• Through a four month Clinical Process
Improvement Leadership Program, professionals at North Shore Medical Center in Massachusetts developed a process improvement to gain efficiency in
communicating urgently requested
x-ray results, or “wet reads.”
• The initial steps included summoning a
diverse team, mapping the process in
detail, and clearly defining the problem.
Once the problem was defined, the
team brainstormed potential solutions
and constructed a priority/pay-off
matrix.
• By using the Plan Do Study Act (PDSA)
system, a repeating cycle of activity that
tests the new experimental work flow
by tracking, adjusting, tweaking, and
tracking again, efforts were built upon
until the goal was met. The average wet
read turnaround time went from
44 minutes to 15 minutes, a reduction
of 66%.
EXECUTIVE SUMMARY All industries, from healthcare to airlines to automobile manufacturers, have seen a huge drive toward
improved efficiency and decreased cost
in the last 5 to 10 years. In the medical
field, increasing workloads, decreasing
reimbursement, and a global financial
crisis all add drag to future speculations.
Leaders in business, technology, and
healthcare are cross-pollinating their
knowledge and innovations to create
brand new performance metrics with
fantastic results. When adopted by one
radiology department in Massachusetts,
these strategies gave a quick shot of efficiency and improved patient care.
North Shore Medical Center (NSMC)
is a network of hospitals, ambulatory care
sites, and physician offices, which together
create the area’s largest healthcare provider and one of its largest employers. It
is the second largest community hospital
system in Massachusetts. NSMC offers CT,
MRI, mammography, diagnostic, nuclear
medicine, ultrasound, bone densitometry,
and interventional radiology. Bed size is
300 plus and annual procedure volume
for radiology is approximately 225,000.
NSMC is part of Partners Healthcare,
a collaboration of community, specialty,
and world-renowned academic hospi-
tals. Partners offers a four month Clinical
Process Improvement Leadership Pro-
gram (CPIP). Founded in 2010, it engages
clinical teams in the use of process
improvement tools to reduce variation in
care and improve outcomes for patients. It
is modeled after the Advanced Training
Program at Intermountain Healthcare in
Utah where physicians developed exhaus-
tively meticulous process and outcome
studies to strike upon the best types of
care. Eventually they aligned the entire
staff on everything from basic dosage to
major surgeries. The result is utilization
is lower, outcomes are better, and costs
are dramatically lower—as in, almost
half the national average in 2009. CPIP
is a fast-paced immersion program that
gives participants the tools and business
strategies to evaluate and improve a pro-
cess at their own institution.
The nuts and bolts of the course are
straightforward. In 2012, over a period
of four months, twenty teams from seven
of Partners affiliated hospitals in the Boston area attended seven full day seminars
held by leaders from the Partners institutions. CPIP is built around collecting,
analyzing, and evaluating data in order
to standardize care. Students quickly
learned the basics of team-based process
analysis and the measurements needed to
turn theory into action.
Each team is led in developing, testing, and implementing an improvement
project. Within the four month timeframe, they strive to develop a process
improvement project and present the
work at the end of the course. The short
By Mary Ellen Tobey, RT(R)(M), Alvin Yamamoto, MD, and Dawn Robertson
Process Improvement:
Wet Reads
