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Service Blueprint of Hospital Radiology Department

Radiology Department Service Blueprint at Texas Health Arlington Memorial Hospital

Executive Summary

            The Texas Health Arlington Memorial Hospital (THAMH) is a large-scale health facility that offers services to people living in Arlington Texas and the surrounding communities. THAMH distinguishes itself by providing its patients with high quality of service and continuously aims to improve the quality of service and performance of its multi-competent healthcare services. As a part of the service it provides, it has a state of the art outpatient radiology imaging center and a highly skilled staff. This center meets the demanding requirements that are necessary to assist in the proper diagnosis of the medical conditions of the clients at THAMH. An evaluation of the planning and reporting process of the imaging center at THAMH reveals that the imaging center is inadequately utilized. The inefficiency of the imaging center is largely due to the scheduling and reporting system that is currently employed. The Current Process Analysis (Appendix A) illustrates areas where the management team has a major opportunity to improve the current quality of service and maximize customer satisfaction. A centralized scheduling process in conjunction with voice recognition software (RadWhere) is capable of increasing the efficiency of the imaging center scheduling and reporting process systems. The Proposed Service Blueprint (Appendix B) of the imaging center scheduling and reporting process system, implements these elements to increase the efficiency and reliability of the imaging center process.

Introduction

            The aim of this paper is to examine the quality of the services provided by the Texas Health Arlington Memorial Hospital (THAMH) Radiology Imaging Center through a study of the Current Service Blueprint (Appendix A), which outlines the current service process. It will identify areas of inefficiency that can be optimized to enhance the capabilities and reliability of imaging services available to THAMH patients. It will also recommend the changes that are needed to overcome these weaknesses by providing a Proposed Service Blueprint (Appendix B), which depicts the modifications required to modernize the process and increase the efficiency of the services provided by the radiology imaging center of THAMH.

History and Background of THAMH

            The Arlington Memorial Hospital was founded in 1958 to meet the growing community requirements of the residents of Arlington, Texas and was based on a community effort with the objective of providing “high-quality healthcare” to the residents of Arlington (50th Anniversary, 2008). Nearly four decades later Arlington Memorial Hospital merged as a part of Texas Health Resources (THR). THR was established in 1997 through the combination of Fort Worth-based Harris Methodist Health System with Dallas-based Presbyterian Healthcare Resources. Subsequently, in 1997, Arlington Memorial Hospital joined THR, which serves the Dallas-Fort Worth metro area, and is the nation’s third largest hospital systems market, behind only New York and Los Angeles (Roberson, 2008). As of Jan 1, 2009 ‘Texas Health’ will precede the name of the 12 hospitals in the North Texas market and THR will spend in excess of $20 million updating signs and logos (Roberson, 2008). This will firmly identify the link between the high quality hospitals, such as Texas Health Arlington Memorial Hospital (THAMH), and THR, the largest hospital system in North Texas.

In its current form THAMH consists of a 417-bed-acute care, full service hospital that essentially provides services to residents of Arlington and the surrounding communities. The healthcare services provided by THAMH includes comprehensive cardiac care, an electrophysiology lab, women’s services, orthopedics, gastro-enterology, an advanced imaging center, extensive rehabilitation services, emergency services, health maintenance, disease prevention classes, support groups, and community services. (Texas Health Arlington Memorial Hospital, 2009).

Like any other healthcare system today THAMH also faces competition in the provision of healthcare services to the communities it serves from several hospitals that also serve the same areas. These hospitals include the Medical Center of Arlington, USMD, Methodist Mansfield, and JPS in Fort Worth. To offset this competition and maintain its edge in the communities that it serves, THAMH continues to strive for improvement in the quality and the standards of the wide ranging components of healthcare services that it provides. An example of this striving for improvement can be seen in THAMH becoming one of the few hospitals worldwide and the first in Texas to receive the prestigious designation of “Cycle III Chest Pain Center — the highest accreditation possible for treatment of chest pain — by the Society of Chest Pain Centers” (Texas Health Arlington Memorial Hospital, 2009). Such a designation highlights the quality and standard of care provided by THAMH to patients that suffer with heart attacks and cardiac disease among the communities that it serves. This analysis and the recommendations on improving the quality and efficiency of its imaging center is being proposed as part of the strategic goal of continually striving for improvement in the quality and standard of healthcare services provided by THAMH.

The Imaging Center at THAMH

The imaging center at THAMH offers a complete range of diagnostic, interventional, and therapeutic radiologic and nuclear medicine healthcare services. The imaging specialties available at the THAMH imaging center include CT scan, diagnostic imaging, digital mammography, fluoroscopy, mammography, MRI, nuclear medicine, and ultrasound. These services are provided through a radiology department that is staffed by board certified radiologists and radiology technologist staff members. In addition, the THAMH imaging center provides support to a fully accredited independent radiology residency training program. The THAMH imaging center provides services through routine scheduling or on emergency basis, as both inpatient and outpatient, and covers the full range of ages from infants to the elderly. To ensure that these services are provided promptly and when required, the services are available 24 hours a day, seven days a week. Outpatient services are limited to twelve hours a day, from seven in the morning to seven in the evening.

The imaging center availability and staff manning these modalities at THAMH are well suited for providing high quality imaging support for the healthcare service provided by THAMH. However, any healthcare organization is only as strong as its weakest link in providing services to its patients. An analysis of the current process via the Current Service Blueprint (Appendix A) of the service process suggests that there are significant gaps in the provision of services at the imaging center, which need to be addressed to improve the standard of quality service that THAMH keeps striving for.

Current Service Line

The Current Service Blueprint (Appendix A) pertains to the current radiology outpatient scheduling and report process at THAMH. The service blueprint shows an overview of the process that takes place from the time a physician’s office calls in an order for a patient’s imaging procedures until they receive the final diagnostic report.  During the analysis of the current imaging center scheduling and reporting process at THAMH, two areas of inefficiency became apparent, which are due to the service design. The first area is in the multimodalities decentralize scheduling process and the second is in the process in which the imaging reports are created.

The first encounter of this process is between the physician’s office and the specific radiology exam area, which takes place via a phone call from the physician’s office. The order is then communicated from the exam area to the radiology outpatient front desk, in which a schedule confirmation is communicated by either fax or a phone call back to the ordering physician’s office.  The Current Service Blueprint (Appendix A) illustrates that the current process requires the physician’s office to call multiple areas, and make repeated calls, for an imaging order request. Often, these initial calls are not answered due to the unavailability of the staff, which may be busy in the examination area with patients. There is also the recurring problem of lost orders in each exam area after the order has been faxed from the physician office, which has contributed to numerous delays in the scheduling procedure. Another major problem with the current decentralized scheduling process is that each individual exam area is not consistently communicating with each other. For example, if a patient happens to have two radiology procedures scheduled on the same day, there is no system to coordinate the appointment times. The net result is that the scheduling system is inefficient and not sufficiently consistent to sustain THAMH’s target of excellent quality and high standards. This service design shows an imbalance in the service triangle in delivering the service as promised to the ordering physician’s offices.

In addition, the current reports process of the raw verbal data dictated by the radiologist is a very unreliable, inconsistent, and lengthy process.  It has contributed to numerous delays in ordering physicians receiving final reports. The major contributing factor to the problems in the current reporting process is that the raw verbal data has to be submitted into the RIS/HIM system in order for the transcriptionist to dial in and type the draft report. The finished report is then placed in a queue where it waits for the radiologist to review, approve, and sign. The signed report is then manually forwarded to the radiology clerical staff, before being sent to the ordering physician either by fax, courier, or mail. This lengthy reporting process may reach the ordering physician as fast as thirty minutes from the time the report was signed and approved, or it may take several hours. This not only presents a delay, but also projects an image of unreliability and a lack of system control. These imaging reports are crucial in the diagnosis of the patient, and delays in the required interventions significantly detracts from the respected reputation of the high quality service offered by the imaging center at THAMH.

The Proposed Service Line

            Closing or reducing the service gap presented in the current outpatient scheduling and reporting process at THAMH will be necessary to increase service quality and improve customer satisfaction. From the results of the analysis of the Current Service Blueprint (Appendix A) the radiology management team should consider a centralized scheduling process. This proposed centralized scheduling process will reorganize the ordering and scheduling process, where it will take place at the radiology outpatient front desk instead of the various imaging modalities.  A centralized scheduling process will reduce phone calls that are not being answered, lost orders, and redundant communications, which in total accounts for a major portion of the dissatisfaction felt by the physicians’ offices over the recent years. In addition, because the calls will be answered by the same radiology clerical team, and not by the various radiology procedure areas, the new process will be perceived as a more consistent and reliable service.

The radiology management team should also implement a voice recognition system, such as RadWhere, for their imaging report process. This voice recognition system allows the initial raw verbal dictation from that radiologist to be digitized and typed, which will eliminate the bottleneck that the current process has between the transcriptionist dial in and the radiologist signing and approving the final report. The voice recognition system would not only help expedite the final report to the ordering physician’s office, but would also be a major cost saving for the organization as the current transcriptionist contractor could be eliminated. The final signed report would be directly submitted to the ordering physician’s office by the radiologist without having radiology clerical staff involvement.  Overall, the most noticeable effect of this implementation would be that the reports would be submitted immediately after the radiologist’s dictation. This is in contrast to the current process; which may take from 30 minutes up to several hours for the ordering physician to receive final reports.

The essential features of speech recognition software, with regards to hospitals, is that it eliminates the excessive turnaround time, and is a convenient means of producing medical documentation in a digitized format for electronic health records. These can then be immediately reviewed and corrected by the author at the point of dictation. Speech recognition increases the efficiency of the creation of health records, and reduces the strain on the concerned medical professional, which ultimately saves money for the hospital (Philips Speech Recognition Systems, 2008; Nuance care, 2009).

The benefits accruing through the use of speech recognition software in report generation can be summed up as:

  • Reduction in expenses for transcription.
  • Significant increase in the productivity of the medical and radiology professionals.
  • Improved patient care and patient satisfaction by more precise documentation and faster delivery of reports.
  • Overall, reduced length of stay in hospitals for patients. (Nuance Corp, 2008).

The recommendations for improving the services provided at the imaging center at THAMH involves the implementation of a new centralized scheduling process in conjunction with the RadWhere voice recognition software for report generating and submission. With the implementation of these recommendations, the radiology imaging center’s inefficient order placement system, and the time delays in generating reports of image examinations, will be eliminated. In addition, the proposed changes in the Proposed Service Blueprint (Appendix B) of the radiology outpatient scheduling will assist THAMH to hone its competitive edge in facing the many competitors it has in the market of Arlington and the surrounding communities.

Conclusion

Study of the Current Service Blueprint (Appendix A) of the radiology ambulatory scheduling and reporting process structure of the THAMH imaging center reveals that it is inefficient and contributes to delays and unpredictability in the imaging center resulting in a decline in the quality of services given to THAMH patients. Evaluation of the features of a centralized scheduling process paired with the voice recognition system (RadWhere) demonstrates the benefits of using these elements and shows that their incorporation and implementation into the current process will remove the inadequacies that are present in the outpatient scheduling and reporting process. The Proposed Service Blueprint (Appendix B) illustrates the streamlined outpatient scheduling and reporting process system of the imaging center at THAMH. It has been developed incorporating the elements of centralized scheduling with the addition of voice recognition software (RadWhere). This updated blueprint will eliminate the delays and uncertainties associated with the current system. This will increase customer care and reflect positively on the image of THAMH as a high quality imaging center. It is strongly recommended that THAMH amends the outpatient scheduling and reporting process system of the imaging center at THAMH and adopt the Proposed Service Blueprint (Appendix B).

References
  • 50th Anniversary (2008). Retrieved February 20, 2009, from http://www.texashealth.org/body.cfm?id=2134&oTopID=2133
  • Nuance Corp. (2008). Speech recognition: Accelerating the adoption of electronic medical records”. Burlington, MA: Author. Retrieved February 20, 2009, from www.nuance.com/healthcare/pdf/wp_healthcare_MDEMRadopt.pdf
  • Nuance care (2009). Retrieved February 20, 2009, from http://www.nuance.com/care/
  • Philips Speech Recognition Systems. (2008). HC2008 Speech Recognition News. London: Phillips. Retrieved February 20, 2009, from www.speechmagic.com/index.asp?file=2969
  • Roberson, J. (2008, August 15). Texas Health Resources renaming 12 hospitals. The Dallas Morning News. Retrieved February 20, 2009, from http://www.dallasnews.com/sharedcontent/dws/bus/stories/081508dnbushospitalbranding.3fa3672.html
  • Texas Health Arlington Memorial Hospital becomes first in Texas, one of few worldwide, to receive prestigious chest pain center designation (2009, January 1). Retrieved February 20, 2009, from http://www.marketwatch.com/news/story/texas-health-arlington-memorial-hospital/story.aspx?guid={1DF70515-A89E-4BC9-B4C8-848EA5461110}

Service Blueprint of Hospital Radiology Department

Proposed Service Blueprint of Hospital Radiology Department

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