Taking an Imaging Department to a New Level

With the U.S. in its current economic recession andbe easy to identify and easy to solve. However, the
President Barack Obama's promise of addressingreader is not privy to understanding that the issues,
healthcare reform in 2009, eliminating waste is going toalbeit seemingly simplistic, did not have the expected
be a key factor in the survival of non-profit hospitals,reasoning as the supervisors initially thought. An
private practice physicians, for-profit free standingimportant lesson the supervisors learned is not to
clinics, and imaging departments. LEAN can helpsolution jump, i.e. make a uniformed decision, before
imaging practices improve their contribution margins bythey fully understood the entire process. Only when a
re-evaluating "how they have always done business."process is understood from the very start to very end
Many regulatory agencies (e.g. JCAHO, ACR, Nationalcan an informed change be made.
Quality and the U.S. Government) are pushing forFor example, the CT department discovered that
better patient care, improved patient flow, safety, andpatients were getting conflicting information from their
quality. As a result, healthcare as an industry must takereferring physician, the CT department, and the RN
an introspective look at how they meet patient needswho provided a pre-procedure call. This communication
along with the safety and quality of care they provide.process confused the patients and in turn decreased
JCAHO requires the reporting of quality data topatient satisfaction scores.
support the National Patient Safety Goals and theThe MRI department decided an eight day wait period
National Quality Forum is pushing health informationfor an MRI scan is neither efficient (not sufficient) nor
technology.competitive in today's environment. Therefore, the
In light of the national economic trends, healthcaresupervisor, technologists, and front office staff utilized
reform and the changes in pay for performanceLEAN. They designed a more efficient way to
regulations within healthcare, LEAN tools can be aschedule patients, immediately reducing the wait period
partner with imaging facilities to view work differentlyfrom eight days to one day.
by identifying potential savings of time, resources, andThe Ultrasound department identified a need to
the elimination of errors; thereby increasing the viabilityimprove the transport mechanism for patients' safety.
of quality healthcare.The initial measure showed 42% of patients were
Issuetransferred with the proper device. This was important
The current imaging departments at Kootenai Medicalnot only for patient safety but staff safety during
Center did not have a defined approach totransfer. After applying LEAN to this process the
communicate changes. Furthermore, changes (notpercentage immediately increased to 90%. It is
improvements) were not articulated to all staffimportant to know that this project, although not trying
because they were based on current trends and quickto identify transport issues, discovered that the
decisions. This resulted in wasted time, rework,transport times were in fact sufficient. Prior to this
miscommunication and staff frustration.project, one could hear anecdotal statements such as,
Background"it takes transport 45 minutes to an hour to get
Kootenai Medical Center's Imaging Services providespatients to us". Now, we thank the transport team.
Radiology, Interventional, MRI, Nuclear Medicine, CT andThe Nuclear Medicine department determined that it
Short Stay services. Each department has a "working"takes longer than expected for patients to present to
supervisor who is responsible for the budgeting andthe department due to check-in procedures. When a
staffing of their respective areas. The turnover rates inpatient arrived for their appointment they were
each department were sporadic. Imaging Services'required to travel to one location to register then to a
patient satisfaction scores were low and also sporadic.different location to check in and finally to the Nuclear
Lastly, employee engagement was one of the lowestMedicine Department for their appointment. This
in the organization.process, once identified using LEAN, was concerning
Current Conditionbecause the majority of Nuclear Medicine patients are
The imaging department is fortunate to haveelderly and/or very ill. Isotopes decay at a rapid rate,
radiologists who are some of the most advanced inso decreasing the time it took patients to present at
their field. In addition, the department is 100 percentNuclear Medicine was significant. Patients were being
digital, allowing a turnaround time from minutes to 2registered in concert with all emergency room patients,
hours. There are over 140 FTE's including 13 FTEsometimes triaged, and were asked to wait in the
radiologists. The department, divided into four locations,emergency waiting room.
maintains a total of three Computed TomographyThe outcome was an immediate success for the
Scanners (CT), two Interventional Radiology suites, fivepatients because they now register in the MRI
Ultrasound suites, two Mammography suites, fivedepartment which is adjacent to the Emergency
X-ray rooms, a mobile Positron Emission TomographyDepartment and across the hall from Nuclear Medicine.
(PET) and two Magnetic Resonance Imaging MachinesPatients no longer have to walk past the Nuclear
(MRI).Medicine department to check-in for their appointment.
Target ConditionThis resulted in a 24 minute improvement in patient
The director and department supervisors decided theywait time.
wanted to be the benchmark in their organization for allCost Benefit
measures. The entire team is committed to provideAt the time of writing this text, the benefits are still
today's outcomes by determining the need for abeing identified. As stated earlier, not only are the
consistent way of decision making for processespatients satisfied, the results are in the numbers.
within the departments that was both simple and easyThe imaging department went from one of the lowest
to learn by the front line staff and supervisor. Theyscoring departments in the hospital for employee
wanted to provide a tool that would also improvesatisfaction to the highest in employee satisfaction in
employee satisfaction. Most importantly, the teamone year (Avatar/Gallup). The department went from
made a commitment to improve patient satisfaction.a negative contribution margin to +3.8% in one year. In
Counter Measuresaddition, the department achieved the 96th percentile in
During the months of May and June of 2008, thepatient satisfaction (Avatar). Dropping to a 4.5%
Imaging Services supervisors were trained in LEANturnover rate in 2008 was a huge success. To date in
tools to improve their processes. As a group, each2009, we have experienced 0% turnover and zero
supervisor participated in a seven week course oncevacancies. The department now has a pool of
a week for two hours. The premise behind the trainingapplicants waiting for a potential opening.
was to assist the supervisors in understanding theFollow Up
tools of LEAN and understand an entire process fromImaging organizations should embrace the benefits of
the patients' perspective prior to making any change.implementing LEAN. They should change the feeling of,
They were asked to "throw away" the axiom "we"we don't have time", "we don't have enough staff" or
have always done it that way"."it costs too much" to "what is ideal for our patients". If
While in the process of work, they learned to createimproving process in an organization is simple, then
and document a value stream map as in example 1.why hasn't it already been done? Engaged employees
The value stream map allowed everyone toare the key to your organizations success and
understand how a request is made, the individual stepsproviding them the opportunity to learn and use tools is
which occur along the way, and the data collected.a start. If you are questioning the relevance of LEAN in
The value stream map assists in identifying non-valueyour organization then answer the following questions:
added time for the patient by identifying waste, as1. Are patients complaining about your services?
defined by Toyota Production Systems, in the following2. Is your organization's turnover not meeting
areas:o Overproduction - producing more than, fasterbenchmark?
than, or sooner than is requiredo Waiting - idle time that3. Is your organization duplicating processes?
could be used more productivelyo Transporting -4. Are people in your organization performing identical
unnecessary transport of parts, materials, or peopleotask differently?
Inappropriate processing - operations that add no value5. Are you finding processes in your organization are
from the customer's perspectiveo Unnecessarynot standardized?
inventory - exceeding one-piece flowo UnnecessaryIf you answered yes to any of these questions then
excess motion - any movement by people oryou should consider LEAN in your organization. With
equipment that does not add valueo Defects - rework,decreases in reimbursement for imaging services,
repair or waste in its simplest from outcomeshaving to provide the same services for less dollars is
The supervisors of the imaging department were ablea reality. The choices are to either decrease staffing
to complete seven projects. As one views theor eliminate waste.
outcomes he or she may assume these issues should