Abstract:
A method and system for measuring and quantifying inefficiencies in a medical procedure such as a radiological procedure. Inefficiencies are measured and quantified by collecting a plurality of characterization measurements, where each characterization measurement corresponds to an individual step in the procedure. Once the measurements are collected, a sum of squares analysis is performed on them to determine the effect of each step on the procedure. The process steps are further analyzed to determine the activities within them that have the highest impact on the time needed to complete the task or tasks that make up the step. These tasks or key drivers are then subjected to a regression analysis to determine their effect on the time to complete the procedure. The key drivers may then be changed to adjust the procedure as desired.

Description:
BACKGROUND OF THE INVENTION 
     The present invention relates to methods and systems for improving the performance of a department in a healthcare facility. More specifically, the present invention relates to a method of evaluating and reducing inefficiencies in the department. 
     Healthcare facilities such as hospitals and clinics are generally organized in departments specializing in specific areas of medical science such as immunology, cardiology, and radiology. Generally, specialized personnel and equipment are available in each department to provide medical treatment in the area of specialization. Often times, these departments must repeatedly perform the same or similar procedures on many patients. By way of example, radiology departments often carry out many similar procedures using radiant energy to diagnose and treat disease. One well-known use of radiation is in the creation of radiographs that are used to evaluate injuries such as bone fractures. 
     In general, before a specialized procedure is performed in a department of a healthcare facility, a patient is evaluated by a physician that typically does not specialize in the medical area covered by the relevant department (the “referring physician”). Once the referring physician has determined that a specialized procedure would facilitate the diagnosis or treatment of the patient, the patient is sent to the applicable department and the staff there conducts the requested procedure. 
     While the above description makes the process seem simple, examining a patient can be logistically complex and involve many steps. Using a radiological procedure as an example, following his or her initial examination, a patient must schedule an appointment for the radiological examination. Then, the patient must travel to the department at the appointed time and date. Upon arrival at the radiology department the patient registers with the radiology staff and is prepared for the radiological examination, if necessary, such as by donning an examination gown. The patient may then have to wait until an examining room is available and then is examined. Following the examination, the radiograph or other imagery must be examined by a radiologist. Finally, the radiologist prepares a report which is then sent to the referring physician. 
     The competence and efficiency with which each of these tasks is conducted affects the overall quality and efficiency of the radiology department. It also affects the patient&#39;s and referring physician&#39;s satisfaction with the services performed. Thus, to the extent that efficiency and satisfaction could be improved, the operation of the department, including such things as quality and profitability, could also likely be improved. Yet, scientific and other structured methodologies have not, in general, been applied to study and improve the operations of a radiology department or, for that matter, other procedures that are carried out on a relatively frequent basis in the departments of a healthcare facility. Accordingly, there is a need for a method or system of evaluating and improving the operations of a department in a healthcare facility. 
     SUMMARY OF THE INVENTION 
     Therefore, the present invention provides a method and system for measuring and quantifying inefficiencies in the operations of a department in a healthcare facility. The method and system are useful in identifying the root causes of inefficient operation of the department so that change can be effected that improves the operation of the department. 
     The method includes the acts of collecting a plurality of characterization measurements for a medical procedure, where each characterization measurement corresponds to an individual step in the procedure. The collection of the measurements may be done by a variety of known manual and automated techniques, none of which is critical, by itself, to the invention. Of course, like any measurement process, accurate measurements are desirable. Once the measurements are collected, a sum of squares analysis is performed on the measurements to determine the effect of each step on the examination procedure. Further analysis is conducted to determine the activities within each process step that have the highest impact on the time needed to complete the subject task that makes up the step. These activities are known as the key drivers. A regression analysis is then performed on the key drivers to determine the effect of the key drivers on the overall time to complete the procedure. The key drivers are then changed to adjust the procedure as desired. 
     It is an advantage of the present invention to provide a structured analysis of medical procedures conducted in a healthcare facility. As a part of the analysis, key root causes for inefficiency are found and analyzed appropriately. Another advantage of the present invention is that the procedure may be modified to reduce or eliminate the identified causes of inefficiency. This results in procedures that may be accomplished in less time and with less resources than previously obtainable. The reduction in time leads to shorter completion times and faster diagnoses and treatments. The reduction in resources leads to enhanced profitability and lower prices. 
     Other features and advantages of the present invention will become apparent by consideration of the detailed description and accompanying drawings. 
    
    
     BRIEF DESCRIPTION OF THE DRAWINGS 
     In the drawings: 
     FIG. 1 is a flow chart illustrating the general process of producing a report for a radiological examination conducted on a patient in a radiology department; and 
     FIG. 2 is a flow chart illustrating the process of producing a report on a radiological examination where steps that heavily impact or drive report turn around time have been identified. 
    
    
     DETAILED DESCRIPTION 
     As noted above, scientific and other structured methodologies have not, in general, been applied to improving medical procedures. The inventor has discovered that by conducting certain statistical analyses on medical procedures, inefficiencies in those procedures may be identified. Further, once those inefficiencies are identified, improvements to the process may be made. While it is assumed that the reader understands statistical methods, before discussing the particular aspects of the present invention, a brief summary of the statistical methods used is in order. 
     Analysis of variances (known as “ANOVA”) is a statistical methodology used to test hypotheses about differences between two or more means (intermediate values). For example, suppose a researcher has performed a study on various methods of caring for plants; methods A, B, C, and D, with a control group E. Suppose, again, that the goal of the study is to determine if one method is more effective than the others and, for purposes of this example, assume that twenty plants are assigned to each group. At the end of the study, changes in health were found for each plant. However, how does the researcher compare the means of each of the groups in order to make a determination as to the effectiveness of the methods? One way would be to individually compare each group to all the others. For the present example, this would require ten comparisons. Using ANOVA, the number of comparisons may be reduced. 
     Without explaining the entire underlying theory, ANOVA relies on statistical sampling. A sample is a finite number (N) of scores and those scores may be interpreted through such statistics as the mean (x), the mode (M o ), the median (M d ) and standard deviation (s x ). The sample statistics may then be used as estimators of the corresponding parameters in the population model. A sampling distribution may then be found to further analyze the sample statistics. Ultimately, the variance of a population and a measure of how different the means are relative to the variability within each sample may be used to determine the likelihood that the differences between the means of each group are due to chance rather than real effects. ANOVA analyses may be conducted using commercially available software. 
     Before one embodiment of the invention is explained in detail, it is to be understood that the invention is not limited in its application to the details of construction and to the arrangements of components set forth in the following description or illustrated in the drawings. The invention is capable of other embodiments and is capable of being practiced or of being carried out in various ways. Also, it is to be understood that the phraseology and terminology used herein is for the purpose of description and should not be regarded as limiting. 
     FIG. 1 schematically illustrates a radiological examination procedure  10  resulting in the generation of a radiological report  12 . (It should be understood, that the radiological procedure  10  is used as an exemplary medical procedure and that the teachings of the present invention are applicable to other procedures.) As noted above, once a determination is made that a patient needs or requires a radiological procedure, the patient (represented by the patient P) interacts with a radiology department with the final result of producing a radiological report. The procedure  10  may be conceptualized as having four major steps: a pre-examination step  15 ; a main examination step  17 ; an evaluation step  19 ; and a distribution step  21 . The pre-examination step  15  involves several sub-steps: ordering the radiological procedure  23 , scheduling the procedure  25 , waiting for the examination  27 , and registration  29 . Once ordered and scheduled, the actual examination or procedure is conducted. The main examination step  17  includes a period of patient preparation and waiting  31 , an actual examination period  33 , and quality control review  35  of the image made during the examination. Once an image of sufficient quality has been produced, it must be evaluated by a radiologist. The evaluation step  19  requires image hanging or display  41  and review and interpretation  43  of the image. Generally, as the radiologist reviews the image he or she dictates an oral report on the results of the radiological procedure as represented by a dictation sub-step  45 . The final step in evaluation of the examination is a transcription sub-step  47  where the dictated report is transcribed to a form that may be printed. 
     Once the report is transcribed, it is distributed. The distribution step  21  involves a report printing sub-step  51 , a printing to signature box sub-step  52  during which the printed report is transferred to a signature box, a signing of the report sub-step  53 , and an actual distribution of the report sub-step  55 , where the report is sent to the referring physician, the patient, or both. The radiology examination process as shown in FIG. 1, is represented in a process map shown below in Table 1. Each process step has a corresponding characterization measurement. In other words, each process step may be considered as representing a characterization measurement. 
     
       
         
               
               
               
             
           
               
                 TABLE 1 
               
               
                   
               
               
                 STEP 
                   
                   
               
               
                 SEQUENCE 
               
               
                 NUMBER 
                 PROCESS STEP 
                 CHARACTERIZATION MEASUREMENT 
               
               
                   
               
             
             
               
                 1 
                 Ordering of the 
                 Military hour of day call comes from referring 
               
               
                   
                 radiological 
                 physician to radiology department at hospital or other 
               
               
                   
                 procedure 23 
                 facility. 
               
               
                 2 
                 Scheduling of 
                 Time of scheduled exam. 
               
               
                   
                 procedure 25 
               
               
                 3 
                 Waiting for 
                 Elapsed time between referring physician call and 
               
               
                   
                 examination 27 
                 scheduled exam time. 
               
               
                 4 
                 Registration 29 
                 Elapsed time between patient arrival at registration 
               
               
                   
                   
                 desk of facility and patient arrival in radiology 
               
               
                   
                   
                 department. 
               
               
                 5 
                 Patient preparation 
                 Elapsed time between moment patient arrives in 
               
               
                   
                 and waiting 31 
                 radiology department and the moment patient called 
               
               
                   
                   
                 for examination. 
               
               
                 6 
                 Examination period 
                 Elapsed time between moment patient is called for 
               
               
                   
                 33 
                 examination and initial image or scanning completion. 
               
               
                 7 
                 Quality control 
                 Elapsed time between initial image or scanning 
               
               
                   
                 review 35 
                 completion and the moment the image is sent to the 
               
               
                   
                   
                 review or reading stack. 
               
               
                 8 
                 Image display 41 
                 Elapsed time between moment the image is sent to the 
               
               
                   
                   
                 reading stack and the moment it is viewed (put on a 
               
               
                   
                   
                 view box) by a radiologist. 
               
               
                 9 
                 Review and 
                 Elapsed time from Exam put on view box by 
               
               
                   
                 interpretation of 
                 radiologist and exam sent for dictation. 
               
               
                   
                 image 43 
               
               
                 10  
                 Dictation sub step 
                 Elapsed time for dictation of report. 
               
               
                   
                 45 
               
               
                 11  
                 Transcription 47 
                 Elapsed time from moment dictated report complete to 
               
               
                   
                   
                 transcription complete. 
               
               
                 12  
                 Printing 51 
                 Elapsed time from transcription complete to report 
               
               
                   
                   
                 sent to printing. 
               
               
                 13  
                 Printing to signature 
                 Elapsed time from report sent to printing to report put 
               
               
                   
                 box 52 
                 in radiologist&#39;s signature box. 
               
               
                 14  
                 Signing of the report 
                 Elapsed time from report put in radiologist&#39;s signature 
               
               
                   
                 53 
                 box to radiologist signs report. 
               
               
                 15  
                 Actual distribution 
                 Elapsed time from radiologist signs report to report 
               
               
                   
                 55 
                 sent for distribution. 
               
               
                   
               
             
          
         
       
     
     The measurements listed in Table 1 may be made using various known manual and automated statistical collection techniques. By collecting the characterization measurements for each of the plurality of steps in Table 1, a sum of squares in an ANOVA may be used to determine the effect of each step on the examination procedure  10 . The result is a model containing the effect each process step has on the overall measurement of the time needed to complete the procedure  10 . This time is equivalent to or may be considered to be the report turnaround time (“RTT”). The results of an exemplary ANOVA based on the characterization measurements of Table 1 are shown in Table 2. The ANOVA illustrated was conducted using Minitab™ software. 
     
       
         
               
               
               
               
             
               
               
               
               
             
           
               
                 TABLE 2 
               
               
                   
               
               
                 STEP 
                   
                   
                 PERCENTAGE 
               
               
                 SEQUENCE 
                   
                 SUM OF 
                 OF 
               
               
                 NUMBER 
                 PROCESS STEP 
                 SQUARES 
                 CONTRIBUTION 
               
               
                   
               
             
             
               
                   
               
             
          
           
               
                  1 
                 Ordering of the 
                 14,481,112 
                 6.2% 
               
               
                   
                 radiological procedure 
               
               
                   
                 23 
               
               
                  1_1 
                 Day of the week 
               
               
                  1_1(a) 
                 Monday 
                 1,978,734 
                 0.8% 
               
               
                  1_1(b) 
                 Tuesday 
                 1,701,501 
                 0.7% 
               
               
                  1_1(c) 
                 Wednesday 
                 3,822,467 
                 1.6% 
               
               
                  1_1(d) 
                 Friday 
                 7,855,616 
                 3.4% 
               
               
                  1_1(e) 
                 Sunday 
                 272,808 
                 0.1% 
               
               
                  3 
                 Waiting for 
                 18,058,259 
                 7.7% 
               
               
                   
                 examination 27 
               
               
                  4 
                 Registration 29 
                 12,783,330 
                 5.5% 
               
               
                  5 
                 Patient preparation and 
                 16,853,469 
                 7.2% 
               
               
                   
                 waiting 31 
               
               
                  6 
                 Examination period 
                 8,288,351 
                 3.5% 
               
               
                   
                 33 d 
               
               
                  7 
                 Quality control review 
                 13,766,310 
                 5.9% 
               
               
                   
                 35 
               
               
                  8 
                 Image display 41 
                 10,401,856 
                 4.5% 
               
               
                  9 
                 Review and 
                 17,796,404 
                 7.6% 
               
               
                   
                 interpretation of image 
               
               
                   
                 43 
               
               
                 10 
                 Dictation sub step 45 
                 12,519,046 
                 5.4% 
               
               
                 11 
                 Transcription 47 
                 21,929,350 
                 9.4% 
               
               
                 12 
                 Printing 51 
                 21,515,497 
                 9.2% 
               
               
                 13 
                 Printing to signature 
                 9,113,492 
                 3.9% 
               
               
                   
                 box 52 
               
               
                 14 
                 Signing of the report 
                 16,903,437 
                 7.2% 
               
               
                   
                 53 
               
               
                 15 
                 Actual distribution 55 
                 23,580,814 
                 10.1%  
               
               
                   
                 Total 
                 233,580,814 
                 563.2% 
               
               
                   
               
             
          
         
       
     
     The data in Table 2 reflects the results of the ANOVA analysis modified to accommodate experiences encountered during the measurement process. First, the second sequence step, scheduling a procedure  25 , was eliminated because the time to complete the step was found to be insignificant in relative comparison to the times required to complete other tasks. In addition, an additional sequence step, day of the week, was added to the analysis because it was found that the specific day that the exam was ordered or performed affected completion of the procedure. This occurred because staffing levels often varied by the day of the week. In general, the first part of the week was fully staffed where the latter part of the week or “weekend,” as used herein, was staffed at lower levels. 
     While adding or removing steps based on observations is not required, doing so enhances the accuracy of the analysis. Once the data in Table 2 is obtained, each of the process steps may be further analyzed to determine the activities within each that have the highest impact on the time needed to complete the subject task. In other words, the “key drivers” for each step are determined. As an alternative to analyzing each process step, those process steps having the highest percentage of contribution to the sum of squares total may be identified. Preferably, and as shown in Table 2 and FIG. 2, the top five or six measurements are identified. For the example discussed herein, the top six measurements were waiting for an opening  27 , review and interpretation of image  43 , transcription  47 , printing  51 , signing of the report  53 , and actual distribution  55 . 
     Once the key drivers are identified, whether derived for all or only a portion of the process steps in the procedure  10 , a multiple regression method is used to determine the effect of the key drivers on the overall measurement, i.e., the RTT. The regression analysis performed is consistent with standard regression methods where the dependent variable (in this case, one of the process steps in the procedure) is examined in light of its independent variables (the activities or sub-steps that make up each process step). The correlation between the dependent variable and its independent variables determines which activity or sub-step has the greatest impact on the overall process. As with the ANOVA analysis, the regression analysis may be performed using commercially available software such as the Minitab software noted above. Once the important independent variables or key indicators are found, they are modified to change the larger process as desired. This is best understood by reference to Table 3, below. 
     
       
         
               
               
               
             
           
               
                 TABLE 3 
               
               
                   
               
               
                 PROCESS 
                   
                   
               
               
                 STEP 
                 KEY DRIVER 
                 IMPACT ON RTT 
               
               
                   
               
             
             
               
                 Waiting for 
                 Problem: Staffing of Technicians 
                 Decrease RTT variation 
               
               
                 an opening 
                 Solution: Overlap technicians shifts &amp; 
                 by 30% and decrease 
               
               
                 27 
                 match scheduling of examinations to 
                 RTT mean by 120 
               
               
                   
                 schedule 
                 minutes 
               
               
                 Review and 
                 Problem: Radiologists batching jobs, 
                 Decrease RTT variation 
               
               
                 interpretation 
                 “overnight” and “weekend” effect 
                 by 8% 
               
               
                 of image 43 
                 Solution: Move to overlapped shifts 
               
               
                 Printing 51 
                 Problem: Batch printing as a result of 
                 Decrease RTT variation 
               
               
                   
                 radiologists batch work routine. 
                 by 11%, lessen 
               
               
                   
                 Solution: Printing at end of transcription 
                 “overnight” &amp; 
               
               
                   
                 and transcribing staffing matched to new 
                 “weekend” effect 
               
               
                   
                 Radiologists staffing patterns 
               
               
                 Signature 
                 Problem: Batch review and signature of 
                 Decrease RTT variation 
               
               
                 box 52 
                 reports 
                 by 7% 
               
               
                   
                 Solution: 1) Extended radiology coverage 
               
               
                   
                 to level loads, signature pull demand 
               
               
                   
                 2) Process step disappears with voice 
               
               
                   
                 recognition and systems that permit 
               
               
                   
                 paperless process 
               
               
                 Actual 
                 Problem: Reports signed at beginning of 
                 Decrease RTT variation 
               
               
                 distribution 
                 shift, which amplifies “overnight” &amp; 
                 by 14% and decrease 
               
               
                 55 
                 “weekend” effect 
                 RTT mean by 150 
               
               
                   
                 Solution: Electronic signature and 
                 minutes 
               
               
                   
                 distributive printing 
               
               
                   
               
             
          
         
       
     
     In the example shown in Table 3, the first key driver or indicator found was poor staffing that affected the time a patient had to wait for an available examination time, i.e., an opening. For example, a physician might order a procedure on a Tuesday morning but there may not be an opening until the following morning, causing a wait of about twenty-four hours. This wait is caused, in large part, by the single-shift staffing schedules of radiology departments. For example, if a department operates from 8 am to 4 pm, and all openings are booked for that period, an overnight delay is automatically added to the wait period because the next possible opening will occur the following day. By overlapping two shifts, e.g., 6 am to 2 pm and 12 pm to 8 pm the operating hours for the department are extended to 6 am to 8 pm increasing the number of possible openings in a single day and decreasing the likelihood of an overnight delay. Thus, one solution to reducing the time of the waiting for an opening step  27  is to overlap schedules. 
     The next key driver or indicator found through the regression analysis was batch processing. It was found that radiologists tend to wait until numerous images have accumulated before they are reviewed. Generally, an overnight delay occurred because radiologists reviewed images the day after they had been made. The same would occur at times when staffing levels were reduced, such as might occur on Saturdays and Sundays. These delays cause inefficiencies in transcription because transcribers face times of little activity followed by times where numerous dictated reports must be transcribed. By overlapping the schedule of radiologists, a more consistent stream of dictated reports is generated causing a more consistent production of transcriptions. The improvement is enhanced by matching transcription schedules to radiologist staffing. 
     Interestingly, it was found that batch behavior caused inefficiency in the printing and signature box steps  51  and  52 . By effecting changes that cause more consistent production of work product, the RTT was reduced. Further, the results indicate that implementing electronic solutions such as voice-recognition and electronic distribution technologies are likely to eliminate the need for steps affected by batch processing. Thus, it is believed that further improvements in RTT may be made in hospitals and healthcare facilities that implement these technologies. 
     As can be seen above, the present invention provides a structured methodology for improving the efficiency of medical procedures and, more specifically, the production and distribution of radiological information. Various features and advantages of the invention are set forth in the following claims.