Last March, a pilot project was set up to establish England's first radiology network in Kent and Medway. During its first year, the network made cash savings, delivered quality improvements and laid the foundations for new models of radiology service delivery for the future, writes Moira Crotty
Although the pilot project has now ended, its success was such that the local health economy is looking to secure its future.
Dartford and Gravesham, East Kent, Maidstone and Tunbridge Wells, Medway Maritime and Queen Victoria Hospital, East Grinstead all supply radiology services to the whole of Kent and parts of Surrey. The rapid deployment of NHS Connecting for Health radiology information systems and picture archiving and communication technology in 2005-06 fostered close working relationships between the radiology service managers, which they were keen to develop further.
With assistance from Connecting for Health and NHS South East Coast, a pilot scheme was created, focused on six specific elements:
- creating a cross-organisational staff bank;
- standardising elements of management information reporting;
- sharing procurement of consumable items and image acquisition equipment;
- establishing a cross-organisational best practice forum;
- sharing radiological examination reporting across organisations.
In the course of the project, we learned that trusts are more variable in terms of processes and management structures than we imagined. This is perhaps inevitable given the different sizes of the organisations concerned, but it did cause some interesting challenges with the moves towards shared standards and processes.
Good, clear communication was crucial to success, and a variety of techniques were used to ensure this. Within the teams, one solution developed when dealing with procurement of consumables was to structure the information to be gathered using a template. These were produced jointly by the people who would be asked to complete them.
When dealing with complex topics, we made use of "straw men" as a way of stimulating a discussion and identifying points of agreement and disagreement. In some cases, this created unexpected additional benefits in helping individual organisations understand their own processes better. For example, we developed a flowchart showing the procurement of imaging equipment. All the managers agreed it represented their processes, but we later discovered that this was not entirely the case in practice. We also made great use of face-to-face meetings, particularly when potentially difficult or controversial items needed to be resolved.
In focusing on management information reporting and sharing radiology examination reporting, we were seeking to leverage the technology to deliver benefits over and above those already realised in individual trusts. Perhaps the single greatest lesson here has been the understanding that these are not solely, or even primarily, technical challenges. Contractual issues, stakeholder management, good operational management, comprehensive user education and training, and attention to implementation detail are all vital.
To standardise the management information output of the radiology information systems we first had to rigidly standardise the mechanisms for inputting data. This was not an original conclusion - it had been identified at the time the systems were deployed. What was new was understanding the degree of effort this required. That we achieved it is a tribute to the trust staff involved.
Unity is strength
Some of the achievements to date, and plans for the future, would be impossible without a network of some form. Clearly, obtaining discounts for supplies bought in bulk is one example, but perhaps more powerful is that of the best practice forum, which has forged a new relationship with the local Connecting for Health supplier and partners. This has allowed us to make clinical quality improvements (to computerised radiography equipment), which would not have been possible for an individual organisation.
A radiology network has worked well for Kent and Medway on a pilot basis and should be possible for other health communities. We are now reviewing how this could be mainstreamed. Good relationships between the radiology service managers, with a shared vision and a willingness to compromise, have been critical to our success.