Radiology Operations: Ineffective Management

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Table of Contents

Inefficient Strategies
Departmental Activity versus System View
Relating Setup Time, Run Time, and Equipment Time
Application of Dimensions
Redesign Leader
Process of Recording of Vital Signs
Analysis of One Performance Measure
References

There are three main ineffective strategies employed by the radiology department administrators. The first one is, “identifying and cutting costs without deeply understanding the problems within the system” (Ondategui-Parra, et al., 2004, p. 633). This approach assumes that cutting costs is an inevitable reality of running modern-day radiology departments. Therefore, the administrators wrongly assume that cutting costs will lead to greater efficiency in the eyes of financiers. Partly, healthcare financiers are responsible for this attitude because they equate cost management to efficiency (Jacobs, Rapoport, & Jonsson, 2009). The problem with this approach is that if it is not the result of careful analysis of how the entire system operates, then it can result in several unseen consequences.

The second problem with the strategies adopted by radiology department administrators is “adding information systems and additional medical equipment to the existing systems” (Ondategui-Parra, et al., 2004, p. 633). The addition of information systems is a cause of the bottlenecks brought about by system administration requirements in many institutions. Such requirements include data entry requirements, information management, and slow uptake of the system (Guerra, 2011). Information technology solutions work best where the objectives are clear to all stakeholders. In addition, the support of the staff is vital to the success of newly introduced information systems.

Thirdly, radiology department administrators err by “imposing higher performance standards and holding employees responsible for meeting those standards” (Ondategui-Parra, et al., 2004, p. 633). The problem with the imposition of performance standards is that the new standards assume that the employees have been operating inefficiently and require stricter regulation for them to increase their efficiency. Systemic problems can only worsen employee morale when it is clear that they cannot meet the new performance standards. This results in even worse inefficiencies due to the exasperation of the employees. Performance standards, just like new information systems, require knowledge-based approaches (Perkins, 2006). It is important to understand how the system operates before applying any new performance management techniques.

Inefficient Strategies

One of the inefficient strategies used in the local department relates closely to the implementation of performance standards. The prevailing global economic downturn is responsible for the reduction in healthcare financing. This makes it difficult for local hospitals to employ the required number of medical professionals. Therefore, local administrators are trying their best to make up for the shortfall by demanding more from the available staff. There are stringent requirements relating to hours spent on duty and the number of patients attended to within the period. Most doctors feel overwhelmed by these requirements. Secondly, there was an attempt to employ new electronic medical systems, which required increased data input from medical practitioners. The uptake was very slow and the implementation failed.

Departmental Activity versus System View

The relation between the establishing of a baseline for departmental activity and the system view by stakeholders has several characteristics. First, these two approaches are part of the system within which the medical facility operates. They are valid indicators of the operations of the department as part of a larger system. The two views have a significant difference. The departmental view depends on the vantage point of the members of the department. Particular officers within the department see the departmental view based on their “positions, roles, and locations” (Ondategui-Parra, et al., 2004, p. 633). Their daily activities related to their functions within the organization influences their perception of issues inherent in the operations of the department.

However, the system view relates to the total picture of the operations of the department. It is a view that includes all the “tasks, flows, queues and decision points” in the facility in which a department is a single unit (Ondategui-Parra, et al., 2004, p. 633). In other words, it is the overall view of the interrelationships in the system. The relation between establishing a baseline for departmental activity and the system view by stakeholders is that the baseline for departmental activity explores the sum total of the views held by the members of the department, while the stakeholders view focuses on the role of the department in the overall healthcare system.

Relating Setup Time, Run Time, and Equipment Time

In many ways, it is possible to relate setup time, run time, and equipment time to the operations of the local hospital. At the local hospital, patients use a prescribed process to access medical care. The role of a medical doctor in this hospital is to see patients in the outpatient section and to monitor the progress of admitted patients. The outpatient section is very busy. It handles patients who are usually conscious of time and are keen to receive medical attention quickly. Before a patient can see a doctor, the patient passes through a nurse who records data relating to the patient’s vital organs. This information includes height and weight of the patient, blood pressure, and body temperature. After this process, the patient joins one of the queues to see an available doctor. The setup time required for the patient to see a nurse and to join the queue in the doctor’s pool is about five minutes. However, patients regularly take up to thirty minutes before seeing the nurse on duty. Thereafter, it takes about fifteen minutes to see a doctor, with the time spent in the queue varying depending on the number of doctors available. At worst, patients wait for up to one hour. The setup time, in this case, is about one and a half hours, including the time spent waiting in queues. In case there are no queues, the time reduces to just five minutes. The run time is equivalent to the time the patient spends with the doctor.

Application of Dimensions

Three dimensions describe the operations of the local department. These are the number of patients served per day, queuing time, and nurse productivity. The number of patients served per day is a basic metric that forms the basis for measuring physician productivity. In fact, this statistic can help in determining the optimal nurse to doctor ratio in the outpatient section. Secondly, the overall number of outpatients served in a day is also an important to dimension in the measures of efficiency in the local department. This measure helps in determining the efficiency of the entire outpatient wing of the hospital in comparison to the total resource outlay. Thirdly, nurse productivity affects the levels of efficiency of the doctors. In this sense, it is imperative to monitor the productivity of the nurses in order to plan for the efficiency of the doctors.

Redesign Leader

Redesign leader refers to the person or team leading the redesign effort (Ondategui-Parra, et al., 2004). A redesign leader can be at the departmental level or in the senior levels of the organization. Usually, successful redesign efforts have the support of top-level administrators. Such administrators provide institutional support required for the implementation of the redesign project. The main role of a redesign leader is to ensure that the organization remains focused on improving efficiency in the long term, and not just as a one-time thing. This means that the leader needs to find and implement proposals for iterative improvement of work processes.

Part II

The hospital deals with both outpatient and inpatient cases. The following processes listed in this exercise relate to the outpatient section.

Reception of patients in the waiting pool
Recording of vital signs by duty nurse
Consultation with the doctors
Admission into the inpatient section
Treatment of patient

Process of Recording of Vital Signs

One of the processes in the hospital is the recording of vital signs by the duty nurses. This process is standard with very little variability. Such processes have the best potential to yield savings because of the ease of optimization. Before the duty nurse calls out a patient to come in for the readings, the receptionists receive the patient and establish an electronic record. The receptionist ensures that critical patients receive immediate attention. They watch out for signs such as bleeding, excruciating pain, and obvious injuries to decide on whether to fast track a patient. For the rest of the patients, the duty nurse calls them based on their time of arrival. The nurse records the readings as explained earlier. Thereafter, the nurse sends them to the second queue leading to the consulting rooms. The first available doctor calls out the next patient in the doctors queue. The process under examination ends with the sending of patients to the doctors waiting pool.

Figure 1: Process diagram for mapping put patient reception

Analysis of One Performance Measure

One of the measures used to measure the performance of the outpatient department is the number of patients served by the duty nurse. The duty nurse serves many patients before directing them to the doctor’s pool. One nurse is able to supply five doctors in this work center because the nurse takes about a fifth of the time it takes a doctor to serve a patient.

Officially, a doctor is not supposed to hurry the treatment process to ensure that each patient receives adequate attention. However the presence of patients in the doctors pool creates a sense of urgency. In some cases, such as during weekends, the administration of the local health facility stations two nurses to facilitate speedy processing of patients. The two nurses can support up to ten doctors. However, the typical doctor to nurse ratio on any shift is one nurse to three doctors. This ratio came from the uncertainty of the treatment process. Once a patient is in the consultation room, it is not easy to tell how long they will be in the doctor’s presence. In some cases, referrals to specialists in the same hospital are necessary, just as doctors may require certain lab reports before proceeding with treatment. These elements clog the system leading to a growing number of patients in the doctor’s pool as the day progresses.

References

Guerra, A. (2011). EMR Problems Hurt Doctor Efficiency, AMA Says. Web.

Jacobs, P., Rapoport, J., & Jonsson, E. (2009). Cost Containment and Efficiency in National Health Systems: A Global Comparison. Weinheim: Wiley Verlag.

Ondategui-Parra, S., Gill, I. E., Bhagwat, J. G., Intrieri, L. A., Gogate, A., Zou, K. H., et al. (2004). Clinical Operations Management in Radiology. Journal of the American College of Radiology , 1 (9), 632-640.

Perkins, B. B. (2006). Medical Delivery Business, Health Reform, Childbirth, and the Economic Order. Piscataway, NJ: Rutgers University Press.

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