Recently I was at UKRC, the largest radiology tradeshow in the UK, and I had the opportunity to join two McKesson customers at a symposium about transformation driven by quality in imaging. These customers told us how their organizations used strong governance groups, data-driven decision making processes and continuous improvement to improve quality in their imaging workflows across their entire enterprises.
I believe that with the adoption of Accountable Care and Value-Based-Care in the United States, there are more and more similarities between the challenges the public system in the UK and Ireland face and the challenges the health providers in the US face. While there are differences in geography, the desire for improved quality and consistent improvement through peer review are truly universal.
Transforming Quality in Ireland
In January 2010, the Royal College of Physicians of Ireland set out to improve patient care, increase public confidence, improve communication, identify good practices and identify areas for improvement. To call these goals ambitious would be quite an understatement.
This large-scale overhaul included four key elements:
- Create key quality indicators
- Collect more data
- Collect more accurate data
- Compare key quality indicators against national benchmarks.
The first site went live with the new automated quality improvement system in 2014 and by May 2016, 40 sites were up and running. The new quality workflow is integrated with the radiologists’ regular reading workflow, giving physicians the ability to receive alerts and launch their peer reviews (prospective and retrospective) directly from their workstation. The resultant quality data is then reported out to Ireland’s new national Quality Improvement reporting system.
Only one year after implementation, the pilot site (University Hospital Waterford) reported 2,770 completed peer reviews, 796 radiology alerts issued and 221 ED alerts raised.
Five major lessons learned in Ireland’s Quality Improvement Program
The patient care improvements taking place are astounding, and equally important are the lessons learned in achieving a transformation of this magnitude, as reported by the national association:
- In conjunction with key stakeholders, develop a roadmap for quality which clearly demonstrates the value in undertaking the task.
- Recognize the importance of regular communication in affirming consensus and continued buy-in to the goals of the programme.
- If you put in place systems that make it easy to capture quality activities within physicians’ existing workflow, it will be more effectively adopted
- Acknowledge that programs will evolve, and be open and flexible to accepting feedback.
- A big-bang approach is not advisable. Incremental deployment can promote adoption of positive changes on an ongoing basis.
The second story we heard was that of Alberta Health Services, an organization that on the surface, has very little in common with its Irish counterpart. And yet, as they articulated their goals and results of their quality program, the similarities were undeniable.
The power of anonymous review in Canada
Alberta Health Services (AHS) is one of Canada’s largest provincial health systems. It provides comprehensive services to more than 4 million people across 255,200 square miles, including millions of diagnostic exams a year.
After the Alberta Minister of Health called for a thorough examination of quality assurance processes as they relate to diagnostic imaging and pathology testing, AHS set out to create a quality assurance (QA) program that would reduce errors and improve patient outcomes through quality improvement in interpretation, reporting and image review.
AHS now uses an advanced routing system to ensure anonymous studies and reports are reviewed and rated and also lets radiologists provide feedback on image quality. Clinically significant discrepancies are quickly routed to an adjudicator for confirmation while discrepancies that are not clinically significant are routed to discrepancy rounds… To ensure significant discrepancies are addressed in a timely manner, the reporting radiologist acknowledges receipt of the notification. In the absence of this acknowledgement, the system automatically initiates an escalation process, and if the discrepancy is not confirmed, the reviewing radiologist is informed of the change and the reason.
AHS learned some powerful lessons about the value of timely and anonymous review. During her presentation, Marlene Stodgell-O’Grady, the Director for Diagnostic Imaging said “Peer review of recently reported studies has allowed us to identify clinically significant discrepancies early and positively affect patient outcomes. Anonymous studies truly support an education focused program and just culture. In fact, education-focused, anonymous peer review can change culture and improve patient care without finding discrepancies or errors.”
The parallels between these two success stories really illustrated for me the powerful changes that can take place when healthcare organizations, no matter where they are, decide to raise the bar, and use quality as a benchmark. This mindset places a priority on patient care and quality outcomes that is both timely and applicable in the US healthcare industry’s shift from volume to value. As you’re navigating this change, be sure to consider the lessons learned by your like-minded peers across the globe.
To learn more about the role quality workflows played in their transformations, request the full presentation, Transforming Radiology with Quality Improvement and Collaboration. For more information about the Conserus suite of enterprise imaging solutions, please visit our web site.