Radiology best practice: Extracting value and improving operational efficiencies in a large health system

The continuity of business is vital in any setting but even more so in hospitals when patient encounters and care delivery may be interrupted. Considering the importance of the work that is carried out in healthcare facilities, developing continuity of business plans at all points of patient care is completely essential.  Setting an example for other facilities, Spectrum Health System in West Michigan has developed a unique methodology to improve the fidelity of the patient experience in radiology during a planned system downtime or system disruption. Continuity of business in a facility as large as Spectrum Health requires thoughtful planning, setup, reaction, and follow through to ensure everything runs as according to plan.  George Vallillee, manager of Radiology Information Solutions at Spectrum Health, shares the details of his approach, plan and resulting improvements in Spectrum radiology’s operational efficiencies.

George Vallillee, Manager, Radiology Information Solutions, Spectrum Health

Value equation

Value in radiology can be measured on many different levels from absolute cost, to quality of service, to accuracy of diagnosis and treatment plans. Because the healthcare environment has changed so dramatically, brought about by the need to mitigate the consistently increasing costs of healthcare, it’s vitally important to seek out new avenues to improve the patient experience.

“What we were trying to do at Spectrum,” explains Vallillee, “was look at how we can accomplish ever increasing levels of value without going into the six-figure investment cycle that radiology has become accustomed to. How can we improve the stability of the patient encounter using lean processes and new techniques?”

Radiology at Spectrum Health is a complex system of people, processes and technology working like a well-oiled machine. With a radiology staff consisting of 900 people, most of whom are technologists, Spectrum Health Radiology serves its communities with 11 hospitals and 170 ambulatory and service sites and operates the only Level 1 Trauma Center in West Michigan.

“Over a 24x7 cycle, we run extremely well, like an engine, but when we’re looking at improving the paradigm of enhanced care and better value to the customer, we asked the question, ’What do we do when one of our engine cylinders fails?’” asks Vallillee.

In the case of radiology being highly technology driven, Vallillee and team looked at the technology component and considered the business continuity plan for when a core piece of technology, such as EMR or PACS, is unavailable.

Documented strategies

If you’re a pilot and there’s an engine fire in the right engine of your plane, what do you do next? Will you and your crew know how to operate when your traditional workflow is out the window? Pilots use a well-documented system of checklists configured to each particular type of aircraft and covering most every detail that occurs on a flight. The steps are well-thought out in advance by the engineers who built the plane, and by the safety experts who know it best. Why couldn’t the same concept be used in radiology?

“As complex as our systems are, we didn’t have anything similar,” says Vallillee. “I turned to the pilot training I experienced earlier in my life to come up with the idea for a similar series of checklists to follow in situations of system downtime or failure in our radiology department.”

“The placards do a great job of outlining what each individual should do during a system interruption," says Vallillee.

The new project was proposed by Vallillee and initiated soon thereafter. It was largely driven by teams whose input was mainly intellectual collateral, drawn from daily workflows, and drawn from the radiology and IT system used throughout Spectrum. Key roles within the department were identified, and detailed workflows were documented. There are eight key roles identified during the discovery process. These individuals either work within the radiology department, or interact with the radiology department. Each role has its own set of placards for reference, and the placards are located at clearly marked places within the hospital system. Each set of placards contains tabs to identify the different critical systems that may be malfunctioning, such as the EMR, PACS or the hospital’s network. Individuals that represent each specific role can use the set of placards to reference detailed instructions on how to maintain operations for their function under each type of system failure within the downtime environment. Additionally, there is a placard for testing the downtime system environment such that the readiness of the system is well understood at all times.

“We have a set of placards for our Radiologists, for our different types of Technologists, our Support Services staff, as well as the Radiology Event Commander,” Vallillee explains. “We see the commander role as the administrator on call. Their job is to look at how operations are being assaulted by the interruption, how it is affecting backlogs, and to determine any other operational impacts that the system disruption may be causing.”

Creating the placards was a beneficial, comprehensive, and cost effective first gate in the process.

“Our system footprint spans all of Western Michigan,” says Vallillee. “The placards do a great job of outlining what each individual should do if a system interruption takes place, but one of the greatest challenges is coordinating what all these people should be doing during a particular event.”

Communication system

Disseminated on their PACS companion monitors, a broadcast ticker will alert all technologists of a system interruption. 

“We call it a P-CAST,” says Vallillee. “PACS Communication Alert Status Ticker. It may say something like: We’re experiencing issues with the network. Please stand by for updates. It will then follow with another message. Initiate your downtime procedures. This is the indication that directs them to find their checklists and begin operations within the downtime environment,” he continues.

Disseminated on their PACS companion monitors, a broadcast ticker called a P-CAST will alert all technologists of a system interruption.

The team has gone through a couple iterations and rehearsals of the alert system to ensure the message is seen and acknowledged, so the correct actions will take place. After the initiate message goes out, all the checklists deploy throughout the enterprise and actions are harmonious, where the providers involved in delivery and care are all working in a coordinated fashion.

Even with the successful deployment of the placard system and the ticker alert system, the team still encountered challenges. Due to the facility’s size and quantity of imaging equipment, it is not possible for all the imaging equipment to be connected to the downtime PACS environment. The team worked with medical and administrative leadership at Spectrum Health to determine a “minimum equipment list” (MEL) to be used during an interruption event.  As a result, the team created room signs on which stickers were posted indicating DT PACS. These are specifically marked modality control rooms and also where the workstations are equipped to read on the downtime environment.  

“We came up with a subset of modalities and reading rooms where staff would be able to move over during an interruption,” Vallillee says. “If you have three CTs next to each other, but only one of those three is connected to our downtime environment, they need to be sure they’re scanning patients on that system,” states Vallillee. “The DT PACS stickers are critically important to ensure that the patient encounter is being performed in keeping with our capacity during the downtime.”

The placard and ticker alert systems also walk the users back to the live system. To close the loop, feedback is collected from all who participated and is incorporated into final reporting, and frequently influences updates to the process or placards.

The team created room signs indicating DT PACS where the workstations are equipped to read during a system interruption.

Impressive results and improved satisfaction

Spectrum Health’s system of placards has been successfully rehearsed on several occasions since it was released in March, 2014. It has been heralded as a best practice within radiology; other facilities have inquired about using the placard materials. Vallillee and team are happy to share the details so that other facilities can achieve similar results. The Spectrum system has been tested during planned downtime occurrences for PACS software updates, and has also initiated and deployed successfully when Spectrum encountered dysfunctional network issues.

Overall, Vallillee states that they system is a living project, and changes will continue to be made when necessary. There is a definitive commitment from Spectrum Health’s leadership for the long-term continuation of the project. From a resource perspective, the system took 18 months to develop and launch, but very little staff training had to be conducted to put the system into action. The cost to print and laminate the placards was marginal in comparison to the benefit. Staff satisfaction has improved as well.

“Having the placards is very mentally satisfying for the staff because they know they have the guidance they need to get their job done on behalf of the patient. We created these placards and signage and placed them in 300 rooms across the health system, but when you look at an organization like ours, that’s an extraordinarily inexpensive way of improving operational fidelity when the organization is disrupted because of a technology interruption. Without this,” concludes Vallillee, “what may have happened could have been an exercise in chaos.”