Paradox and imperatives in health care

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Intrigued by Dr. Bauer’s words earlier today? So was I. That’s why I decided to drop in on his afternoon session, “Paradox and Imperatives in Health Care: Effectiveness, Efficiency and e-Transformation.”

Bauer dropped more than a couple of jaws in this morning’s general session when he forecasted a slim 30% chance that some form of health care reform legislation will pass. Those jaws were dragging on the floor when he suggested that radiology, already a beleaguered sector of medicine by anyone’s standards, needs to take the initiative in enacting measures that will improve efficiency and quality of care.

So: how does he imagine the grassroots revolution playing out? What can we do?

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Expected behaviors for team performance

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It’s an obstacle encountered by every workplace: lack of productivity and efficiency brought on by coworkers not operating as a team. So Lisa DiTullio took the podium in one of this morning’s concurrent sessions to provide advice on how to improve team performance. DiTullio, now a specialist in project management, once worked for Harvard Pilgrim in Massachusetts, a health plan so troubled it was turned over to the state government and given 150 days to get its act together—or else.

“A simple investment in team dynamics can yield huge returns,” DiTullio noted. “It’s a process, not a singular event, and practice makes perfect.” She should know: Harvard Pilgrim was eventually able to turn its performance around with the help of some of the exercises outlined after the jump.

According to DiTullio, there should be four key expected behaviors for effective and efficient team performance:

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Pay attention, or success strategies for a challenging economy

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At this morning’s general session, Dave Jakielo, former president of HBMA, took the mic to discuss success strategies in a challenging health care economy. It was a little more doom and gloom for a group of folks who’ve already heard a lot of it here in Phoenix. Which makes Jakielo’s advice both prescient and hard to swallow: stay positive and pay attention.

Jakielo began by asking how many people in the audience had done wage freezes. A few hands went up. He asked how many radiologists had taken a pay cut for the first time, and a few more hands went up. “If your hand isn’t up, folks, odds are it will be by this time next year,” he said. “That means we have to change and adapt. If you’re not paying close attention to what’s going on in health care today, you may find yourself . . .” He drew laughs from the crowd as he displayed a picture of a shack with a sign reading, “Sh** Creek Paddle Store.”

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Performance management: the other stimulus plan

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There’s been a lot of talk here at RBMA about “performance improvement,” those two magical words that, according to many, are the key to unlocking your business’ full potential. But how exactly is performance measured, benchmarked and managed? On hand to answer that question this morning was Fred Downs, practice administrator at Diagnostic Imaging Specialists in Atlanta, Georgia.

Over the years, DIS’ performance plan has evolved from a “capital punishment” model to a “performance improvement” model. In the capital punishment model, qualifying events and behaviors for termination were enumerated, but feedback on performance was absent, and there was no organized mechanism for dealing with issues.

Wanting to deal with these problems, DIS went to a production model of performance, with poor results. “My personal favorite was, ‘I don’t believe in the RVU system,’” Downs recalled. People argued that the problems weren’t on their end, or that they worked hard enough. Over time, there was little change in staff behavior.

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Generational Issues

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At dinner with members of a prominent radiology group this evening, the conversation turned to generational differences and how they impact management and corporate culture. This was something of a hot topic at this year’s RBMA conference, where it seemed like everyone had an opinion about the younger generations—specifically, Gen Y (my own crowd) and the so-called “millennials”—and how we’re impossible to work with. (Oh, really? Say it to my face, already!)

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Paramjit Chopra, MD: What You’re Doing Wrong

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“When I look at this country,” said Paramjit Chopra, MD, who immigrated to the US twenty years ago, “I realize that we are incredibly spoiled. We want everybody to have everything, and we don’t want to worry about who’s going to pay for it. The basic principle of economics is that there is going to be scarcity.” Just the facts at this morning’s session on what radiologists need to do to prepare for health care reform, where Chopra led the discussion.

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Jim Borgstede, MD, on Staffing and Imaging Workload

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Jim Borgstede, MD, kicked off this morning’s second session on the topic of “Where is the Radiologist?: Radiology’s Changing Dynamics.” The well attended panel focused on staffing and imaging workloads; Borgstede reported that workloads for radiologists have increased sharply since the early nineties, while payment has begun to level off. Well, no huge shocks there.

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Pat Kroken on Improving Hospital Relationships

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Pat Kroken began her session this morning by referring to herself as “the ultimate capitalist.” She mentioned a few operational issues that can be overlooked by radiology groups working with hospitals, including the issue of remote reads touched on by Dr. Borgstede. “Remote reads introduce a whole new business dynamic to the hospital-radiologist relationship,” she said.

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Scientific Methodology for Performance Assessment

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Quality improvement. It’s the phrase on everyone’s lips at this year’s RSNA, and several sessions this morning will focus on the nuts and bolts of the process, providing a roadmap for making concrete steps toward practice improvement. Dr. James Duncan spoke on using the scientific method to assess physician performance. “The public is spending an incredible amount of money on health care,” he said, “and their impression is that they’re not getting their money’s worth.”

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Anatomy of an Error

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This morning’s sessions on quality improvement continued with Jonathan Kruskal, MD, PhD, focusing on safety and risk management in radiology. His presentation, “Anatomy and Pathophysiology of Radiological Errors,” kicked off with a quote from AJR: “It is not the occurrence of error that is damning, but the failure to seize on it as an opportunity for improvement.”

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Zero Defects: Is It Possible?

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Lucy Glenn, MD, spoke this morning on strategies for minimizing errors in diagnostic imaging. She began by discussing the concept of “zero defects”: “We as health care workers have to change our mindset,” she said. “What the typical organization wants is very few defects. We have to embrace what the patient wants, which is no defects. We have to get to a mindset where we think that perfection is possible and injuries are avoidable.”

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What You Can Learn from the Rise and Fall of Cosmetic CT

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Jonathan Berlin offered an interesting case study during this evening’s “Dos and Don’ts” session on strategic planning and marketing. “This will get us thinking about some of the things people have done wrong in the past,” he said. The case he discussed dates back to 2001, when two businesspeople decided to lease an EBCT scanner to perform whole body scans, cardiac and lung scans and virtual colonoscopy. He called the fledgling cosmetic imaging company “Life CT.”

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8 Key Drivers of Employee Engagement

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Managers, be advised: Work to increase satisfaction rather than engagement among employees at your peril. Why? You could end up retaining a disengaged employee who is quite satisfied with their position and happy to stick around to poison your culture by influencing the 52% of your workforce that is neither engaged nor disengaged. That was the advice of William R. Johnson, MBA, CRA, director of diagnostic services, Summa Wadsworth-Rittman Hospital, Wadsworth, Ohio, who spoke on Interviewing, Recruitment, and Retention during the Leadership Institute Basic Management Skills program on Wednesday morning. Johnson says that engaged employees take fewer sick days, have higher job satisfaction, are more satisfied with their personal life, and help attract top talent. Companies with engaged workforces across all industries earn 13% greater returns over the past five years.

“Engagement, in contrast to job satisfaction, is about passion and commitment, the willingness to invest oneself and expend ones discretionary effort to help the employer succeed,” Johnson says. Engagement is measured by the things an employee does that they are not required to do to keep their job, like stocking the linen closet between patients. “Satisfaction comes from engagement. If all you do is try to please people that won’t engage people. “We want to focus on engagement.”

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