Introducing "The Quandary"

Quandary is defined as a state of uncertainty or indecision as to what to do in a difficult situation.

Never confuse movement with action -- Ernest Hemingway.

As the inaugural topic for both me and this blog, I have chosen to discuss an issue that will be a recurring question for radiologists as we deal with the myriad of changes we see in health care; how to do more, more efficiently.

 

Whether we are discussing accountable care, meaningful use, or any number of other topics, in the final analysis it all comes down to one simple truth: to survive, radiologists are going to be required to increase interpretation accuracy, improve interpretation quality and interact more frequently with a wider range of healthcare professionals. We will be doing these things in the face of decreasing reimbursements for our professional interpretations. All of these things slow us down. So, how do we accomplish these 3 tasks?

 

As Hemingway stated, movement and action are not the same. Trying to simply read faster and read more is the surest way to decrease report accuracy and report quality. To take action, we need to be more efficient, not faster.

 

Our product, what we sell in the healthcare market place, is our interpretation. If this interpretation is perceived to be of poor quality or poor accuracy then we are perceived to be of poor quality and poor accuracy and therefore, replaceable. Additionally, it is clear that in the new healthcare paradigm, more and more of our everyday colleagues will be healthcare professionals and not just other doctors. These colleagues will include a larger numbers of nurses and nurse practitioners and physician assistants to name a few. In many cases, we will need to take extra time to ensure these new colleagues understand the nuances of our interpretations and/or take advantage of our broad range of knowledge on both the disease process as well as the imaging. This third leg of our imaging foundation, is every bit as important as the first two. Without this third leg, our radiology foundation won’t support the changes we need to make to say relevant to our patients and colleagues.

 

So again, how do we do more, more efficiently. First, getting faster is clearly not the answer. Improving efficiency, not the same as just getting faster, is the target we need to aim for. To improve efficiency we need to get rid of all those little things that are unnecessary and become a lean operating mechanism. The following are 5 things to consider when thinking about how to improve efficiency:

1.        Start with the little things. Saving small amounts of time over a large number of repetitive tasks equals saving a large amount of time. For example, how do you approach any study? Is there any way that you can improve how you review an examination, in other words improve your pattern of search?

2.        Don't assume what you're doing now is the best the best or only way to do a task.. All of us fall into habits that slow us down. For example, how do we move between cases? Taking time to review, and find all of the bad habits that cost you time will save you a large amount of time in the end.

3.        Doing more isn't always best. Pushing through those last 5 or 10 cases instead of taking a few minutes to stretch and refocus will cost you time. When we are tired, our pattern of search tends to fall apart and we find ourselves going over sections of the examination more than once to ensure that we haven't missed something. This is more likely the more complicated the case. So, what would take us to 3 minutes to review, takes is 5 minutes when we are tired. And, when we are tired and need a break we tend to be less accurate.. So, taking a short break to rejuvenate not only saves time and increases efficiency, it improves accuracy as well.

4.        Is what you are putting into your dictations really important? On one of my first days in private practice, one of my older colleagues gave me a bit of advice that I try to adhere to today. He said, everything in a report should be pertinent to the question at hand, the description and discussion should be clear and precise, and finally, the interpretation should be appropriately brief. Do your reports follow this? Reports that are too long tend to go unread while reports that are too short are believed to be of poor quality even if they are accurate.

5.        Is your information technology (IT) staff, hardware and software working for you, or are you working for them? Does your IT system, including your PACs and viewer allow smooth and easy review of cases, transition between cases and retrieval of cases/prior examinations? Do you have a voice dictation system that works as hard as you do? If not, you are probably wasting a lot of time trying to get these things to work together instead of getting on to the next case.

 

In real estate, it's location, location, location. For radiologists it's going to be all about efficiency, efficiency, efficiency. Radiologists who are efficient do the same amount of work in less time, leaving time for the 3 essentials for building a strong and stable radiology practice -- accuracy, quality and collegiality.