1. A multidimensional audit of
a radiology department
in a large-sized hospital
| BACKGROUND | RESULTS
| A radiology department has a central position within a hospital as it supplies a service to
many of the internal departments, internal and external referring physicians, and a large |1| Main problems elicited on result-side of the model:
number of patients.
| Relationships and co-operations between the employees of the department
| In order to provide a good service, it is crucial that both the operations of the radiology People (radiologists, nurses, administrative and logistic staff) were problematic.
department and the co-operation with internal departments and referring physicians are optimal.
| A very low employee satisfaction level was measured: low motivation level, perception of
| In a large-sized hospital – a merger of different hospitals – the different cultures of the high workload, etc.
former hospitals were still tangible.
| This was also reflected in the radiology department, which resulted in a broad number of
| Waiting times for ambulatory patients to get an appointment are (becoming) problematic for
problems for the department and impacted patients, employees, other units in the hospital,
echography, CT, mammography and orthopaedic MR.
referring physicians, etc. Patients
| An inadequate patient-centred approach was observed in the department.
| The Board of Directors of this hospital requested an audit of their radiology department.
Internal
Customers | Problematic and insufficient co-operation with other internal departments.
| OBJECTIVE
Hospital | Deteriorating image of department within the hospital.
| The objective of this project was to identify and objectify internal and external complaints,
and define the underlying problems within the department or hospital.
| This organisational audit focused on processes, patient and employee satisfaction, internal
co-operation and Service Level Agreements (SLA), general organisation, planning, |2| Main causes elicited on organisation-side of the model:
different functions and roles within the department, etc.
| The original polarisation in the group of radiologists - started out of the merger - is still very active.
| Excessive informal communication in the department resulted out of polarisation,
Leadership unprofessional behaviour and insufficient formal communication network.
| METHODS | A lack of a well-defined organisational structure within the department resulted in
inadequately performed tasks and neglected responsibilities.
| An adjusted version of the EFQM-model (European Foundation of Quality Management) was
used in the audit (Figure 1). This model is a framework for understanding the relations | The dual management team’s operations (Head Nurse and Head Radiologist) were
between what a department does (organisation-side) and the results it can achieve (result-side). challenging: they had no defined vision and strategy to execute and no well-defined
organisational structure to work with.
Figure 1 IMPACT EVALUATE
| Conflicts within the group were obstructing the development of a general supported vision,
Management People
Of People
Strategy & mission and strategy for the department.
Policy
Management Patients | Insufficient monitoring of the market and quality indicators (e.g. waiting times, throughput
Strategy &
Leadership
Policy
Of Hospital times, patient satisfaction, etc.) was observed.
Processes Internal
Customers
Management
External
Of Resources Customers | Unrealistic time allocations for certain functions led to a short term approach: only the most
essential tasks were performed and little time was spent on the development of the
ORGANISATION RESULTS Management
Of People department (e.g. HRM of staff is more than resource planning).
| The human resource management within the department was inadequate.
CHANGE AUDIT
| We approached this audit in 4 different phases (Figure 2) | The appointment scheduling in the department was very supply-driven: the agenda was set
Management
up based on available resources and not based on market demand.
| The first phase – ‘Intake phase’ – gave us an understanding of the context of the department Of
Processes
and the hospital by means of interviews with hospital management and the Board of Directors. | Lacking co-operation with other internal departments resulted in uncoordinated procedures
and processes.
| In the ‘Definition phase’ - phase 2 - the entire result-side of the model was captured in order
to define the problems in/with the department for all stakeholders: radiologists and Management
Of Resources | Allocation of resources – radiologists, machines and nurses – was suboptimal.
employees (people), patients, internal doctors and head nurses (internal customers), GP’s and
other co-operating hospitals (external customers).
| The results were elicited by using perception and performance parameters. These parameters
were captured by means of structured interviews, surveys, measurements, observations, | RECOMMENDATIONS
data-analysis, etc.
The audit defined a large number of recommendations for the department to tackle the
identified problems. Below, the main recommendations are described.
| In phase 3 priorities were given to all problems caputered in the previous phase. An audit
track or change track was defined for the high priority topics. | Defining a general shared vision and mission for the department is vital.
| Consequently, concrete objectives and strategies need to be determined and incorporated
in a structured strategic document including a systematical review.
| In the Audit phase – phase 4 A – several topics were further analysed to determine the
underlying causes of the problems defined in phase 2, by mapping the result-side on the | Developing a new and well-defined organigram – including functions, tasks, roles and
organisational-side of the model (Figure 1). responsibilities, information lines, etc. – is a second crucial element. This recommendation
was enclosed in one of the change tracks that were implemented in this project.
| Different analysis methods were used: observations, interviews, registrations, work shops,
profile-analysis, data-analysis, surveys, etc.
| Inventorying all conflict topics and systematically discussing, objectifying and clarifying
these topics is necessary in solving the current polarisation.
| Change tracks – phase 4 B – were identified out of previous phases. Implementing a change
track implies a change of the organisation-side that has an impact on the result-side, which | Coaching the strategic meetings within the department is necessary to facilitate the
can be remeasured (Figure 1). problematic decision process.
Figure 2 | Developing SLA’s with the different internal departments, starting with the Emergency Room
as their main internal customer.
| Developing a structured formal communication network is necessary to restrict excessive
INTAKE
PHASE 1 informal communication.
| Changing the current supply-driven appointment scheduling to a demand-driven system
INTERNAL RADIOLOGY DEPARTMENT will be indispensable.
| Setting up a quality system and monitoring quality parameters is fundamental in a
quality strategy
demand driven appointment scheduling system.
ExTERNAL PATIENTS | Decreasing work load for staff and increasing general efficiencies can be achieved by
PHASE 2 CUSTOMERS
RADIOLOGY
separating the variable (no appointment) and fixed (appointment) patient flows.
processes organisation
| Improving resource planning by tackling acute and threatening staff shortages.
| Developing a long term plan for increasing the number of radiologists, simultaneously
INTERNAL CUSTOMERS
determining subspecialisation.
PLAN | Standardizing processes (e.g. patient transportation, application of examinations),
PHASE 3 OF APPROACH procedures and guidelines to optimize the co-operation with the internal departments.
| Enhancing human resource management by defining concrete policies for training and
evaluation of staff.
AUDIT CHANGE
PHASE 4A PHASE 4B
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