The case study revolves around an imaging center in the San Francisco Bay Area in California. The center had 3 competitors in its 10 miles radius. Thus they were trying to gain an advantage over the competitors and retain loyal customers and the task at hand related to Outpatient Imaging Reports.
From the list of improvement ideas, one had a high frequency- decreasing turnaround time. Physicians wanted to test the patients sooner and patients wanted early updates of their test.
The central leadership decided to use the Six Sigma tool kit to find the root causes behind the existing turn around time.
High Turnaround Time(TAT) for Outpatient Imaging Reports – 64 hours
During the DEFINE stage, the goals were clearly stated and the team members were identified. The industry standard TAT was 24 hours and the aim was to bring down the TAT to 24 hours or below.
In order to MEASURE the process, a turnaround process map was drawn. The team identified various points that affected the TAT. They also identified that many of those issues were under their control in the Outpatient Imaging process.
The ANALYSIS of the process data revealed 4 steps which took up a considerable amount of time. These were data entry into the radiology information system (RIS), transcription, report signature and report delivery. When technicians completed the scan, they pushed the images to the picture archiving and communication system(PACS) but missed closing the exam on RIS. The missing of this step meant that the scanned report couldn’t be sent and the facility wasn’t reimbursed.
Also, transcription and signature of the physician took a long time. This happened because the physicians had to re-familiarize themselves with the patient’s history before they signed off the report. And the transcriptions of the patient’s history took a long time to arrive.
In order to IMPROVE the process, the data entry technicians were trained and the importance of feeding the RIS was emphasized. Also, with the help of senior management, a software was put in place so that the radiologists could dictate, verify and sign off the report in a speedy manner.
The new changes had their own set of challenges. After the above things were set in place, a final reason for high TAT was revealed. The signed reports were not being faxed immediately. Making changes to the delivery protocol meant high cost, compliance with the U.S. Health Insurance Portability and Accountability Act, physician preferences, system capability, and the effect of interruptions of physicians’ office faxes during work hours.
But with great support and coordination, the process was streamlined.
In order to keep the process under CONTROL, regular feedback was taken from the customers. Also, for standardizing the process, the changes were said to be implemented in other processes of the center as well.
Physicians were happy to serve and customers satisfied with timely reports. The technicians had a new found purpose and the overall morale of the team went up.
Most importantly, the TAT went from 64 hours to 9 hours, an 85% improvement.
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