Managing Continuous Improvement in Imaging: MultiCare Health System
Continuous improvement is an oft-repeated catchphrase, but achieving it while maintaining or even ramping up efficiency can be difficult. That was the dilemma faced by Tacoma, Washington-based MultiCare Health System (MHS) in 2009. “We wanted to be able to close the loop on our quality assurance, getting the results of review back to the individual radiologist for his or her input,” recalls Andrew Levine, MD, Chair of the Executive Committee at Medical Imaging Northwest, one of three radiology groups serving the health system. “We needed a system that was integrated into the PACS so the radiologists wouldn’t have to go find a piece of paper and fill it out, interrupting their workflow.” In fact, the paper-based technologist QA system had resulted in complaints from radiologists that their quality improvement efforts were for naught, according to Kathy Floyd, Imaging Quality Coordinator at MHS: “You might send in something and never hear back on what was being done about it.” Streamlining QA That all changed in late 2009, when MultiCare implemented the Quality Intelligence Communication System (QICS™) by peerVue for quality assurance of both radiologists and technologists. “QICS gave us the real-time ability to do QA on prospective and retrospective cases,” Levine says. “Each radiologist also gets three cases to review on Monday morning. It can be done very quickly and easily—it takes just a few moments for each.” Further, the system allows for technologist- and transcription-specific QA. “We have the ability to open up the case and comment with any concerns, and if the technologist has done an especially good job, we can let him or her know that as well,” Levine says. “The case is reviewed with the technologist and the loop is closed in QICS. It creates great learning opportunities.” Floyd adds that because the health system’s radiology department self-edits reports, MHS developed a module in peerVue that deals solely with transcription. “A random selection of cases goes to the transcription QA person who takes a look at the body of the report to see if everything makes sense,” she says. “It’s just one more level of review.” More robust QA was only the beginning, however. Jim Sapienza, Imaging Services Administrator at MHS, notes that there is tremendous value in the years of data the health system has now accumulated. “We have three full calendar years of using QICS to capture comparative data,” he says. “We contract with three radiology groups, and the data allow us to compare and contrast metrics related to quality.” These metrics allow the health system to raise the bar for its radiology practices every year. “In the two to three months prior to the next calendar year, we review this year’s metrics and determine what next year’s target and best practice levels will be,” Sapienza says. “It’s written into a contract that we call the ‘shared quality and service agreement.’” Continuous Improvement Sapienza explains that the process of identifying and establishing these metrics is collaborative and data-based, leveraging information drawn from QICS, the EMR, and the dictation system. “We have six radiologist metrics a year, and when we get to a point where we’ve sustained one for three-plus years, it’s time to talk about bringing in a new metric,” he says. “So for 2014, we might decide to maintain four metrics at current levels, but we also want to take a step up and find two more metrics to challenge us and take us to the next level.” Floyd issues reports on the technologist data collected by the system on a monthly basis, making quality levels transparent across the organization. “I create monthly technologist QA reports with pivot charts so the data can be sorted by site and by modality from either radiologist feedback or technologist feedback,” she says. “Radiologist QA reports are generated monthly and quarterly. I also create charts on a monthly basis to look at indicators, trends, whether we are seeing a lot of one particular type of problem and why. It allows the sites and managers to focus on what they need to do for process improvement.” QICS has enabled the expansion of imaging QA beyond the radiology department as well. “We’ve added on a space dealing with adequacy of clinical information from clinicians, and we’ve also allowed the trauma and stroke service lines privileges,” Levine says. “These are two areas where when you make mistakes, you can have big problems with outcomes owing to the complexity of the clinical scenarios they’re facing. To us, this is much more than a radiologist system.” Sapienza concludes that the use of software-based QA has enabled MultiCare to foster a culture of continuous improvement. “What we’ve found is that having a good electronic tool that provides that closed feedback loop creates a solid foundation for decision-making and change management,” he says. “It underscores the culture of process improvement and helps get everyone on board.” Cat Vasko is editor of HealthIT Executive Forum.