This aligns well with the goals of Partners HealthCare, which has named patient safety as a major focus for the coming year.

New technology will demand the development of new management protocols but will also bring in new tools for the QME. For example, new, sophisticated software tools for the analysis of service metrics will bring the methods used to the next level and to facilitate customization. In addition, the scope of service metrics will be broadened to include topics not previously addresses, such as financial management. As new policies are adopted, QME will train personnel to ensure the highest level of competency and communicate to the Department as a whole through presentations and written articles in the Department newsletter, Radiology Times.

As the methods of QME become more sophisticated, so does the need to raise the skill level of the QME team, through visiting other hospitals and institutions, attending conferences, taking courses at the National Graduate School for Quality Management, and acquiring expertise in relevant data systems.

While the achievements of the QME team over the last decade have been remarkable, there is always more to accomplish. We look forward to next decade with confidence, knowing that the team will help the Department adapt to changes that will come with move to a new building, new technology, and growth in the utilization of Radiological diagnosis and interventional techniques.

QME TIME LINE: 1993 – 2002