Quality in the Spotlight

The ACR Conference on Quality and Safety brings together a diverse group with a common goal: improving patient safety and imaging quality.quality in spotlight

In February, radiologists ranging from residents and fellows to practice leaders gathered in Scottsdale, Ariz., to discuss one of radiology's most important topics: the safety of patients and the quality of radiology.

The conference is rooted in an informal 2004 gathering by a collection of radiologists seeking to improve quality within the specialty. In 2005, the group of 16 convened in Sun Valley, Id., to exchange ideas and plan the first Quality and Safety Symposium, held in 2006 and hosted by the ACR. Today, what began as a small gathering of dedicated physicians continues as the ACR's annual Conference on Quality and Safety. While the event still attracts a set of passionate health-care providers, its curriculum has been refined and its scope broadended. And now there are far more than 16 attendees.

In fact, this year the conference sold out, with a final count of more than 130 attendees, which demonstrates the timeliness of the theme. "Everyone in health care is under more scrutiny to prove that they are delivering quality health care, and it's going to be important to take an active role in ensuring quality and making sure that we have systems in place to demonstrate that quality," said conference attendee Stephen Lee, MD, a resident at Baylor College of Medicine in Houston.

Defining Quality

Joseph R. Steele, MD, MMM, deputy head of clinical operations in diagnositc imaging and associate professor at the University of Texas MD Anderson Cancer Center in Houston, began by outlining three conventional methods of measuring quality: clinical quality (measured by patient outcomes), service quality (measured in terms of patient experience and satisfaction), and economic quality (measured in cost). While each can contribute to overall patient care, Steele asserted that none of these on its own leads to meaningful improvements in care.

Instead, Steele encouraged attendees to think differently about the role of metrics in patient care. "Quality in imaging is about building systems that provide better care, and not about fulfilling metrics," he said. In the future, said Steele, radiology will move toward measuring outcomes rather than using intermediate metrics focusing on processes. While this shift will be difficult, measuring the impact of imaging will allow the specialty to demonstrate its integral role in patient care.

Start Here

David B. Larson, MD, MBA, Janet L. Strife Chair for Quality and Safety in Radiology at Cincinnati Children's Hospital Medical Center in Cincinnati, the conference faculty chair, and co-creator of the Sun Valley Group, set out a basic model for quality improvement, which attendees could use to frame their own quality improvement projects. It included the following principles.

Decide what you want to improve. Before launching a quality improvement project, Larson, who also serves as chair of radiology quality and safety, chief of quality improvement, and assistant professor at Cincinnati Children's Hospital Medical Center in Cincinnati, instructed attendees to define both their specific goals and their overarching, mission-related objectives. He began with examples of high-level goals, like improving patient safety and satisfying referrying physicians. From there, he narrowed to more specific, measurable, and actionable goals (for example, setting a date by which to reduce turnaround time by a certain amount).

Define how you will know if improvement is happening. Quality improvement programs must track data carefully to guide the development of projects and gauge progress. Improvement metrics might track data such as the number of times an event occurs or the amount of radiation delivered. These measures should be agreed upon and in place before the project begins.

Develop a set of changes aimed at improvement. Larson suggested making changes based on a process map, which traces each step in completing a process. This map should be drawn up by observing the processes taking place, with input from the individuals involved. Larson instructed attendees to use this map to identify where problems are arising. From there, they could come up with a set of changes to address the problems.

Test changes before implementing. Before changes are put in place, Larson emphasized the importance of auditioning the new processes. He suggested planning out and walking through a sample scenario that would challenge the process. After analyzing the results, quality improvement teams must choose to adapt the changes and retest, adopt the changes that prove successful, or abandon changes that prove flawed. For example, a new process that turns out to be overly cumbersome for the staff involved may need to be simplified. A process that actually makes the situation worse would most likely be discarded.

Built-In Collaboration

While faculty presentations proved valuable, attendees also had a chance to participate in round-table sessions, in which small groups worked through common challenges together. "I don't have all the answers," Steele said at the beginning of each round table he moderated. He went on to tell participants that many of the answers they were looking for would come from their fellow attendees. These round tables offered opportunities to share knowledge, best practices, and lessons learned.

The round tables are just one example of how program organizers built collaboartion into the structure of the conference. The program also included Q&A sessions, topic-specific panels, and the opportunity for attendees to meet with organizers in one-on-one session to talk through planned projects.

Taking Theory to Reality

C. Dan Johnson, MD, professor of radiology and chair of the Department of Radiology at Mayo Clinic in Scottsdale, Ariz., closed the conference with practical advice on building a quality infrastructure. He emphasized the importance of developing a quality program that meets the needs of each individual setting. "Quality can be defined and measured in many ways," he said. "The best ways are customized to your department, your customers, and your environment."

While the threats to radiology are as real as ever, Johnson pointed to quality and safety as an important key in shaping the future of the specialy. "The risk of radiology being commoditized is certainly out there," he said. "And the best way for us to preserve our future and the value that we bring to patients is to improve quality and safety."

By Lyndsee Cordes

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