Enhancing same-day access to magnetic resonance imaging.

PURPOSE The aim of this study was to provide better patient access to MRI within 24 hours through process improvement. METHODS The MRI process in an academic radiology department was examined. Customer value was determined using a Kano questionnaire. Current state process and performance data were measured. Process time and process value mapping were conducted. Underlying root causes that hampered MRI process flow were identified and prioritized using a fishbone diagram and failure mode and effect analysis. Statistical analysis, queuing theory, and statistical process control were used to describe and understand process behaviors, to test hypotheses, to validate solutions, and to monitor results. RESULTS Timely access to MRI examinations within 24 hours was identified as a key customer value. A total of 33 failure modes leading to process wastes, together with 113 potential failure causes, were worked out, of which 14 failure modes were prioritized and dealt with. Having improved the process, patient access within 24 hours increased from 53% to >90%. The mean cycle time was reduced from 52 to 39 minutes. The monthly throughput increased by 38%. Scanner productivity was increased by 32%. Revenue and savings are estimated to be about €247,000 in the first year, after subtracting all costs. CONCLUSIONS Patient access to MRI within 24 hours has been granted for >90% of requests. Improved productivity and cost saving are achieved simultaneously.

[1]  G. Boland,et al.  Stakeholder expectations for radiologists: obstacles or opportunities? , 2006, Journal of the American College of Radiology : JACR.

[2]  Donald M Berwick,et al.  Cottage industry to postindustrial care--the revolution in health care delivery. , 2010, The New England journal of medicine.

[3]  James H Thrall,et al.  Quality initiatives: Key performance indicators for measuring and improving radiology department performance. , 2010, Radiographics : a review publication of the Radiological Society of North America, Inc.

[4]  Alan P. Carlin,et al.  Marginal Cost Pricing of Airport Runway Capacity , 1970 .

[5]  Alastair Baker,et al.  Crossing the Quality Chasm: A New Health System for the 21st Century , 2001, BMJ : British Medical Journal.

[6]  Peter S. Pande,et al.  The Six Sigma Way: How GE, Motorola, and Other Top Companies are Honing Their Performance , 2000 .

[7]  Pablo R Ros,et al.  Survey of the use of quality indicators in academic radiology departments. , 2006, AJR. American journal of roentgenology.

[8]  C. Johnson,et al.  Process improvement: what is it, why is it important, and how is it done? , 2010, AJR. American journal of roentgenology.

[9]  E. Litvak,et al.  Cost and quality under managed care: irreconcilable differences? , 2000, The American journal of managed care.

[10]  K. Shojania,et al.  Management of MRI wait lists in Canada. , 2009, Healthcare policy = Politiques de sante.

[11]  Eliyahu M. Goldratt,et al.  What is this thing called theory of constraints and how should it be implemented , 1990 .

[12]  Ben Wang,et al.  Managing Patient Service in a Diagnostic Medical Facility , 2006, Oper. Res..

[13]  J. Vest,et al.  A critical review of the research literature on Six Sigma, Lean and StuderGroup's Hardwiring Excellence in the United States: the need to demonstrate and communicate the effectiveness of transformation strategies in healthcare , 2009, Implementation science : IS.

[14]  Amedeo R. Odoni,et al.  Use of Queuing Models to Estimate Delay Savings from 4D Trajectory Precision , 2009 .

[15]  C Berger,et al.  KANO’S METHODS FOR UNDERSTANDING CUSTOMER-DEFINED QUALITY , 1993 .

[16]  W. Vickrey Congestion Theory and Transport Investment , 1969 .

[17]  H. Forman,et al.  Workload of radiologists in United States in 2006-2007 and trends since 1991-1992. , 2009, Radiology.