A Combined Approach
Radiologists are working with their colleagues to improve the patient experience through initiatives big and small.
When her husband, Nick, was diagnosed with stage 3 rectal cancer in 2004, Jennifer L. Kemp, MD, FACR, diagnostic radiologist and body imaging subspecialist at Diversified Radiology in Denver, thought she knew what to expect. By then Kemp had been a private practice radiologist for seven years, experience she thought would make navigating her husband’s care — including surgery, chemotherapy, radiation, and imaging — seem like second nature.
But Kemp quickly discovered that all of the medical training in the world couldn’t prepare her for the difficulties Nick and patients like him encounter within the health care system.
From institutional bureaucracy to clinical complications, Nick, who was 37 years old at the time, faced many challenges throughout his care. One thing Kemp remembers most is how scared her husband was throughout his treatment, especially when it came to undergoing CT scans. “Nick would get his imaging results just one or two hours after his exams, thanks to my connections, but even that short amount of time was torture for him,” she says. “Then Nick would make himself crazy analyzing the words that the radiologists used in their reports, which often are not super cut-and-dry because we sometimes see things that we’re not sure about. Those things would haunt Nick for months until his next scheduled scan.”
As Nick completed his treatment and was declared cancer-free, Kemp could only imagine how difficult navigating the health care system must be for her own patients, who don’t have the same expertise and connections. To make things a little easier for them, Kemp launched several initiatives to optimize the patient experience at her practice. It’s an approach more radiologists are taking to provide added value, increase patient satisfaction, and improve clinical outcomes, as outlined by the ACR’s new Commission on Patient- and Family-Centered Care. “We want to ensure our patients are treated the same way we would want ourselves or our family members to be treated when it comes to their care,” says Garry Choy, MD, MBA, staff radiologist in the division of thoracic and cardiovascular imaging at Boston-based Massachusetts General Hospital (MGH).
To enhance the patient experience at their practices, radiologists must first know what their patients want. Radiologists can gather this information through written or electronic surveys or patient advisory panels, both of which can reveal improvement opportunities that radiologists wouldn’t otherwise consider. For instance, Andrew J. Gunn, MD, assistant professor of radiology and surgery at Barnes-Jewish Hospital in St. Louis, remembers when he was a resident at MGH, and a survey revealed that MRI patients most wanted warm blankets during their exams. “I never would have thought warm blankets would be the most important thing to patients,” Gunn admits. “It just goes to show that we don’t know what patients want unless we ask them.”
Once radiologists understand what their patients want, they should meet with their team members, including nurses, technologists, office managers, and perhaps even their referring physicians, to develop a plan for meeting those expectations, Gunn says. This is also a good time for radiologists to remind their teams about the importance of delivering exceptional customer service throughout each episode of care. “From the time a patient hits the department to the time they leave the department, we need to make them feel comfortable,” says Sabiha Raoof, MD, chair of the radiology departments at Jamaica Hospital Medical Center and Flushing Hospital Medical Center in Queens, N.Y. “Our focus has to be on the patient every step of the way; it cannot be about what is convenient for us.”
When radiologists hear “optimizing the patient experience,” they often think about delivering findings to or meeting with patients directly. Choy and Raoof have both made patient encounters part of their optimization strategies. In 2012, Choy and his team developed the Radiology Consultation Clinic at MGH, where radiologists, at the request of referring physicians, meet with patients who have had imaging that demonstrated findings of emphysema, vascular and coronary atherosclerosis, and hepatic steatosis to show them their images and explain how their conditions have changed over time. The idea is that the more patients understand their conditions, the more likely they’ll be to make healthy lifestyle changes, such as quitting smoking. “It’s a novel way radiologists can practice that has a direct impact on the patient experience,” Choy says.
Like Kemp, Raoof began thinking about patient experience after enduring a personal health crisis. Despite being a radiologist and coming from a family of doctors, Raoof was overwhelmed when she was diagnosed with breast cancer. From insurance coverage issues to near-miss medical errors, Raoof experienced it all. So after completing chemotherapy in 2007, Raoof made patient experience a priority, and in 2012 she launched a program called MAD (Make a Difference) Rounds at her hospital. At the program’s onset, Raoof rounded to hospital rooms alone, asking patients if they needed anything — from their pillows fluffed to their rooms cleaned. Since then, the program has grown to include nearly 100 hospital clinicians and administrators who make rounds every day to address patients’ needs. “The MAD team’s goal is to solve any issues a patient has immediately,” Raoof explains. “If the patient wants to speak with a doctor, for instance, we page the doctor to come see the patient right away.” (Read a case study about MAD Rounds at .)
While patient encounters are one way to optimize the patient experience, they’re not the only way. Radiologists who can’t make patient encounters part of their optimization strategies shouldn’t feel discouraged, Kemp says. Radiologists must be realistic about what they can accomplish and take a tiered approach to achieving their goals, she says. “Every radiologist and every practice is different, so I encourage radiologists to start with little things that feel right to them and their practice,” Kemp says. “They should take one small step, and if that goes well, then they should take another small step. These small steps might not seem like much at first, but even just one small step can make a big difference for our patients.”
One of the first things Kemp and her team did to improve the patient experience was develop patient postcards, which the technologists give patients before they leave the department. The cards not only outline what a radiologist does and when patients can expect to receive their exam results, but they also include the department’s phone number and invite patients to call with questions. “Since we give the cards to patients during their exams, we don’t have to pay postage, and it doesn’t slow the radiologists down at all,” Kemp says. “It’s a simple, low-cost initiative, but we’ve received a lot of positive feedback from both patients and hospital administrators, as a result.” Building on that effort, Kemp and her team now list the radiologists’ direct phone numbers at the bottom of their reports and making web videos to educate patients about their exams. Patients can view the videos on iPads in the waiting room.
Raoof and her team have also taken steps to educate patients about the radiology department and imaging exams. Among other things, they’ve hung several informational items in the waiting room, including photos and the specialty areas of each radiologist, posters explaining that the department is ACR accredited, and certificates indicating that the each member of the technical staff has taken the Image Wisely and Image Gently pledges, committing themselves to radiation safety in both adult and pediatric imaging. Also displayed are the Joint Commission’s Speak-Up campaign posters, encouraging patients to ask questions about their care. “We want patients to feel empowered to ask questions and tell us how we can make their health care experience better,” Raoof says.
Like Kemp and Raoof, Choy and his team have implemented several initiatives that have had a big impact on patient experience. These include wait-time monitoring and room availability programs. Using proprietary software to conduct statistical analysis of the department’s historical wait-time data, the wait-time monitoring program calculates how long patients can expect to wait for exams on any given day, at any given time. The wait time is displayed on a monitor in the waiting room. “If we communicate wait times properly, patients feel that we’re organized and that we respect their time,” Choy notes.
The department’s room availability program takes efficiency further, sending a notification to a computer monitor in the technologists’ work area whenever an exam room becomes available. “It streamlines the patient workflow, so you don’t have any empty rooms,” Choy explains. “We want our exam rooms to be 100 percent utilized to ensure patients aren’t sitting in the waiting room any longer than necessary.”
While experience optimization won’t cure a patient’s illness or completely eliminate a patient’s anxieties, it can help patients feel more empowered and more valued – making these actions well worth the effort. “It’s never a perfect situation whenever somebody is going through cancer or trauma, but we have the power to make it a little easier,” Kemp says. “We became doctors to help patients, and this is the epitome of helping our patients. I want our patients to have a better experience than my husband and I had. It’s the right thing to do.”
By Jenny Jones, Imaging 3.0 content specialist