How to Build a Quality Infrastructure

1 Imaging Performance Partnership How to Build a Quality Infrastructure Research Brief October 2013 Ben Lauing, Analyst lauingb@advisory.com

2 Building a Solid Foundation Three Imperatives to Create a Value-Centric Infrastructure 1 2 3 Dedicate Staff to Quality Solicit Multi-disciplinary Feedback Select and Track Value- Centric Metrics Programs should assign ownership to staff for value/quality improvement initiatives Encourage other service lines, staff to participate in value discussions Understand where your program stands currently, and potential areas for improvement

Imperative #1: Dedicate Staff to Quality 3 Identifying the Owners Imaging Performance Partnership Quality Quick Poll Results Percentage of Radiology Programs With FTE Dedicated to Quality n=57 Imaging Staff Responsible for Managing Quality Initiatives 1 Among Programs Without Dedicated FTEs 40% 40% 32% 28% Yes 51% 49% No 16% 16% 20% 1) Some institutions split quality responsibility between multiple people; hence total percentage exceeding 100. Source: 2013 Imaging Performance Partnership Quick Poll; Imaging Performance Partnership interviews and analysis.

4 No Standardization of Titles Programs Report Variation in Titles for Quality FTEs Director of Quality Medical Imaging Variance Analyst Radiology Quality Coordinator Systems Analyst Quality Assurance Performance Improvement Specialist Manager, Quality and Project Management Director, Quality Assurance Quality Assurance Manager Performance Improvement Coordinator Quality and Safety Analyst Performance Improvement Specialist Director, Corporate Compliance & QA Compliance Officer Abstractor Process Improvement Engineer Quality Analyst Quality Management Supervisor Quality and Safety Manager Quality Coordinator Project Manager, Quality Improvement Quality Assurance Coordinator Radiology Quality Assurance Manager Quality Assurance Analyst Source: 2013 Imaging Performance Partnership Quick Poll; Imaging Performance Partnership interviews and analysis.

5 Delineating Responsibility Hapley Health System 1 Dedicates Two Quality FTEs to Radiology Case in Brief: Hapley Health System 1 Six-hospital health system located in the Southwest Radiology employs two FTEs dedicated to quality One manager focuses on accreditation, clinical quality, reporting metrics Second manager focuses on quality improvement projects, efficiency, standardization efforts Committee meets monthly; quality managers meet weekly to check in Modality Managers Quality Assurance Committee Quality Manager Accreditation Quality metric tracking, reporting Radiology Chairman Director of Imaging Special Projects Manager Quality improvement projects Initiatives for LEAN optimization 1) Pseudonym.

6 A Sign-Up Sheet for Quality Haverford Hospital 1 Builds Intranet Site for Quality Improvement Projects Haverford Hospital 1 Radiology Quality Projects Welcome to the quality portal! Here you can sign up to work on one of the many quality improvement projects we have planned for radiology. Improve report dictation accuracy Technologist mentorship program Radiologist-technologist communication project Scheduler scripting Improving patient education across the imaging cycle back Case in Brief: Haverford Hospital 1 450-bed hospital located in the South Radiology director posts current and future quality improvement projects on intranet site Staff members log in and sign up to manage, participate in quality projects that interest them 1) Pseudonym.

Imperative #2: Solicit Multi-disciplinary Feedback 7 Collaborating with Other Specialties Radiology Quality Efforts Include ED, Primary Care Physicians Radiologists Radiology Medical Director Medical Physicist Director of Imaging Radiology Quality Committee Hospital Quality Manager ED Medical Director ED Nurse Manager Case in Brief: West Kendall Baptist Hospital Part of Baptist Health South Florida, a six-hospital system located in South Florida Includes other specialists in quality committee (e.g. ED clinicians, primary care physicians if necessary) Radiologists on committee educate referrers on appropriate imaging Noticed high number of ED orders for CT without contrast followed by orders for CT with contrast for same patient; quality committee now focusing on reducing duplicate CTs Director of Imaging sees herself as connector; shares case studies, data on utilization and denials to reveal opportunities for improvement Source: West Kendall Baptist Hospital, Miami, FL; Imaging Performance Partnership interviews and analysis.

8 Understanding Current Perceptions Swanson 1 Launches Imaging Cares to Solicit Stakeholder Feedback Technologist Patient Referring Physician Imaging Cares Website Website allows stakeholders to deliver feedback to imaging program Information used to assess current performance, understand what requires improvement Running to Criticism We don t make it easy to give feedback, whether from patients or our own workforce there s nowhere for them to go. Director of Radiology Swanson Hospital 1 Case in Brief: Swanson Hospital 1 650-bed academic medical center located on the east coast Launched Imaging Cares website to collect feedback from techs, patients, referring physicians Information used by imaging department to reveal strengths, areas for improvement 1) Pseudonym.

9 Changing the Focus to Quality Affinity Meetings Connect Members of Same Modality, Program, Facility Case in Brief: UCLA Health Two-hospital health system with 15 imaging locations in Los Angeles, California Transformed traditional meetings for relaying announcements into collaborative discussions for quality improvement Scope of affinity meetings expanded from intra-modality to clinical programs (e.g. prostate/fibroid), outpatient centers Anyone involved expected to attend schedulers, nurses, etc.; system strives for balance of senior, junior staff Affinity meetings take place every 6-8 weeks for ~1 hour; depending on position, staff members may attend multiple meetings Created Performance Improvement Matrix for affinity groups across system to track progress of quality initiatives Old Action Item Performance Improvement Matrix Accountability 1 Tech Review Shauna & Diane 2 Scheduling Efficiency 3 New Action Item Status Meeting tomorrow Due Date 10/15 Perd & Jerry Complete! 9/17 1 Report Standardization Andy & April Just initiated 11/1 2 Source: UCLA Health, Los Angeles, CA; Imaging Performance Partnership interviews and analysis.

10 Sharing Best Practices System-Wide at HFHS 1 Annual Quality Forum Gives Opportunity to Learn from System Colleagues Case in Brief: Henry Ford Health System 2012 Quality Forum Seven Teams Won 15 of 111 Teams Selected for Competition 111 Teams Presented Quality Improvement Projects 12-hospital health system based in Detroit, Michigan Quality councils from hospitals across the system convene at annual forum to share successful quality initiatives Small percentage selected to compete; participants vote for winners Two of seven winning projects in 2012 were in radiology 1) Henry Ford Health System.

Imperative #3: Select and Track Value-Centric Metrics 11 Assessing Current Performance Begin by Examining Baseline Metrics Access and Scheduling Throughput and Productivity Efficiency Radiologist Performance Patient Satisfaction Sample Metrics Seconds before call answered Call abandonment rate Time to third available appointment Turnaround time Procedure volume per CT/MR Procedures per technologist Turnaround time Call coverage Subspecialty expertise Percentage of patients recommending institution to friends/family Percentage of patients willing to return to institution Partnership Resources Enhancing Outpatient Access Perfecting the Outpatient Experience Turnaround Time Benchmarks 2013 Turnaround Time Survey Productivity Benchmarks Improving Imaging Throughput Radiologist Professional Services Dashboard The Changing Radiologist Role Perfecting the Outpatient Experience

Advancing Performance Measurement Pushing the Dial by Identifying Three Types of Quality Metrics 1 2 3 Structure Process Outcome Resources in place Method of improvement Impact of improvement efforts

13 Example Metrics: Patient-Centered Radiology Goal Structure Process Outcome Enhance patient education FTEs trained to answer patient questions Educational materials available to patients online, in office Percentage of patients called prior to scan Percentage of patients receiving teach back method Percentage of patients given program contact information Reduced no-show rates Decreased cancellations upon arrival Patient understanding of scan objective Patient satisfaction Tailor results delivery Patient portal System of communication between radiology and referring physicians Percentage of referring physicians asked about results delivery preferences Percentage of results delivered in set timeframe Patient comprehension of results Patient satisfaction Referring physician satisfaction

14 Example Metrics: Clinician Excellence Goal Structure Process Outcome Boost technologist performance Annual performance review process System for radiologist feedback Protocol adherence Number of exam audits Number of techs undergoing remedial training Repeat rate Strengthen the radiologist read Double-blind peer review Mechanism for followup on radiologist errors 360º review process Number of scans flagged during peer review Number of errors not addressed Percentage of errors caught early enough to inflect patient care Error rate Accurate patient diagnosis Refine the radiology report Voice recognition software Regular report audits Standardized reports Number of report errors found per radiologist Number of reports not in standardized template Report accuracy Referrer satisfaction

15 Key Takeaways Developing a Quality Infrastructure 1 2 Imaging departments should establish accountability for quality efforts. Only half of surveyed members reported having a dedicated quality FTE. While the specific position can and does vary, someone should take responsibility for overseeing quality initiatives. Radiology should seek the input of internal and external stakeholders to identify opportunities to improve performance and demonstrate additional value. Because radiology contributes to the success of other specialties, administrators should forge ties with leaders across disciplines to address quality issues. Collaborative discussions ensure any and all quality concerns are addressed and allow radiology to have a hand in improving the entire continuum of care. 3 To make the greatest possible impact, quality managers should set clear goals and track value-centric metrics. Mastering traditional quality metrics is essential, but programs should go one step further by identifying structure, process, and outcomes metrics that directly impact goals and clearly elevate radiology s value proposition.