Once the problem was defined, the
team brainstormed potential solutions
and constructed a priority/pay-off
matrix—a four quadrant chart that rated
the impact of an intervention versus the
ease of implementation (Figure 2).
If it’s never asked, it will never be
known what is possible. The team
needed to come together in order to see
all the options so this was quite a learning experience. For example, it was initially thought the transcriptionists could
help deliver the wet read results, but that
would have created a whole new level of
complexity for them—an unintended
consequence. Some people thought they
had all the answers and could make the
fix right away, but the tempo was slowed
down to show the value of the measurements learned in the CPIP course.
From several potential interventions
in the priority/payoff matrix, one seemed
to have the biggest impact and, in theory,
seemed easy to implement: automatically
faxed results built into the radiology
information system (RIS). With the help
of the IT team members, a process was
programmed into the RIS that triggered
an automated fax for any case designated
as a “wet read.” All reports are autofaxed
if the referring physician profile in the
RIS reflects this preference. The dif-
ference in the wet read process is that
they are being processed sooner with no
handwritten note being faxed to the pro-
vider. Also, there was only a small per-
centage of preliminary reads requested,
the majority of them pediatric cases.
Failure is inherent to process
improvement. Initially, the automated
process failed for several providers who
did not have fax numbers in the RIS.
This prompted a tweak to the system so
that it notified several personnel when
a fax failed for any reason. Also, cases
with critical findings had to be reported
appropriately. For critical findings, such
as a pneumonia or acute fracture, the
results were verbally communicated
according to department protocol.
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
NSMC team worked closely with the RIS
programmer and staff during the PDSA
cycles to rectify any failed steps or loose
ends. One issue which was easily fixed
was missing or incorrect fax numbers.
These were detected and corrected and
from that the no fail system was developed. This was an alert system to key
personnel in radiology of failed faxes.
Details of the three PDSA cycles are
shown in Figure 3.
Initially, the team sought to reduce
wet read turnaround time by 25%
because it was an achievable target. Also,
25% would be a big leap in efficiency.
The well-structured working course kept
the team on track with coaching, case
studies, interactive exercises, and lots of
Figure 2 • Prioritized List of Changes (Priority/Pay-Off Matrix)