Do you want a CT with that? Exploring the 'McDonaldization' of radiology

American sociologist George Ritzer believes our society and culture are moving toward “McDonaldization”—meaning institutions and organizations are adapting characteristics like those of fast food chains.

There are four components to Ritzer’s definition of McDonaldization—efficiency, calculability, predictability and control. Some argue that radiology would benefit from such a move to an efficient, predictable, assembly-line model. But is it a sustainable model for the radiology industry?

In a recent analysis published in the Journal of the American College of Radiology, authors Benjamin R. Gray, MD, and Richard Gunderman, MD, PhD, of the department of radiology at the Indiana University School of Medicine in Indianapolis, discuss Ritzer’s four components within McDonaldization and how each can benefit or harm a radiology practice.

Efficiency

“Efficiency is undeniably important to radiologists, especially in contexts in which resources of time and energy are tightly stretched, such as busy on-call shifts,” the authors wrote. “Yet in both fast food and radiology, there are pitfalls in the unbridled pursuit of efficiency.”

Many radiology practices question how their workflow can move as efficiently as possible from the initial request for imaging to the radiology report. Though efficiency is important in a radiological setting, where time is critical in many cases, the authors say it can lead to radiologists feeling like assembly-line workers and can negatively affect morale and engagement.

Calculability

McDonald’s bottom line is volume, or to provide a lot of food for little cost. For this to succeed, various aspects of production are measured and monitored, the authors explained. Radiology departments and organizations do pay attention to quantitative analytics, and, if they are used properly, performance will improve and wasted time will be reduced. But there are still pitfalls to calculability.

“In many cases, a stringently quantified approach to work leaves workers and those they serve feeling like numbers whose humanity is of no interest to the organization,” Gunderman and Gray wrote. “Aspects of experience that cannot be quantified necessarily get left out of the equation, with the result that dissatisfaction and turnover rates in fast food are often high.”

Predictability

Predictability in a fast food environment—knowing how the food will taste or how employees are dressed—is comforting to customers. The same can be said for radiology environments. Patients take comfort in knowing that systems are in place to protect their safety and promote excellence in care, the authors wrote. And radiologists also like the stability within their work environments.

“Yet complete predictability entails a lack of spontaneity, improvisation, and creativity,” Gray and Gunderman wrote. “This trend is increasingly prevalent in radiology, in which more and more emphasis is being placed on the standardization of the radiologist’s work.”

Making radiology more predictable, however, can reduce radiologist morale and suppress unique characteristics and personalities, the authors added.

Control

Most work performed in a fast food setting is controlled. Employees have specific tasks that are monitored and controlled by rules that ensure “an efficient, low-cost and highly predictable operation.”

Radiologists are also monitored to ensure they meet productivity targets. Many times, this is done to an excess, and radiologists can become less engaged with their work. A highly controlled work place also represents a “de-professionalized” environment to many radiologists.

“In creating a work environment in which every radiologist can be easily replaced with another, the distinctive knowledge and skills of each radiologist count for less and less,” Gray and Gunderman wrote. “Again, the tendency is to treat the radiologist as a mere unit of production, a perspective that is largely antithetical to professionalism.”

For radiology to be of value, a controlled environment is necessary; however, measures taken that could lead to radiologists feeling disengaged can be detrimental.

“The McDonaldization of radiology might well generate substantial returns for practice owners,” the authors concluded. “But attempting to build and sustain a radiology practice that relies excessively on the principles of the fast-food industry will neither appetize nor nourish the radiologists who work in it.”