The Business Case for Patient-centered Care

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As part of a growing trend toward giving increasingly savvy patients greater control over their health care, radiologists are taking a more active role in patient-centered care, tailoring their practices to meet consumer needs. Putting the patient first might seem obvious or intuitive, but the idea has not always been at the forefront of the specialty, according to Vol Van Dalsem, MD, clinical associate professor of radiology at the Stanford School of Medicine.
Michael Brant-Zawadzki“It was arrogance to think that we have such an important and desired service that people should be grateful they are getting it—not worried about how efficiently and how safely they were getting it.”
-- Michael Brant-Zawadzki, MD


Van Dalsem participated in a session on the patient-centered–care movement, “Patient-centered Radiology: It’s Good Business,” on November 29, 2011, in Chicago, Illinois, at the annual meeting of the RSNA. He shared how his team at Stanford sought to improve the patient experience, beginning with easing the burden of scheduling—and providing valet parking at the door and Internet access in the waiting rooms. Turnaround times for scheduling and for returning calls were reduced, along with patients’ waiting times upon arrival. “In medicine, unfortunately, there’s the whole concept of ownership,” he says. “There’s a paternalistic view. It’s echoed, sometimes, in how referring physicians feel. What we’ve tried to do is make our process as easy and supportive of the patient as possible. “People are sick, bewildered, and frightened. How can we make things easy and transparent?” he continues. “There has to be a change in mindset: We work for the patient.” Better Communication Michael Brant-Zawadzki, MD, executive medical director of neurosciences at Hoag Memorial Hospital Presbyterian in Newport Beach, California, also participated in the session. He concurs that it was the attitude of the medical system that prevented many of these changes toward greater focus on the patient in the past. He says, “It was arrogance to think that we have such an important and desired service that people should be grateful they are getting it—not worried about how efficiently and how safely they were getting it,” nor about how much friendliness was extended. Brant-Zawadzki stresses the importance of communication to improve the patient experience. Such changes require that radiologists come out of the shadows: They have typically remained in the reading room, delivering completed reports to referring physicians who then translated the results to the patient. A growing number of radiology practices are now delivering results directly to patients through letters and web portals, he notes. In the past, patients had the ability to read their own reports, but few actually did so. With information more easily accessible online, new questions emerge about the best way to convey complicated information that can have profound effects on people’s lives. “If patients are going to be reading their own reports, should they be able to understand the reports? Should they be able to speak with radiologists?” Brant-Zawadzki asks. “None of that was ever thought about because radiologists were in the background.” At the University of Pennsylvania, Nick Bryan, MD, chair of the department of radiology, seeks to communicate clearly and accurately to patients in a timely manner. Bryan and his team have experimented with sending letters directly to patients explaining their test results. Now, he says, the group is taking a slightly different tack. In a pilot program for patients who undergo mammography, interventional-radiology procedures, or abdominal CT exams, the patient will be sent an email message, with links to the report, a week after the report was sent to the referring physician. “Typically, we haven’t communicated reports to patients, which has typically kept us removed,” Bryan says. “The main thing we produce medically—the report—we never deliver to the patient. It’s not clear yet how we’re going to modify behavior because we still have to write a technical document.” Getting Started Bryan reports that these changes represent a major shift in how the department of radiology at the University of Pennsylvania practices medicine. Similar changes have taken place in other areas of medicine, including in the rest of the university’s health system, where the results of all laboratory tests are now available to patients online. “We’ve always known patients have the right to see these reports, but we viewed that as the exception, rather than the rule,” Bryan says, pointing out that the electronic medical record has made providing online results to patients easier in recent years. He adds, “There’s no longer an excuse for not making reports available.” An industrywide effort toward providing more transparent health care is certainly driving many of the changes for radiologists and radiology practices. In addition, with imaging the target of increased compensation cuts, there is a desire for radiology to make itself more valued as a profession, Brant-Zawadzki says, which will include being more visible to patients. This, more than anything, represents the business argument for increased patient-centered care: It will be critical to safeguarding the specialty’s future. For radiology practices working to provide more patient-centered care, Vol Dalsem recommends first taking a step back and looking at the whole process, from scheduling to the final product, from the patient’s point of view. “Take a look at the process to see ways you can improve it. Then look at the culture. Try to embrace a culture (from the person who parks the cars all the way to the CEO) where you instill this mentality: patient first, last, and always. It’s a mindset shift. We work for the patients. It’s not the other way around,” he says. For radiologists in the forefront of their profession, the changes can’t come soon enough. “We should have been doing this years ago,” Bryan says. “We have a responsibility to provide our service—our product—to the patient. What’s good for the patient is good for our profession.” David Rosenfeld is a staff writer for