hybrid surgical suite, when we have our
interventional suite idle for 80% of the
time, which has exactly the same level of
functions they need. That direction has to
come from the C-suite. The C-suite needs
to get in touch and call on us as a consultant. We have not been at the table.
Bedel: When you say that word, efficiency, we’re never done. I think of it as
the elephant you keep trying to push up
the hill, and the minute you turn your
back, it will squash you. It’s a never ending focus. And our teams we’re pounding
on to be efficient need to understand the
value they add and the reasons why we’re
asking them to do things.
Lesic: We need to talk about capacity
issues, because I think we have a lot of
capacity in places that aren’t utilized.
Everybody wants to do their studies
between 8 and 4: 30. I have three MRs
that are very busy between maybe 8 and
6, but when I do capacity studies on it,
I find I really only need two and a half.
Ochoa: We’re looking at our outpatient
imaging centers. Should they be open
Saturdays and Sundays? And what times?
Nine o’clock on the weekends? Eleven
o’clock? We’re in the process of looking
Holland: In tough financial times, it’s
difficult to experiment and innovate.
How are your organizations innovating?
How are you look to get better, faster,
Claybourne: We are about to launch
a distributed imaging initiative where
there will be one work list for all of the
Mayo enterprise. Radiologists from any
of the sites will be able to take from those
lists based on their subspecialties. So
they’re setting up all kinds of rules for
which kinds of exams each radiologist
can read. We’re excited to see how it all
pans out. The general radiologists in the
small sites like mine are very concerned,
because they wonder, “Am I going to
read wrists, ankles, and chest x-rays the
rest of my career?” It has pros and cons,
and I think we will see turnover because
Roy: In my organization, we’ve created a
department called CS Medicine. They’re
taking everything we do on different
disease categories and developing best
practices. But what’s missing from that
care model? They have the oncologists
and cardiologists, but they don’t have
pathology and they don’t have imaging
as part of that. They’ve been very successful in eliminating unnecessary exams
and reducing length of stay, but taking
it to the next level, they have to leverage
the knowledge that imaging physicians
can bring. Imaging physicians can have
a dialog with doctors and say, “No, you
don’t need that CT scan—you need an
ultrasound, you need an MRI, you need
whatever.” If they would partner with
radiology, we could do probably double
what they’ve done, in less time.
Ochoa: At our institution, we put in a
whole layer of horizontal management.
We have people responsible for lab
throughout the five hospitals. We have
people responsible for radiology, pathology, and cardiology. We’ve started really
looking at what we’re doing and what the
variation is. We’ve done a lot to reduce
variation and lower our costs. We’re looking at software that will allow a referring
physician who’s reviewing an image to
send a text to any of the radiologists currently reading. It’s going to be interesting
how our radiologists embrace that—it’s a
conduit to the physicians, where they can
get back to them immediately and have a
conversation about the patient.
Steffen: Advocate is teaming up with a
lot of vendors. We’re teaming with Blue
Cross Blue Shield of Illinois. We’re teaming with GE on DoseWatch and the
Blueprint. So I see more and more partnerships with non-hospital based places.
Vasquez: I think we need the right infra-
structure in order to innovate. Among
our 13 hospitals, we have seven groups
of radiologists. Recently, all the chairs of
imaging were called to the mother house
and they were told to come up with a
plan to create just one group. They were
told, “We don’t care how you do it, but
get there, and if you don’t get there by
December, we will give you the plan we’re
going to implement.” As a result, they are
talking and meeting every month.
Holland: In thinking about sustained
change, what are the barriers? What are
the hurdles we have to clear in order to
have a sea change? What gets in the way?
Ochoa: We get in the way. You look at contracts, like the inability to send patients to
a center that has capacity. When I get an
authorization, I get it for just one center.
If I want to move a patient, I have to get
different authorization because we’re not
aligned to get an authorization for Scripps
Health—we get it for Scripps Mercy Hospital. We need to look at ourselves as one
entity, and until we figure that out, we’re
not going to be successful.
Palmucci: At Vanderbilt, we have outpatient imaging centers all around
Nashville, but I am not allowed to send
patients to them because they’re a separate entity, Vanderbilt Imaging Systems,
and the revenue goes there. Management
wants the revenue booked to Children’s
Vasquez: For everything we do, regulations increase—every time we turn
around. For example, a few years ago, I
didn’t have to worry about getting MR
and CT accreditation. We have to get
away from all the regulations so we can
spend more time doing things that are
meaningful to the patient.
Rhynus: It’s up to us, people in our
seats who know what’s going on, to help
change the culture. There is going to be
cultural change. What I don’t know is
how we get all our peers who aren’t at
this table to understand that. It is a huge
education process, and we don’t have a
lot of time to do that.