WORKLOAD MEASUREMENT Radiologist workload
BY DR ADRIAN BRADY
measurement – why and how The workload of diagnostic radiologists lends itself to closer measurement and scrutiny than that of many other medical specialists, yet is frequently misunder- stood and mis-measured, either through a lack of understanding of our role in modern medicine or the lack of agreed, widely-applicable methods of measure- ment. This article describes the design of a valid method for measuring radiology workload and the results of a study to determine workload levels of Irish radiologists.
T
he common historical perception of radiolo- gists as providers of a “support service”, some- what removed from day-to-day clinical care, persists in some quarters, and leads to the belief
that our output can be measured by the number of items of service (e.g. the number of study reports) we generate. It is certainly true that the work of radiologists is still centred on interpreting and reporting on imaging studies, but our role has expanded substantially into direct provi- sion of patient care (e.g. through interventional and other procedural work), and participation in decision making through multi-disciplinary teamwork [1]. Nonetheless, planning for delivery of healthcare frequently focuses only on numbers of studies reported, and furthermore, fails to take account of the great range of complexity of studies we now interpret. Thus, it’s still common to see a radiology department’s output described as “200,000 stud- ies per annum”, with no indication of the relative propor- tions of low- and high-complexity studies. In countries where radiologist staffing is an internal mat- ter for radiology departments or groups, an over-worked department is free to determine its own staff requirement, and accurate workload measurement is less of a burning issue. However, in countries such as Ireland and the UK, Consultant numbers in the public healthcare system are centrally controlled by management structures. In this environment, the use of accurate data for manpower plan- ning is vital, if inequities are to be avoided, and patient services are to keep pace with demand.
THE METHOD OF MEASURING WORKLOAD
Bearing this in mind, in 2009 The Faculty of Radiologists, RCSI (the academic body responsible for provision of post- graduate specialist training in Diagnostic Radiology and Radiation Oncology in Ireland) decided to attempt to define
The Author: Dr. Adrian Brady is Dean, Faculty of Radiologists, Royal College of Surgeons in
Ireland.Ireland. e mail :
abrady@muh.ie
20 DI EUROPE
The output of a radiology department is still often described as “x studies per annum”, with no indication of the relative proportions of low- and high-complexity studies. More valid methods of measuring workload are based on relative value units per whole time equivalent.
APRIL/MAY 2012
an accurate, reproducible and adaptable method of measur- ing radiologist workload, and to collate nationwide data identifying current activity. A number of older measurement tools previously used in the Irish healthcare system were rejected, on the basis of their failure to accurately reflect the breadth and complexity of modern radiologist activity. Some tools used in other jurisdictions were considered, but rejected because their prime focus related to reimbursement issues, thereby incorporating elements of radiographer and other professional activities, and also technical equipment costs. We finally decided to use an adaptation of a measure- ment method previously published by Pitman and Jones, on behalf of the Royal Australian and New Zealand College of Radiologists (RANZCR) [2,3], which clearly separated radi- ologist, technologist and examination room utilization costs, and measured radiologist costs on a time basis. Relative Value Units (RVUs) were assigned to different cat- egories of plain film, mammography, ultrasound, CT and MRI studies. Complex, large-volume studies which required more time and effort to report were assigned higher RVU values than studies with lower complexity or fewer images. The full details of the method used can be found in our papers reporting the outcome of our nationwide survey [4,5]. The second, key element of our measurement method involved logging the amount of time spent by radiolo- gists on activities which would not ordinarily be captured
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