Measuring and managing radiologist workload: Application of lean and constraint theories and production planning principles to planning radiology services in a major tertiary hospital

Abstract

Introduction: We describe how techniques traditionally used in the manufacturing industry (lean management, the theory of constraints and production planning) can be applied to planning radiology services to reduce the impact of constraints such as limited radiologist hours, and to subsequently reduce delays in accessing imaging and in report turnaround. Methods: Targets for imaging and reporting were set aligned with clinical needs. Capacity was quantified for each modality and for radiologists and recorded in activity lists. Demand was quantified and forecasting commenced based on historical referral rates. To try and mitigate the impact of radiologists as a constraint, lean management processes were applied to radiologist workflows. A production planning process was implemented. Results: Outpatient waiting times to access imaging steadily decreased. Report turnaround times improved with the percentage of overnight/on-call reports completed by a 1030 target time increased from approximately 30% to 80 to 90%. The percentage of emergency and inpatient reports completed within one hour increased from approximately 15% to approximately 50% with 80 to 90% available within 4 hours. The number of unreported cases on the radiologist work-list at the end of the working day reduced. The average weekly accuracy for demand forecasts for emergency and inpatient CT, MRI and plain film imaging was 91%, 83% and 92% respectively. For outpatient CT, MRI and plain film imaging the accuracy was 60%, 55% and 77% respectively. Reliable routine weekly and medium to longer term service planning is now possible. Conclusions: Tools from industry can be successfully applied to diagnostic imaging services to improve performance. They allow an accurate understanding of the demands on a service, capacity, and can reliably predict the impact of changes in demand or capacity on service delivery.

Development of a local relative value unit to measure radiologists’ computed tomography reporting workload

“…The major constraint in the improvement of CT output is radiologists’ reporting times . As CT complexity varies according to the anatomical region being studied, there is a need for a method that normalizes medical work across subspecialties and across individual radiologists to address radiologists’ reporting workload and productivity in a contemporaneous context .…”

“…The major constraint in the improvement of CT output is radiologists' reporting times. 6,7 As CT complexity varies according to the anatomical region being studied, there is a need for a method that normalizes medical work across subspecialties and across individual radiologists to address radiologists' reporting workload and productivity in a contemporaneous context. 8,9 To accommodate the professional productivity measures, taking into account the complexity and variability of the different tests, the model of Resource-Based Relative Value Scale (RBRVS), which assigns weights to the interpretation of different tests, has been successfully employed in the United States of America (USA).…”

Externally Acquired Radiological Data for the Clinical Routine – A Review of the Reimbursement Situation in Germany

“…Exact numbers regarding the workload for the provision of second opinions in Germany are currently not available. One study from 2013 shows an estimated workload for radiologists at a maximum-care hospital of approximately 15 % for clinical conferences and 14 % for informal case discussions [13].…”

Ultrasound guided musculoskeletal interventions: professional opportunities, challenges and the future of injection therapy

“…A PGD is a set of ‘written instructions for the supply or administration of named medicines to specific groups of patients who may not be individually identified before presenting to treatment’ and enables practitioners to inject specified doses of medication to patients presenting with stated presentations; for instance, adhesive capsulitis, osteoarthritis of the knee or trigger finger. Independent prescribing is now available in the UK to physiotherapists, nurses and podiatrists who have completed suitable training and other professions are in the process of submitting applications . Independent prescribing is not available to radiographers and is a politically sensitive area that has highlighted the impact of professional dependence and hierarchy …”

“…Independent prescribing is now available in the UK to physiotherapists, nurses and podiatrists who have completed suitable training and other professions are in the process of submitting applications. 54 Independent prescribing is not available to radiographers and is a politically sensitive area that has highlighted the impact of professional dependence and hierarchy. 55 Implementing these changes requires strong clinical leadership.…”