Why the Customer Service Model in Healthcare Doesn’t Work

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 - Paula T. Gonyea, MBA, RT (R) (CT)
Paula T. Gonyea, MBA, RT (R) (CT)

The relationship between IT and radiology has transitioned over the past few decades, from one of little connection to one of complete interdependence. The integration of EMR, RIS, PACS and imaging modalities has allowed great strides in making the radiology workflow more efficient. With this efficiency, though, comes complexity; an upgrade or small change in one element of the system has the ability to impact all things down-stream. Interhospital partnerships can compound this complexity as well in working to standardize technology and workflows across multiple organizations. 

As this relationship has grown over time, the radiology team has become IT’s internal “customer.” We often hear about customer service, internal and external. As colleagues within any institution, we have morphed into customers of one another. Whether the department is radiology, IT, telecommunications, pharmacy, nutrition services, or purchasing, they could all be viewed as service providers. The people working within those industries are “customers” of each other. But what are the implications of a customer/service provider relationship? 

Webster's Dictionary has two versions for the definition of customer: “a person or organization that buys goods or services from a store or business” and “a person or thing of a specified kind that one has to deal with.” But truly, neither of these definitions accurately captures the complex relationship between radiology and IT. It’s worth noting that, in the second definition, not many would want to be defined as someone who one “has to deal with.” Also, the word “customer” is problematic as it can potentially create barriers between departments; the priorities of a customer can be very different than the priorities of a service provider. While IT leaders will stress the importance of customer focus and service, they mean it to be seen as a positive, but it can potentially feel more isolating to those on the radiology team than inclusive. It gives the sense that radiology is on one side of the other. 

A recent discussion with a colleague brought to light the damage that this one word can do. He wanted to know why we were considered customers and not all part of the same team. Priorities take on a different light when they are the shared priorities of a team rather than the individual priorities of departments.

Seeking A Better Word

So if we want to avoid the word “customer,” what would best describe what the radiology/IT relationship should be? Webster's Dictionary defines “partnership” as “a relationship resembling a legal partnership and usually involving close cooperation between parties having specified and joint rights and responsibilities.” With this definition, the word “deal” is replaced with “cooperate.” Joint rights and responsibilities require shared goals, which ultimately impact patient care and may require flexibility from multiple perspectives.

 As priorities change for radiology, flexing IT resources may be necessary. This doesn’t always fall nicely into an IT project plan, which typically has a kickoff, an implementation phase and a “go live” phase with lessons learned being reviewed at the end. Whether the issue is of a clinical nature, an access or backlog issue, or new technology that can fix either, a partnership will allow for flexibility in those changing priorities, because the priorities are shared. IT projects may need to be more fluid and adaptable to clinical needs. At times, allowances must be made for projects with high clinical value that might require workarounds on the IT side.

The same holds true for IT challenges. Whether the challenge is getting systems converted to the latest software version, implementing system redundancy or anti-virus software, radiology as a partner must work with the IT team to address these issues and ensure they are equally considered to be a high priority. Working within a system can be messy at times, with too many priorities and not enough resources. These prioritization challenges bring to light the importance and value of a real partnership over a customer/service provider relationship.

True Teamwork Between Radiology, IT and Purchasing

While partnership is key, we can’t forget the importance of the purchasing department and their role in patient care. The challenges and priorities of this department must be considered by both radiology and IT when acquiring new technology. End-of-quarter deadlines, contractual terms and vendor relationships must be factored into the equation with new purchases. Each acquisition ends with purchasing, which ultimately can make an impact on the final cost, dramatically changing the dynamics of the investment. 

As partners, rather than service providers, the purchasing team can focus on shared goals of acquiring the best technology at the right time with the most agreeable terms.

Extending this model throughout a hospital network allows the purchasing team to have great insights into the technology in use throughout a system and where it makes sense to capitalize on leveraging existing technology and service agreements. This balancing of priorities requires tight communication between the three entities and a solid understanding of each other’s strengths and challenges. The best chance of success includes clearly outlined processes and requirements, as long as there is room for a certain amount of flexibility. As requirements change with clinical advancements, cyber threats, or changing purchasing terms, ongoing communication will help to smooth the process of adjusting priorities.

With this interdependency of IT, radiology, and purchasing comes great responsibility; the responsibility of each department to partner and to function as a genuine team. This integration of bits, bytes and interfaces along with anatomical and physiological data requires consideration of each independent entity as well as the system as a whole. When the three teams engage as partners, the decisions that are made are made through a different lens. The shared priorities are not only radiology’s, IT’s or those of purchasing; they are the priorities that should be considered to first and foremost improve patient care. After all, it is quality patient care that every member of the team can stand behind and support.  

Paula T. Gonyea, MBA, RT (R) (CT), is director of radiology services at the University of Vermont Medical Center in Burlington..