In the Patient's Shoes
Radiologists question — and evolve — the patient experience with input straight from the source.
Unfortunately, receiving a CT, MRI, or other imaging exam referral can sometimes instill a sense of dread in a patient.
To these individuals, a trip to the radiology department usually signifies having to endure a stuffy waiting room, claustrophobic scan, and anxious wait for results. To counteract these negative feelings, radiologists are going to great lengths to ensure the patient experience is not just satisfactory, but exceptional.
New Model of Care
Though the patient-centric care model has been around for decades, it seems to be rising in popularity for radiologists. In her 2010 ACR Presidential Address, Carol M. Rumack, MD, FACR, proposed "patient-focused radiology" as a sixth College pillar.
Rumack cites the JACR® article "Flying the Plane You Service: Patient-Centered Radiology," in which authors Stephen J. Swenson, MD, MMM, and C. Daniel Johnson, MD, MMM, propose that radiology professionals make every choice as if they would be on the next "flight." The co-authors write that, as radiology patients, they would have five wishes:
1. The information to choose,
2. The right examination,
3. A safe examination,
4. Effective communication of correctly interpreted results, and
5. A fair price.
Pat A. Basu, MD, MBA, chief medical officer and chief operating officer of Virtual Radiologic in Eden Prairie, Minn., agrees that the patient-centric radiology can take many forms. So does Mary C. Mahoney, MD, FACR, director of breast imaging and professor of radiology at the University of Cincinnati Medical Center in Cincinnati, who says the term "patient-centric" is, in may ways, all-encompassing. "It's about me as the patient advocate, me as the radiologist helping the referring clinicians, and me as the educator," she says. "It's everything; it starts with scheduling and goes through the entire process of the study, the results, and even the billing. It's letting patients know what a radiologist is and how valuable what we do is for them and [their medical] team."
Understanding this concept's definition is important, but it's equally critical to learn what patients expect from a radiology visit. Basu co-authored the American Journal of Roentgenology article "Creating a Patient-Centered Imaging Service: What Patients Want," which surveyed patient preferences for how and from whom radiologic exam results are received. "If you look at successful customer-supplier relationships, it appears that a key tenet is to involve the customer in decision making and really approach the problem from his or her viewpoint," says Basu.
The survey found that patients want their imaging results communicated much faster than the turnaround provided by most practices. However, "[the process of patient communication] doesn't have to be black and white," Basu says. "You don't have to give every patient every result in person. You could let [the individual] choose what he or she wants."
In this sense, radiologists must pay careful attention to the complete patient experience — from the moment an appointment is scheduled to the follow-up phone call. That's why many have expanded this concept to be called "patient and family centered care (PFCC)," according to James V. Rawson, MD, FACR, chair of the department of radiology at the Medical College of Georgia at Georgia Health Sciences University (GHSU) in August, Ga.
PFCC in radiology includes much more than delivering decent customer service or timely communication with patients. For some, achieving PFCC means answering such questions as the following: What is the proper wall color and form of lighting? Should you play music while a patient is receiving an MRI or CT scan? What types of paintings or murals can help ease concern in the recovery room?
A 2005 study by radiology recruitment specialists from RadSciences Group, "Helping Radiology Patients Relax," asked radiologic technologists about the importance of decor and furnishings in patient relaxation. Of the 431 respondents, 22.9 percent felt that these aesthetic aspects of the practice environment are extremely important in providing better patient care, while 29.6 percent said they are very important. Additionally, 37.1 percent of the technologists stated that wall color and/or new paint could improve the radiology department, while 33.4 percent noted that murals and pictures on the walls would assist in calming patients.
This desire for calm led physicians and staff at GHSU to an important but challenging endeavor: building a new mammography center to prioritize the patient experience. "The decision [to redesign the facility] began because we had a backlog in mammography," says Rawson, remembering the initial redesign process. "But then we realized [the space] was not patient friendly."
Karen C. Panzitta, MD, associate professor of breast imaging at GHSU, elaborates on the renovation: "From my perspective, [the new center] would allow me to treat the patient not only as I wanted to be treated, but as I would want any of my loved ones — my mother or my sister — to be treated."
To meet this goal, Rawson pulled together a mix of surgical oncologists, radiation oncologists, hematologists, and patients to make recommendations. Included in this group was Alice Reese, a GHSU medical college employee, breast cancer survivor, GHSU mammography patient, and patient advisor for the GHSU mammography facility redesign. In the past 12 years, Rawson hasn't installed or replaced equipment without patient advisors at the table. "What the patient needs is something only the patient can tell you," he says. And Rawson's patient advisors helped provide him with this useful insight.
Rawson and colleagues received important feedback from this consortium, including a surprising revelation related to the setup of the GHSU waiting room. Mammography exam rooms were positioned between the waiting room and the restrooms. As such, female patients in the exam rooms were uncomfortable when unfamiliar men walked by on their way to the restrooms. A lot of the suggestions patients contributed were things we wouldn't have thought about," says Rawson. "Once inside the mammography rooms, women didn't want men they don't know walking through for any reason."
To increase privacy, the architect for the redesign also created biopsy recovery rooms. "Rather than being on a stretcher [during recovery] in the same biopsy room, you're not in a much more private room," says Rawson. "We added a hospital-grade chaise lounge and wall murals." Such additions were designed to help patients feel more protected or insulated from the anxiety of the biopsy. Rawson and colleagues came up with a distinct term for the private healing process that occurs after every procedure: "cocooning."
GHSU physicians and administrators didn't stop the wordplay there. In the new center, they phased out the term "waiting room" because "by definition, you expect to wait," concludes Rawson. "We now call it our patient lounge because it looks much more like a coffee shop than a bus stop. It's a place where you want to relax. Waiting doesn't have to be a bad thing. It can be part of the experience and the healing environment."
Relaxation is indeed vital considering the degree of unease mammography patients can develop, according to Reese. That's why it took three redesigns to create the new mammography facility, which opened in 2003. "At first, others looked at it and said, 'If you are trying to capture the low-cost efficient environment of a K-Mart, you did.' This wasn't the environment we wanted," explains Rawson. So the architect did something unexpected: she referred herself for a mammogram at GHSU.
After going through the entire patient experience, the architect realized her design didn't reflect the spa-like atmosphere she — and presumably other patients — desired. "She wanted to come into mammography and have elements of hospitality, like a high-end spa," explains Rawson.
Given her new perspective, the architect worked with the GHSU team to change the color scheme and suggest and hang artwork. For his part, Rawson helped adjust the department's entire workflow. Meanwhile, chairs of different sizes, a water cooler, and a coffee machine were placed in the patient lounge. "We went antiquing," says Rawson. "We found pieces with character and set a tone." Mirrors, hangers, and a small countertop were added to the changing rooms, so women could avoid wrinkling their clothes and could reapply makeup after appointments.
"Every piece we put in was looked at from the perspective of 'How would this contribute to the patient experience?'" says Rawson. "It wasn't about adding efficiency or generating revenue. There was a high level of detail that went into every decision."
The changes have prompted positive feedback. "Patients not only come to their appointments," Rawson notes. "They want to stay and chat at the desk. They are no longer in a hurry to leave."
Improving the Public's Perception
Renovations such as those at GHSU not only make patients more comfortable, but they also make radiologists sit up and take notice. "Women's imaging is a great paradigm for how the rest of radiology should treat patients," says Basu. "Patient-centered care is important. First and foremost, it is for the good of patients," he explains. "It's also for the good of the medical system at large. And lastly, it's for the good of radiologists."
Changing the way radiologists treat and interact with patients and their families can indeed have a great overall impact on some of the specialty's stereotypes. Panzitta emphasizes that PFCC demonstrates that "radiologists who are ultimately reading exams and making the decisions do care about the patient experience."
The emphasis on PFCC continues to grow throughout the radiology community. In fact, according to Mahoney, patient-centered radiology will be an upcoming theme of RSNA 2012. For six years, Mahoney has helped prepare a refresher course for the RSNA meeting on the same topic, which is always a huge hit.
PFCC is undoubtedly becoming a popular and important trend. "The consumer is definitely becoming the priority in modern medicine," says Mahoney. What changes, both large and small, will you make to put patients and their families first?
By Alyssa Martino