The path of least resistance: is there a better route?

In May 2000, the radiology department at Stanford University Medical Center embarked on a five-year journey toward complete digitization. While the end goal was known, there was much less certainty about the steps involved along the way. Stanford worked with a team from GE Medical Systems to implement Six Sigma process improvement methodologies and related change management techniques. The methodical and evidence-based framework of Six Sigma significantly organized the process of "going digital" by breaking it into manageable projects with clear objectives. Stanford identified five key areas where improvement could be made: MR outpatient throughput, CT inpatient throughput, CT outpatient throughput, report turnaround time, and Lucile Packard Children's Hospital CR/Ortho throughput and digitization. The CT project is presented in this article. Although labor intensive, collecting radiology data manually is often the best way to obtain the level of detail required, unless there is a robust RIS in place with solid data integrity. To gather the necessary information without unduly impacting staff and workflow at Stanford, the consultants working onsite handled the actual observation and recording of data. Some of the changes introduced through Six Sigma may appear, at least on the surface, to be common sense. It is only by presenting clear evidence in terms of data, however, that the improvements can actually be implemented and accepted. By converting all appointments to 30 minutes and expanding hours of operation, Stanford was able to boost diagnostic imaging productivity, volume and revenue. With the ability to scan over lunch breaks and rest periods, potential appointment capacity increased by 140 CT scans per month. Overall, the CT project increased potential for outpatient appointment capacity by nearly 75% and projected over $1.5 million in additional annual gross revenue. The complex process of moving toward a digital radiology department at Stanford demonstrates that healthcare cannot be healed by technology alone. The ability to optimize patient services revolves around a combination of leading edge technology, dedicated and well-trained staff, and careful examination of processes and productivity.