Amid change, errors are inevitable. David Larson, associate professor of radiology at Stanford University and member of the RSNA Quality Committee, spoke Nov. 29 at RSNA 2016 on “Common Mistakes in Performance Improvement and How to Avoid Them."

The first key step in any improvement process is knowing the difference between implementation and improvement, according to Larson. Implementation is the process of putting a decision or plan into effect, while improvement is the process of modifying a process to match actual and desired outcomes. Using the five factors of success—leadership, methods, resources, culture and execution—Larson is able to embody the essence of quality improvement.

Larson was able to create a multitude of cases in radiology where improved performance measures failed and how to improve upon the five factors of success.

One case focused on the factor of leadership, in which the leader undermined the change efforts of a new workflow system for technicians. When cases like this occur, Larson explained the organizational leader in charge of change needs to set the vison, model the behavior, empower the correct people, address skeptics, mobilize resources and perform the execution of the change. All of these factors, when conducted by the organizational leader, are sure to keep others from undermining change.

The second case Larson outlined addressed the factor of method, where organizational leaders must follow a "Plan-Do-Check-Act" method of change to address problems. Starting with planning, then doing, studying and finally acting on the problem, organizational leaders address problems. Larson stated that by putting the right people in the right roles, defining why the problem is important, measuring performance, analyzing what caused the problem, improving performance and controlling the problem are all ways of keeping the methods intact.

In a case focused on the factor of resources, where technicians were not able to access information to improve exam time, Larson elaborated on what exactly it takes to be successful in improving radiology practices. Having protected time, educational training, available data, access to experts and having investments in the proper equipment are all resources that need to be spared for the successful change and overall improvement.

Culture plays an important role in improvement in that the shared values are what push interactions forward. In a fourth case, Larson showcased a predicament where communication between all radiology parties was halted. Without the interactions between people, culture erodes and change comes to a stand-still.

The factor of execution is the last and perhaps most important of the five factors of success. The final case Larson choose to highlight was the falling apart of a project due to the abandonment of project roles, leading to an unfinished project. The art of “getting stuff done," stated Larson, is propelled forward by choosing projects and project roles wisely. The sponsor, project manager, project coach and project participant must embrace their roles.