should be representation of the radiology department at senior management
level. The innate suspicion that clinicians and managers sometimes have of each
Waiting time for
department at Bolton: the complex development of a dedicated orthopaedic
radiology service; the simple rescheduling of patients within the CT department;
other can be diffused by recognising that, in most cases, they share the same
ambitions and goals for the radiology service. Lean service improvement events
an outpatient
and the development of a new acute ultrasound service.
are an excellent way of bringing clinicians and managers together, and are a
very effective method of demonstrating the need for investment where service
appointment
Orthopaedic radiology
In 2006, complaints about the orthopaedic radiology pathway were on the
redesign alone is not enough. On occasions, managers may need reminding of the
pivotal role of radiology in the management of many patients and that support
reduced by two
increase. Patients complained that they were waiting excessively in radiology,
radiographers complained that there were too many patients attending in a short
for improvement in radiology can result in speedier assessment of emergency
admissions and reduction in hospital length of stay.
weeks
period of time and clinicians complained about clinics over-running due to the late
return of patients from radiology.
Information technology A team was identified, consisting of staff directly involved in the orthopaedic
Picture Archiving and Communication System (PACS) has given radiology radiology pathway, leaders, patient representatives and staff who were not familiar
departments a fantastic opportunity to change the way they work. No longer with the pathway. Engaging a diverse team including staff who know the service,
are departments tied to hard copy films. This, together with digital dictation and encouraging them to redesign the process as they see fit, is fundamental to
and voice recognition, give the capability to report images as soon as they Lean and enables sustainability to be achieved. The team took a week out from
have been acquired at any available workstation on the system. Same-session their normal roles for a Lean rapid improvement event (LRIE). The aim was to
reporting of ultrasound and inpatient CT is the norm in many hospitals, and improve access to radiology, with shorter waiting times, a better patient flow and
departments should work towards ‘hot’ reporting of emergency department increased staff morale.
(ED), inpatient and GP plain ‘film’ work. Electronic requesting and results
reporting should be implemented to cut the current dead time when requests A value stream analysis was performed, documenting the value-added and non-
and reports are in transit. value added steps in the process. A ‘current state map’ of the journey from arrival
at the main hospital entrance to being discharged from clinic was created. An
The right equipment ‘ideal state’ was identified, the pathway that could be provided if money, resources
Radiology departments need to be adequately equipped. It is a false economy and space were no object. From this a proposed ‘future state’ was created, a
to delay the replacement of obsolete equipment as it becomes increasingly pathway that is achievable in the near future.
difficult to maintain, and there are significant workflow advantages with direct
digital radiography (DR) over computed radiography (CR). There are often further The data demonstrated that a patient could spend five hours on one visit
advantages to be gained by placing equipment in the patient flow outside to the orthopaedic clinic with up to two hours being spent in the radiology
the main radiology department – two examples from Bolton are given below. department. Patients were frustrated with being sent across a main corridor from
Lean service improvement events are useful to optimise the use of existing one department to another, having to queue and give their personal details to
equipment and to provide a persuasive case for equipment replacement where multiple receptionists and having to wait continually in often overcrowded waiting
such need exists. rooms. These problems were exacerbated by prioritisation within radiology of
patients from the ED as a result of the four-hour target for such patients, leading
Capital funding for equipment replacement is often difficult to obtain, and trusts to outpatients having to wait even longer for their imaging. Staff were stressed
should consider the option of a ‘managed facility service’ – essentially purchasing and overworked. Radiology staff were unable to cope with the large numbers of
a service from a supplier who will provide regular equipment replacement, usually patients arriving in a short period of time and delays in their imaging resulted in
over a 10 to 20 year period, to an agreed timescale for a fixed monthly payment. outpatient staff having to cover over-running clinics. Sickness absence rates were
This also takes advantage of the VAT-free status of the purchase of a service as above the Trust target.
opposed to equipment.
Investigation of the clinic booking template identified that the majority of patients
Case studies from the Royal Bolton Hospital were being booked in the first 90 minutes of a session, with up to five patients
The application of Lean is shown below, with three examples from the radiology being booked every five minutes. This was because of the misconception that, if all
52
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IMAGING & ONCOLOGY
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2009
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