New Reliable

The chair of the ACR Annual Conference on Quality and Safety explains how a radiology department is like a Japanese car reliable

The Bulletin caught up with conference chair C. Dan Johnson, MD, FACR, chair of the department of radiology at Mayo Clinic Arizona in Scottsdale, Ariz., to discuss what's hot in quality and safety, what to expect at this year's conference, and which skills radiologists aren't learning in medical school.


Q: What are the hot topics in quality and safety right now?

A: Improving reliability of our processes is a focus for this year's course. We want to achieve high quality and the same good outcome every time we do a particular exam. When you study this, you realize that humans aren't very reliable. When we perform complex tasks, the best we can do is about 97 percent. So approximately three times out of 100, we're going to make a human error in repetitive tasks.

Q: How do you improve those numbers?

A: If you want to achieve reliability about 97 percent, you have to think about improved processes of care and even automated methods new reliable in textof performing a task. One way to do that is to use the Six Sigma and Lean methodologies (see sidebar). With these approaches, the error rate can fall to just three in a million. Boosting our reliability really takes a lot of process reengineering. That's a lot of change within an organization. High reliability doesn't happen by itself. It requires specialized skills and intentional leadership in order to really make it happen.

Q: What are some of the biggest challenges in implementing a high-reliability program?

A: The conference is built around that question. At the center is the goal of process improvement. At the center is the goal of process improvement. Around that core focus are the leadership skills and the key knowledge components that are required to be successful. If you want to improve, you need the improvement methodology and a good understanding of how to manage and lead change. We also cover understanding the external environment, including key regulations, as some processes may be mandated or require certain levels of reliability for certification or payment.

Q: Do physicians learn these skills in medical school?

A: Medical schools are just beginning to wake up to the fact that the care-delivery piece is missing. How do we successfully deliver the best care?

Some schools are starting to structure care delivery into medical school curriculum, sometimes referred to as the science of health care delivery. But for those of us who didn't get this instruction as part of our training, we've got to catch up. One way would be to attend a conference like this one of the subsequent Advanced Radiology Process Improvement Course in June 2014. James R. Duncan, MD, PhD, associate professor of radiology at Mallinckrodt Institute of Radiology at Washington University School of Medicine in St. Louis, Mo., is putting together this course to take people and their improvement projects to the next level. Attendees will focus on a specific project of their choice to carry out at their own institution. The various improvement steps are taught over several months of training using in-person and web-based education. With programs like these, we're trying to build a higher level of training and competence within the radiology community.

Q: What's the payoff for radiologists to improve quality?

A: Everything we do is for the patient. If something doesn't relate to improving the care of the patient, then perhaps we shouldn't spend the effort. If you make the patient focus of your efforts, it becomes very clear what's important.

Aside from that, there's a strong business case for quality and safety. High-quality care is actually less expensive, so the more you improve the quality of care, the better the business case it makes for your radiology department and institution. Quality can also be a market differentiator. If there are two practices in town and one is clearly of higher quality and safety, referring physicians and hospitals will seek out that practice.

Q: What are you most excited about for this year's conference?

A: I'm excited about the world-class team of experts we've gathered from all over the country. For example, Lucille W. Glenn, MD, chief of the department of radiology at Virginia Mason Medical Center in Seattle, will be lecturing. Her institution pioneered Lean process improvement in medicine. Leadership teams at Virginia Mason travelled to Japan to learn the Toyota production system, which includes Lean methodologies, and then implemented a standardized approach for clinical care. She is really one of the world's authorities on this topic.

I'm also looking forward to the scientific session. Paper presenters have 10 minutes to explain their work on achieving consistently excellent performance — that high reliability we're all working toward. It's a really great way for people outside of the faculty to share their thoughts and ideas.

I don't know of another conference like this one. It's a unique opportunity for attendees to get to know each other and learn from a group of experts.

ACR Conference on Quality and Safety
February 14-15, 2014
Scottsdale, Ariz.
To register, visit

By Lyndsee Cordes

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