What Have We Done To Deserve This? Key Performance Indicators in Radiology.

Transcription

1 What Have We Done To Deserve This? Key Performance Indicators in Radiology. Poster No.: C-1505 Congress: ECR 2017 Type: Authors: Educational Exhibit S. Vujnovic 1, S. Vujmilovic 2, D. A. Stojanov 3 ; 1 Banjaluka/BA, 2 Banja Luka/BA, 3 Nis, SERBIA/RS Keywords: DOI: Outcomes, Health policy and practice, CAD, Management /ecr2017/C-1505 Any information contained in this pdf file is automatically generated from digital material submitted to EPOS by third parties in the form of scientific presentations. References to any names, marks, products, or services of third parties or hypertext links to thirdparty sites or information are provided solely as a convenience to you and do not in any way constitute or imply ECR's endorsement, sponsorship or recommendation of the third party, information, product or service. ECR is not responsible for the content of these pages and does not make any representations regarding the content or accuracy of material in this file. As per copyright regulations, any unauthorised use of the material or parts thereof as well as commercial reproduction or multiple distribution by any traditional or electronically based reproduction/publication method ist strictly prohibited. You agree to defend, indemnify, and hold ECR harmless from and against any and all claims, damages, costs, and expenses, including attorneys' fees, arising from or related to your use of these pages. Please note: Links to movies, ppt slideshows and any other multimedia files are not available in the pdf version of presentations. Page 1 of 14

2 Learning objectives 1. Understanding key performance indicators (KPI's) and performance measurement concepts, 2. Learning how KPI's drive performance and change behavior in a Department of Radiology. Page 2 of 14

3 Background The practica of medicine is undergoing continuous change, and one of the key facilitators of this change is medical imaging. The new health care marketplace focuses on the quality of care delivered and patient outcomes, not the amount of care provided. Radiology practices across the Europe face mounting pressure to improve quality and performance. From a managerial point of view, radiology services are among the hospital's most profitable departments, and they attract patients to the hospitals from physicians' offices and small prívate radiology facilities without advanced imaging services(1). To manage a radiology department without measuring performance in today's economical environment is unthinkable. Furthermore, owing to changes in the health care environment such as an aging population, overutilization of health care resources, shortage of health care personnel, and declining reimbursement, strategic planning and management are becoming increasingly important to academic health centers as well(2). One of the means that has been advocated for improving healthcare delivery is the implementation of a balanced scorecard (BSC) (3). Presented by Kaplan and Norton in the early 1990s, BSC have been used in industry to align performance measurement with strategic focus and more long-term planning.bsc advocates the same philospohy that organization should be looked beyond financial meter. In addition to finance-related measures, balanced scorecards include measures related to customer satisfaction, internal processes, and alacrity in achieving improvement. Balanced scorecards are increasingly being used in healthcare delivery and typically include measures related to quality of care, outcomes, and access (4) A key concept in creating a scorecard is that "you get what you measure"(5). KPI's are financial and nonfinancial measures that are used to define and evaluate the success of an organization. KPI's may be used to assess the Department of radiology and define andquantitatively measure progress toward organizational goals. Page 3 of 14

4 Findings and procedure details In order to develop an appropriate set of performance measures for the BSC in the radiology department environment, and to understand those measures in a practical context, a pilot study has been deployed on radiology department in a large tertiary care 1000 bed public hospital in Bosnia and Herzegovina, offering the full suite of radiological inpatient and outpatient services. Four performance management system goals had been established by the leadership (Figure 1.). 1. Translate Department mission, vision, values and goals into clear measurable outcomes that define success, and that are shared throughout the organization and with customers and stakeholders; 2. Provide a tool for assessing, managing, and improving the overall health and success of business systems; 3. Include measures of quality, cost, speed, customer service, and employee alignment, motivation, and skills to provide an in-depth, predictive performance management system; 4. Replace existing assessment models with a consistent approach to performance management. Our departmental mission, vision, values and goals were articulated by the leadership in the formulation of four categories of measurement, which were inspired by the Kaplan- Norton balanced scorecard (Figure 2.) and the Five Rights of Imaging (6). The Five Rights framework implores the radiology community to ensure that each patient receives the right study, using the right order, done the right way, communicated in the right report, and leading to the right clinical action. Categories are: 1. Patient perspective : Aims to increase a safety and quality of care, 2. Stakeholder perspective : Focuses on the interests of internal and external stakeholders), 3. Internal business processes perspective : Aims to develop better product and service characteristics. 4. Financial perspective: Focuses on enhancing the cost structure and using assets to return greater productivity. Within each of these four categories, KPI's were formulated to align with our departmental mission,vision, values and goals. Development of radiology-specific KPI's Page 4 of 14

5 was collaborative effort of radiology department and administration. The key performance indicators that reflect the mission, vision, and strategic direction of an organization are collectively referred to as "dashboard indicators"(7). KPI's commitee identified 25 radiology-specific KPI's and 32 possible metrics. We have chosen our KPI's in an attempt to strike a balance between the critical nature of quality improvement (and other departmental efforts) and the ease of availability of data (including the amount of additional work needed to collect accurate data) (8). Each indicator is selected according to business purpose and the ability to be gathered easily through standard business functions(9). Four categories KPI's are from : 1.Patient perspective (Table 1) 2.Stakeholder (internal and external) perspective 2.1.Reffering physician perspective (Table 2) 2.2.Employee perspective(table 3) 2.3.Equipment related (Table 4) 3.Internal bussines perspective 3.1.Resource utilization and productivity (Table 5) 4.Financial perspective (Table 6) Resistance was encountered from different staff groups when first implementing a BSC. This is because different measures that are being taken to reach an objective challenge the status quo. Staff motivation was improved and maintained by implementing a system of incentives rewarding staff with a bonus for achieving stipulated targets. The benefit from using the BSC in a radiology department is crucially dependent on an adequate selection of objectives and key figures and the measures chosen to attain a set objective. Page 5 of 14

6 Images for this section: Fig. 1: Figure 1. Performance management system goals. Page 6 of 14

7 Fig. 2: Figure 2. Four categories of measurement, which were inspired by the Kaplan- Norton balanced scorecard. Table 1: Patient perspective KPI's. Page 7 of 14

8 Table 2: Reffering physician perspective KPI's. Page 8 of 14

9 Table 3: Employee perspective KPI's. Page 9 of 14

10 Table 4: Equipment related KPIs. Page 10 of 14

11 Table 5: Resource utilization and productivity KPI's. Page 11 of 14

12 Table 6: Financial perspective KPI's. Page 12 of 14

13 Conclusion The use of KPI's can help develop a departmental culture of quality improvement, focus healthcare providers on specific quality improvement projects, and drive departmental performance. Senior leadership must define clear strategic goals that apply to the entire department. Knowing the goals enables managers to understand in what aspects of performance measurements must be centered. Finally a prototype of radiology BSC was implemented in four perspectives including patient perpective,stakeholder perspective, internal business processes perspective and financial perspective. Applying such dashboards could help managers to evaluate radiology department from desirable or undesirable stance of performance. KPI's can provide a snapshot of the organisational performance that is easy to understand and which can enhance communication with key stakeholder groups ranging from patients to staff. KPI's is a valuable tool for helping drive quality improvement,but its adoption will not in and of itself drive change. Other critical factors include committed leadership, a culture of performance improvement, and adequate resources. Page 13 of 14

14 References 1. Silver M, Yi C. Imaging Services. Executive Briefing. Evanston, IL Sg2. 2. Zelman WN, Blazer D, Gower JM, Bumgarner PO, Cancilla LM. Issues for academic health centers to consider before implementing a balancedscorecard effort.acad Med 1999; 74: Weir E, d'entremont N, Stalker S, Kurji K, Robinson V. Applying the balanced scorecard to local public health performance measurement: deliberations and decisions. BMC Public Health 2009;9: Zelman WN, Pink GH, Matthias CB. Use of the balanced scorecard in health care. J Health Care Finance 2003;29(4): Donnelly LF, Strife JL. Performance-based assessment of radiology faculty: a practical plan to promote improvement and meet JCAHO standards. AJR Am J Roentgenol 2005;184(5): High Performance Imaging. Safety Leaders website. # org/greenlight/?step=4#. Accessed September, DeBusk GK, Brown RM, Killough LN. Components and relative weights in utilization of dashboard measurement systems like the balanced scorecard. Br Account Rev 2003; 35: Donnelly LF, Gessner KL.Quality Initiatives Department Scorecard: A Tool to Help Drive Imaging Care Delivery Performance RadioGraphics 2010; 30: Barta RA. Dashboardss: a required business management tool. Biomed Instrum Technol May-Jun; 44(3): Page 14 of 14