With radiology departments facing greater demands but less money, a conference of radiology managers explored problem solving ideas touching on everything from performance to seven day working. Report by Alison Moore

Xray of a hand

Radiology departments are facing greater demands but have less money

Radiology departments are facing greater demands but have less money

Radiology department managers face a multitude of challenges and demands to do more with less.

But a conference of radiology managers, run jointly by Philips and the Society and College of Radiographers, showed that good ideas on how to improve the service and introduce new ways of working are far from thin on the ground - but they take time and commitment to bring it about.

Not a commodity

College president Pam Black made an impassioned plea for radiology not to be treated as a “commodity”.

“We are in a very specialist service - nothing can happen in any healthcare without us. Somehow we have to start telling the world about it,” she said.

Many radiology managers came into post with ambitious plans but found it difficult to implement these, she added. She urged the delegates to think strategically, to work closely with their clinical directors and to ensure they had a voice which could be heard at the trust board.

Dr Patricia Woodhead, patient safety adviser to the Royal College of Radiologists, outlined the need to focus on quality improvement. Trusts could deliver additional capacity at the same time as improving efficiency and patient care, she said.

‘Nothing can happen in any healthcare without us. Somehow we have to start telling the world about it’

However, this required end to end thinking across the clinical pathway: she had visited a trust that introduced seven day ultrasound services but did not look at the need for porters that this created as a result of the extended hours.

One organisation which has tackled radiology performance issues is University Hospital of North Staffordshire Foundation Trust.

Principal radiographer Alice Turner said it had developed a backlog in plain film reporting.

The turning point was when the trust applied to the Imaging Services Accreditation Scheme (ISAS), a marker of high quality care, and the backlog was identified as a cause for concern. The trust recruited extra staff, used a company that provided extra staff to work alongside trust staff on site and changed skill mix. It has now been recommended for ISAS approval.

Tackling complex problems like this and devising a solution that works is often a challenge for radiology departments, where staff and managers can feel overwhelmed by the day-to-day work. But sometimes help can come from other areas such as suppliers.

Graham Tranter, senior commercial development director at Philips Healthcare, says: “We see an increasing appetite to engage in this because of the pressures on radiology departments and the increasing demand they face. While Philips might be known as a supplier of technology, that was only part of the wider picture. It is not just about the technology, it is what you do with it.”

‘Good data is essential to back up plans for change, together with a patient centred approach and the support of teams’

The help that Philips provides can include onsite staff who can assist in a change management project and train staff in techniques such as “Lean” to better enable them to continue with the work themselves.

Rosie Franklin, a healthcare consultant working with Philips, says that staff sometimes have the skills to bring about change - but have not realised it or have not been able to move solutions forward. A fresh set of eyes and specialised skills can help.

“We can do a lot of things like workflow optimisation - we have a lot of tools to improve that if you are talking about Lean and quality,” says Nick Page, customer services operation manager at Philips Healthcare.

“We are able to support education of the staff in basic six sigma - we provide masterclasses for everyone and advanced training for the area lead,” says Stephanie Holden, a Philips operation manager who is working with Ashford and St Peter’s Foundation Trust.

Good data is essential to back up plans for change, together with a patient centred approach and the support of teams. Sometimes low cost changes to the physical environmental, such as improving lighting, can make a real difference, she says.

Seven day solutions

Heralding a sea change in the established hours of service provision from the major imaging equipment manufacturers, Philips Healthcare announced in January that from 1 April it would be offering seven day support from 8am to 8pm as standard for direct customers in the UK.

The trigger for this came as a direct result of feedback at the National Conference for Radiology Managers in 2013, which highlighted the increasing demand for seven day clinical service. Since January, when the announcement from Philips to extend its standard service was made, other manufacturers have also responded, further evidence that the English healthcare system is undergoing a transformation in the availability of clinical service to patients.

To implement an extended support model, technology service providers such as Philips Healthcare have had to undergo a full impact assessment for its infrastructure, systems and staff. To quote Callum Petrie, Philips UK Group HR director: “Philips has had to change the engines whilst the plane has remained flying to implement this change.”

A fully integrated service is essential, although most important is the consideration of the impact on employees who are directly affected by new working patterns. This can only be implemented successfully through extensive consultation with all stakeholders.

Radiology managers can now rely on a structured and cost effective service from their key suppliers as well as giving immediate access to engineers in the event of equipment breakdown throughout their increasing hours of clinical operation.

This new way of working will undoubtedly act as a catalyst for further innovation. As extended hours become the norm, access to 24/7 assistance will become essential. Here, larger equipment manufacturers are uniquely positioned to provide round the clock support.

With the expansion of service, the provision of same day response would also seem a logical next step. So omni-channel will enable a wider range of communication options to customers wherever and whenever they need it. Using these new platforms will allow further optimisation of systems, increasing the potential to predict equipment downtime and repair issues without impacting clinical service.

With constant innovation in a connected age that puts customers at the heart, Philips will continue to provide leading edge solutions to its customers and, importantly, improve patient outcomes.

Nick Page is customer services operation manager at Philips Healthcare

Driving changes

ISAS accreditation is rapidly becoming a gold standard for departments, sought after by commissioners and patients alike and enabling departments to differentiate themselves from their neighbours. Ms Franklin has been working with Royal Surrey County Hospital Foundation Trust, which is now coming up for completion after just 18 months.

She says service improvements occur as a result of undergoing the accreditation journey as the process requires a change in culture and allows staff to question established pathways and processes.

Departments can often build a business case to support investing in outside help to drive these changes. Ultimately, these changes will save money, says Ms Holden.

Introducing seven day working also requires thinking through what is needed to support that.

Last year Philips asked those attending the radiology managers’ conference how they thought working hours would change. The answer was that they would be providing a seven day service but not necessarily round the clock - it was more a matter of extended hours routinely.

‘Introducing seven day working also requires thinking through what is needed to support that’

This has fed back into the support the company offers for equipment and since April engineers have been available 8am-8pm seven days a work to minimise any down time for equipment.

One of the early customers was Holly House Private Hospital in Essex, which had equipment problems on a Saturday afternoon that were dealt with by an engineer on the Sunday. “To be up and running for a full Monday list was exactly the sort of service we need and caused minimum disruption to patients, staff and referrers,” says imaging services manager Michele Fox.

Mr Page says: “We were the first equipment manufacturer in this field to promote extended hours service as standard - but others are now following, which we think shows there is a very real need for this service in radiology departments.

“We have had very positive feedback from customers. It’s been a big change for us as well - the need to agree new ways of working with our staff mirrors what the NHS faces so we are very aware of the challenges and difficulties around introducing extended hours for our partners.

“We are keen to respond in other aspects of our customer services as well and will continue to refine what we offer to meet customers’ needs during this period of transformation for them.”

Other changes include more ways to contact Philips, such as an online chat facility that operates 24/7, using Philips staff around the world.

The next step could be optimising remote monitoring of equipment to move services from reactive interventions to predictive planned maintenance. This could reduce equipment downtime and delays to vital scans.