Every hospital-based radiology department in the U.S. knows it needs to reduce costs while improving care—now, not later on down the road—but only the most focused and forward-looking manage to pull off the feat one day and, the next, secure its sustainability for many years to come.

Count the radiology department at Children’s Hospital & Medical Center in Omaha, Neb., among the successful.

The heart of the transformation began several years ago. In the process of building a strong base of staff radiologists from what had been a loose collaboration of contracted “place holders,” the department decided to build on the momentum. Various initiatives sprung forth, including taking a hard look at radiology’s IT systems with an eye on maximizing workflow efficiencies.

Perhaps most impressive of all, the right moves were driven from the middle out rather than from the top down.

“Our clinical service chief, vice president of ancillary services, PACS administrator and I held a shared governance meeting with our CMIO and a key IT vendor,” recalls Nicole Hardin, the director of the radiology department. “Out of that, we created a roadmap of ways to close the gaps in integration, software and staffing.” That was in 2012. “We’ve been working off the planning processes that resulted, and relying heavily on that roadmap, ever since.”

And why not? The new governance structure spawned from that opening meeting would go on to yield a new clinical educator position and area action committee within the department, along with greatly improved communications between radiology and other hospital departments. The latter achievement alone has produced numerous cost-avoidance wins, among them significant decreases in duplicate studies, radiation exposures and number of studies per patient.

The radiology department’s experience at “Children’s in Omaha,” as the institution is called for short, stands as an outstanding example of better, lower-cost care through resourceful staffing strategies.

Good governance leads to great gains

Hardin points to the formation of a governance subgroup as a linchpin of the new governance structure. Regularly bringing together the VP of support services, PACS administrator and a hospital IT representative in pre-budget meetings chaired by Hardin, this subgroup tackles unexpected issues and fine-tunes the ongoing planning processes.

The group’s decidedly un-bureaucratic nimbleness shone through early on, when members looked at how radiology would handle workflow while working on an Epic Radiant RIS project simultaneous with a PACS PowerScribe upgrade.

“We quickly agreed that we lacked the resources to handle both types of project at once,” says Hardin. They also agreed that an IT vendor with whom they had long worked, McKesson, held the key in the form of its staff augmentation service.

“This was something we had previously discussed at our shared governance meetings,” explains Hardin. “That made it easy to agree on the benefits of hiring somebody for a short time rather than looking through a staffing service or trying to figure out if we needed a half-time FTE for five years or two years or six months.”

It also helped that McKesson was already familiar with the department’s workflow. “They were able to come in and just pick up like a regular team member, helping us for six months or nine months or whatever we think is necessary,” says Hardin, adding that the initial engagement ran from July to December of last year.

Emphasizing ‘action’

Freed from the constraints of working short-staffed for months at a time, Children’s radiology department has been able to realize solid—and measurable—value from its new clinical educator position and area action committee.

Comprised of clinical and support supervisors as well as one technologist each from CT, MRI, ultrasound, nuclear medicine and a support staff member, as well as staff from satellite imaging facilities, the area action committee meets every other month for half a day. “We all gather at the table and talk about what’s going well, what we need to change, who we need to communicate with,” says Hardin.

The amped-up collaboration has led to such positive outgrowths as adding daily roundings to radiology’s routine. Twice a day (once for day shift, once for night) a tech visits client departments in the hospital, checking on needs and reinforcing relationships. When rounding to the emergency department, for example, a tech meets with the ED charge nurse to share such information as which radiologists are in, and who is reading studies in the various imaging modalities.

“Sharing information that detailed can help workflow,” says Hardin, “because the ED doctors know who to contact directly if they need to collaborate on a case.”

The area action committee exists as part of the department’s strategic plan to monitor efficiencies, including in IT systems, and to come up with ways to better integrate them going forward with, for example, PACS.

And the results of all the pro-active measures? Hardin cites internal studies showing impressive improvements achieved since the launch of the area action committee. The radiology department has:

• Increased its close following of procedures to avoid central line infections from 75 percent to 98 percent;
• Increased its compliance with hand-hygiene guidelines from 86 percent to 97 percent;
• Decreased turnaround times for reporting discrepancies from 19 hours to eight hours; and
• Decreased imaging of wrong body parts from 3 percent to 1 percent.

Hardin is quick to point out that, through all the technology implementation, organizing governance and interdepartmental relationship-building, the department is ever mindful of reflecting the hospital’s mission: So that all children may have a better chance to live.

Teaching, training, troubleshooting

Another big benefit to grow out of the radiology department’s stable yet flexible IT staffing solution: the clinical educator’s capacity to not only up the department’s game on the educational front but also to free up the PACS administrator on whom those duties used to fall.

“We knew for some time that we needed to create a clinical educator position,” says Hardin. It was clearly the best way, she adds, to both keep up with training on IT systems and keep techs up to date on best practices and protocol changes.

In the past, the department had its PACS administrators trying to train people as well as troubleshoot software. Those schedules often don’t coordinate well, says Hardin. “If you have a physician working the OR and the PACs workstation goes down, that’s where the PACS administrator needs to be—not in a classroom teaching about a new software product,” she says. “And that’s previously how workflow went. The PACS administrator would train when they weren’t putting out fires. Now we have two separate positions that are really focused on, and dedicated to, one area or the other.”

The addition has also led to constantly improving communications that bridge what the radiologist has in mind for a study versus what a referring provider might have in mind, says Hardin before adding: “That’s a constant educational circle.”

Hardin points out that there are some important differences between pediatric and adult radiology, especially in hospital settings.

“At our facility—and I think this is the case of most children’s facilities—you provide imaging service until you solve the problem for the child. What that means is that there’s a lot of collaboration with referring providers, technologists, scheduling departments and others,” she explains. “It all happens almost real-time, compared to an adult facility, where you might perform one study, wait for the report, talk to your referring provider and then come back the next day or on a different appointment time to complete the next step in your phase of care. The phases of care for pediatrics tend to blend together and happen more quickly.”

So it was that, at Children’s in Omaha, it became vital to have an educator on staff within radiology—and as-needed IT staff from McKesson to make all the various departmental “upgrades” possible, workable and repeatable as best practices.

“We often talk about imaging for a better life for these kids,” adds Hardin. “Everything we do really traces back to that.”