From Bad to Great: How One Radiology Department Made the Transition

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Until a short time ago, Advocate Condell Medical Center (ACMC) in Libertyville, Illinois, was in the bottom quartile in customer satisfaction. Its growth was stunted, at best, and annual losses of $50 million had become the norm. The radiology department was a shambles. Today, however, the picture is far more rosy. The hospital now ranks among the top 10% of comparable institutions in outpatient-imaging patient satisfaction, according to Press Ganey. With revenues growing at a steady clip, the radiology department alone has increased cash collections by $1 million per year. The catalysts: initiatives and solutions implemented in accordance with an operations/service-excellence model and a roadmap for sustainable excellence that supports the execution of these changes. Airica Steed, EdD, MBA, RN, CSSMBB, was formerly vice president of professional services and operations excellence at Advocate Healthcare Corp, the hospital’s parent company, and currently serves as enterprise chief experience officer and clinical assistant professor, health policy and administration, at the University of Illinois Hospital & Health Sciences System in Chicago. Steed co-presented “Achieving World-class Service in Imaging by Embracing Transformational Excellence” on August 14 at the AHRA 2012 Annual Meeting and Exposition in Orlando, Florida. She chronicled the transformation undergone by ACMC and its radiology department. Configured within what Steed deems a Malcolm Baldrige National Quality Award framework, ACMC’s operations/ service-excellence model is employee led and takes into account the hospital’s main customers—patients and their families—as well as physicians and employees. It calls for harnessing the Six Sigma™ method and its DMAIC (for define, measure, analyze, improve, and control) approach. DMAIC calls for eliminating waste and for streamlining and standardizing operations; integrating people, processes, knowledge, and technology; migrating from a punitive culture, in which sticks rather than carrots dominate, to one that emphasizes high levels of performance; and instituting accountable leadership. The roadmap used at ACMC lays out steps to be taken in the course of applying the model. These include establishing a reason for action, reviewing current performance (with applicable comparisons), identifying root-cause opportunities, and designing solutions that address identified problems. Other steps encompass celebrating outcomes and quick wins, performing pilot testing and implementing solutions, developing best (and next) practices and empowering those who will assist the organization in achieving them, monitoring and sustaining performance, ensuring continuous improvement and learning, and sharing lessons learned. Building an Infrastructure The radiology department’s transformation initiative began with the establishment of an infrastructure for improvement without which, Steed says, creating change would have proved impossible. “We knew that neither change nor excellence happens in a vacuum,” Steed says. Comprising leaders’ buy-in; comparative research on departmental performance (conducted in-house, through reviews of pertinent literature, and at conferences); and a set of multidisciplinary teams, “The infrastructure was essential to going forward,” Steed says. To get leaders on board, Steed and her colleagues presented clear rationales for an imaging-services overhaul. In the radiology department, the reasons extended far beyond customer dissatisfaction. The intake process was cumbersome (at best), with multiple steps and phone calls required to accomplish the task. “It wasn’t uncommon for patients to spend over an hour, be transferred to what seemed like 15 million people, and take a million different steps before they were finished,” Steed says. “It is not an exaggeration to say that if I were eight months pregnant and needed an ultrasound—well, good luck getting it done in time.” Waiting times after scheduling were equally excessive; for example, report-turnaround time exceeded 16 hours. No-show rates exceeded 6%, and patients’ frustration with being unable to reach a live person by phone resulted in a high percentage of abandoned appointments. A root-cause survey—conducted as part of the research component—revealed that only 53% of appointments fell into the preregistered category. In addition, the department faced high rates of claim denial, significant bad debt, and poor morale among physicians and staff. Multidisciplinary