A3 DIAGNOSTIC IMAGING & MRI

Summer 2021
 Title/Short description:
Team:
EAM MEMBERS/CHARTER FOR STRUCTUR

ACTIVITIES/MILESTONES
Position Role
Kickoff
Information Gathering
Director of Imaging Project Sponsor
Data Review and Priority Setting
Manager, Imaging Operational Owner PDSA 1:
Supervisor, Diagnostic Implementation PDSA 2:
Radiology Leader PDSA 3:
Implementation 30-Day Review
Supervisor, MRI
Leader 60-Day Review
Senior Mgr, Patient 90-Day Review
Project Leader
Relations
Patient Relations
Project Coordinator
Intern

VP, Operations Executive Champion

 BOX 1: REASON FOR ACTION
At Emory Johns Creek Hospital, the MRI and
Diagnostic Imaging team have struggled to
consistently meet the target of a mean score of 95
for “definitely” likely to recommend in FY2021
(92.8% rolling 3-month average for MRI and 94.5%
for diagnostic radiology), resulting in decreased
morale for the teams and decreased ability to mee
the service expectations of our community.
Trigger: Patient checks in Done: Patient leaves
facility
In Scope: Registration, Out of Scope: Physician
changing, procedure, practice procedures,
immediate post- inpatient, ED
 BOX 2: INITIAL STATE

# True North Pillar Metric Initial State

Mean Score:
Overall Likelihood May 2021:
1 Diagnostic
to Recommend 91.67%
Radiology
Overall Likelihood
2 Mean Score: MRI May 2021: 90.1%
to Recommend Initial State Qualitative
 What are the attributes of the current state?
1. Lengthy wait times
2. Lack of communication about delays (non-AIDETH)
3. Materials and space not competitive with industry standard
4. Staff unable to manage “fires” while performing procedures
5. Routinely wrong coding of orders slows flow.
BOX 2: INITIAL STATE – PRESS GANEY

TIC RADIOLOGY

MRI
INITIAL STATE: HEAT MAPS – X-RAY
 INITIAL STATE: HEAT MAPS – X-RAY

EMES
UT
ACTION

OPPORTUNITY AREAS
INITIAL STATE: HEAT MAPS MRI
 INITIAL STATE: HEAT MAPS – MRI

EMES
UT
ACTION

OPPORTUNITY AREAS
TIAL STATE: EMPLOYEE FOCUS GROU
esses
Need person specifically for vetting, not good use of tech time
Need trained scheduler that can call patients before and after
Need established protocols for procedures per provider preferenc
onnel
Need more technicians, especially during peak times
Need more transporters – transporting the inpatients extends dela
Need circulator to manage patient updates and questions when s
procedures
ities
No one is coming into properly clean equipment or environment
Employees have to do it themselves
Waiting area is not comfortable – stark, cold, not relaxing during o
stressful non-invasive procedures (other facilities have secondary
waiting area for MRI)
TIAL STATE: EMPLOYEE FOCUS GROU
ces
o cost estimations for procedures
ong process to allow patients to get costs
essured for productivity, not service. Don’t feel like they can paus
xtra layer of service when cases are stacking up.
of comfort
andard at other hospital are scrubs/disposable shorts. The gown
dustry standard.
ccess to snacks/beverages post-procedure for guests
RI is furthest away from waiting area, having to walk that far for p
euro or chronic pain issues is challenging.
usic doesn’t work great in the MRI rooms.
NITIAL STATE: GEMBA OBSERVATION
h modalities: “Hurry up and wait,” lack of consistency in using
and Radiology staff (not consistent introductions, delays)

of 5 observations of X-ray conducted, 4 had no suggestions or

m the patients or areas in which staff did not meet expectation
patient arrived at 1:50 but procedure didn’t start until 2:50. S
t frustrating was lack of connection with staff (Other than tech
oductions and MD was “generic.” Appreciated the soothing sp
nliness of the X-ray room.
NITIAL STATE: GEMBA OBSERVATION

: Told to come 30 minutes earlier, then sat for 30 minutes. MR

s dirty, had sticker on wall from 3-26-2021. Hated the gowns. T
times to pre-register and thought he hadn’t when he had. Not
out paperwork again when he arrived if he pre-registered.
: Came early, then waited for nearly 45 minutes in waiting area
fficulty placing line, needed to wait for IR to arrive. Nothing to
hat space.
MRI 1: Technician was balancing competing issues with inpat
ient waited. Pt had no complaints but was not comfortable in
r her procedure to begin.
INITIAL STATE - PATIENT COMMENTS
wait times
any patients felt like they were forgotten about in the waiting room
on’t like being told to come in early only to have appointment not start
endly staff
any comments regarding front desk staff but said technicians usually ve
ng room
old, not relaxing, especially during delays (compare MRI to new Xray spa
enter – no distraction or creature comforts)
ot being sanitized. No hand sanitizers
rty floors, dust and stains in MRI waiting area
hairs hard to get out of, especially people with disabilities.
bathrooms
les with scheduling
 BOX 3: TARGET STATE
True Initial Target
# Metric %
North State State
May 2021:
1. Xray LTR 95.0 95.0 ↑3.3%
91.7%
May 2021:
2. MRI LTR 95.0 95.0 ↑4.9%
90.1%

Target State Qualitative

 Patient’s procedures are anticipated and ready to
go with minimal wait times
 Excellent communication on progress and
quantified durations
 Competitive, modern and industry standard
 Staff engaged and supported by leadership
 BOX 4: GAP ANALYSIS
Gap
Description of Gap Suspected Root Cause
Letter
Poor communication of Lack of dedicated
A
wait times and next steps circulator
Too much time spent Should be anticipated pri
B vetting orders which to arrival, prevented if rad
delays turnaround time tech scheduled.
Sub-par physical
C Cleanliness
environment
D Patient discomfort Current gowns unwieldy

*Use tools like Fishbone and 5 Why (see next pages)

 BOX 4: GAP ANALYSIS - FISHBONE
ETHODS MATERIALS PEOPLE

Lack of
Unsatisfied with
dedicated
ys snap gowns
circulator
Patients want
more comfortable More staffing
clothes
during peak
Tracking
periods.
methods
Scrubs Proba
Dedicated
Vetting radiology tech Defin
scheduler
“Likelih
Recom

…
…
ent …

RONMENT Supplies Other

BOX 4: GAP ANALYSIS – PICK CHART

eduled
IMPLEM Patient CHALLE
Managing PT Rounding
ogether ENT GOWNS
anxiety N Gtech
Rad E schedulers
Patient
Routine Cleaning Resuming Poor Patient Prepping (LPs, etc. Arriving Late
Waiting area for get sent home) (from MDs?)
n MRI patients
Passport for Waiting for
ent Order Cleanup
Service Staffing for
hift)
volumes Radio
ations Anesthesia/IV Sedation noti
Pillowcases not on time wait
POSSIBL KIBOSH
E
l for assistance (translated) Patients not dressed
(weekends)
 BOX 4: GAP ANALYSIS – 5 WHY?

WHY#1 WHY#2 WHY#3 WHY#4 WHY#

Schedulers are Suspect, M
Unaware of Confusing information
nt Arrives Late unfamiliar with the Actionable S
appointment time at scheduling
processes Root Cau
ommunication of Technologists too busy to Staffing shortages
Lack of circulators. ..
es and next steps notify front desk during peak periods.
Doing records requests
esk not notifying No one else doing
Don't have time and managing phone .. ..
ts about delays calls. that job
Suspect, Most A
.. .. Actionable Suspect .. ..
Root Cause

.. .. .. .. .. ..

Suspect, M
.. .. .. .. .. Actionable S
Root Cau

.. .. .. .. .. ..

.. .. .. .. .. ..
 JUNE COMMENTS
30 + minute wait after registration
he wrong entrance of the hospital and therefore had difficulty finding the outpatie
wever, once I was in the right place, I didn't have to navigate anywhere on my own
.
at the front desk was very aloof and unfriendly bordering on rude
me for my test after I was gowned up and my reading material locked up was over
f two orders for my tests was lost and had to be tracked down
y unexplained wait time was unacceptable. if I had been told the wait would be len
n out my book rather than just having a tv on in the waiting room. misplacing the
ncompetence or lack of attention to details
e helpful if the signage outside indicated where services like x-ray were offered. pa
to head in the parking lot.
ce from the entrance to Radiology was way too far. I had to stop and rest numerou
rived.
st entrance to Radiology should be clearly marked outside (I may have missed seein
ould know the goal even if the parking lot nearby is full.
pace due to Covid restrictions
 BOX 5: SOLUTION APPROACH
Bene
If We…. Then We… Date
Box
Improve
Hire a rad tech Have technologists spending
readin
scheduler
less time vetting the schedule Q1 2022 accur
and more time doing imaging
ord

Put a circulator in Will be able to communicate Keeps

waiting rooms
delays and next steps to patients August 2021 mo
easier

More
Replace snap Improve patient's comfort centr
gowns during imaging July 2021 decr
de
Incr
Create tracking
Have better idea of patient commu
method for front July 2021
 BOX 6: RAPID EXPERIMENTS
Anticipated Actual Follow Up
Gap Experiment
Effect Effect Action
Patients are
Implementing a
A updated about
circulator delays
Patients are
Tracking
B updated
method
about delays
C

D How (and what) will we measure?

ine

ents
 BOX 7: COMPLETION PLAN
Who? What? When? Status?
 BOX 8: CONFIRMED STATE
Initial Target Q1 Q2 Q3 Q4
# TN Metric
State State 2019 2019 2019 201
 BOX 9: INSIGHTS
What could be improved
What went well (Likes)?
(Please Considers)?

aHa! (Learn)
 Link to Rapid Improvement Event Files

for Action: Improvements Implemented:

xxxxx

State: Future State:

xxxxx

Insights:
xxxxx

Current State Future State Post RIE

ric #1

ric #2
Team Picture
 Link to Rapid Improvement Event Files

Other ways to connect stakeholders (e.g. foundation, leadership) to the work:

t Stories, Quantified Impact (e.g. # pts affected), Team Insights, Quotes, Pictures (e.g. befo
after), etc.
er ways to connect stakeholders (e.g. foundation, leadership) to
the work:
Patient Stories, Quantified Impact (e.g. # pts affected), Team
Insights, Quotes, Pictures (e.g. before and after), etc.