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1 Zoran Bojic, MHSc, PMP, CSSBB, CLA, ASQ-CMQOE Ellen Charkot, M.R.T. (R.), BHA Dr. Manohar Shroff, MD, DABR®, FRCPC Department of Diagnostic Imaging November 2014 RSNA 2014

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    Zoran Bojic, MHSc, PMP, CSSBB, CLA, ASQ-CMQOE

    Ellen Charkot, M.R.T. (R.), BHA

    Dr. Manohar Shroff, MD, DABR®, FRCPC

    Department of Diagnostic Imaging

    November 2014

    RSNA 2014

  • 2

    � Radiologists

    � Technologists / RNs

    � Support Staff

    � U of T

    � Michener

    � Mohawk

    � 9 Imaging Modalities

    � RIS / PACS

    � Voice Recognition

    � 130,000 Exams / Year

  • 3

    Legal and Regulatory

    Compliance

    Information

    Management

    Document

    Management

    Procurement

    Management

    Performance

    Measurement

    Human

    Resources

    Utilization

    Management

    Work

    Environment

    Education and

    Training

    Knowledge

    Management

    Risk

    Management

    Leadership and

    Organization

    Process

    Management

    Innovation

    Management

    Radiation

    Safety

    Operational

    Controls

    Service

    Excellence

    Technology and

    Equipment

    Continual

    Improvement

    Quality Management System Elements

  • 4

    Process

    Outcomes

    Structure

    Balancing

    +

  • 5

    � Affinity Diagram

    � Benchmarking

    � Bottleneck Analysis

    � Brainstorming

    � Cause and Effect Diagram

    � Check Sheet

    � Cognitive Walkthrough

    � Control Charts

    � DMAIC Problem Solving

    � Fault Tree Analysis

    � Five Whys

    � Flowchart

    � Force Field Analysis

    � Gantt Chart

    � Heuristic Evaluation

    � Histogram

    � Impact/Effort Matrix

    � Interviewing

    � Kano Analysis

    � Mind Mapping

    � Multivoting

    � Nominal Group Technique

    � Paired Comparisons

    � Pareto Chart

    � PDSA Cycle

    � Project Charter

    � Project Schedule

    � Relationship Diagram

    � Risk Response Plan

    � Run Chart

    � Scatter Diagram

    � SIPOC Diagram

    � Six Thinking Hats

    � Solution Selection Matrix

    � Spider Chart

    � Stakeholder Analysis

    � Usability Testing

    � CTQ Requirements

    � Kaizen

    � Value Stream Mapping

    � Standardized Work

    � Error proofing

    � 5S / Visual Management

    � Kanban

    � Single-Piece Flow

    � Pull System

    � Level Loading

    � Spaghetti Diagram

    � Rapid Changeover

    � A3 Problem Solving

    � Root Cause Analysis

    � FMEA

    � Stopping the Line

    � Just-in-Time

    � TPM

    � MSA

    � Design of Experiments

  • 6

  • 7

    Improved

    collaboration

    Diminished

    organizational silos

    Consensus on key

    priorities

    Consistent execution of

    projects

    Effective allocation of

    resources

    Improved

    communication

    Increased capacity

    for innovation

    Enhanced organizational

    capability

    Systematic risk

    management

    Effective problem

    solving

    Better decision

    making

    Effective change

    management

    High return on

    investment

    Increased staff

    engagement

    Program

    Management

    Benefits

  • 8

    Pa

    tie

    nt

    Sa

    tisf

    act

    ion

    Sta

    ff E

    ng

    ag

    em

    en

    t

    Ed

    uca

    tio

    n a

    nd

    Tra

    inin

    g

    Faci

    lity

    De

    sig

    n

    Mu

    lti-

    Mo

    da

    lity

    Do

    se

    Me

    asu

    rem

    en

    t

    Mo

    dif

    ied

    MR

    Se

    qu

    en

    ces

    Re

    sea

    rch

    Pa

    rtn

    ers

    hip

    Re

    sea

    rch

    Infr

    ast

    ruct

    ure

    Re

    gio

    na

    l R

    ep

    osi

    tory

    of

    DI

    Ima

    ge

    s

    Eq

    uip

    me

    nt

    Re

    pla

    cem

    en

    t

    Ele

    ctro

    nic

    Co

    mm

    un

    ica

    tio

    n B

    oa

    rd

    Pe

    er

    Re

    vie

    w S

    oft

    wa

    re

    Project Group 3

    Service Excellence

    Project Group 5

    Advanced Technology

    Project Group 4

    Innovation and Research

    Strategic Goals

    Fall

    Pre

    ve

    nti

    on

    MR

    I S

    cre

    en

    ing

    Pro

    cess

    Ra

    dia

    tio

    n D

    ose

    Re

    du

    ctio

    n

    Inte

    rve

    nti

    on

    al

    Sa

    fety

    Ch

    eck

    list

    Project Group 1

    Patient Safety

    Sta

    rt o

    n T

    ime

    MR

    I Le

    an

    Pro

    ject

    Ro

    om

    Tu

    rno

    ve

    r

    Sta

    nd

    ard

    ize

    d B

    oo

    kin

    g

    Pro

    cess

    Project Group 2

    Access to Services

    Diagnostic

    Imaging

    Integrated Program

    Management

  • 9

    Interpersonal

    Dimensions

    Communication

    Appointment

    Wait Time

    Wait Time

    After Arrival

    Discharge

    Instructions

    Explanation

    of the Exam

    Preparation for

    the ExamQuality of Care

    Environment /

    Facilities

    Privacy and

    Confidentiality

    Activities for

    Children

    Parking, Food and

    Directions

    Factors

    Impacting

    Patient

    Experience

  • 10

    IMPACT

    EFFORT

    HIGH

    HIGH

    LOW

    LOW

    ���� Safety rounds

    ���� Focus groups

    ���� Daily huddle

    ���� Staff Coaching

    ���� Mentoring program

    ���� Customized surveys

    ���� Benchmarking

    ���� In-person interviews

    ���� Telephone survey

    ���� Website survey

    ���� Comment cards

    ���� Mystery shoppers

    ���� Engage volunteers

    ���� Ongoing communication

    ���� Simulation

    ���� Timely status updates

    ���� In-service sessions

    ���� Online education modules

    ���� Regular reviews of survey results

    ���� List of patient suggestions

    ���� Strengthen complaint process

    ���� Staff feedback in real time

    ���� Daily newspapers

    ���� Washroom cleanliness

    ���� Waiting room comfort

    ���� Q&S Leadership Walkarounds

    ���� New quality indicators

    ���� New staff orientation manual

    ���� TV program selection

    ���� DI website content

    ���� Information pamphlets

    ���� Exam Information translation

    ���� Pain management

    ID Task Name

    1 Provide timely status updates and improve

    communication with patients and families

    who are in the waiting room

    2 Proactively reach out to patients and their families , lis ten

    to their concerns and continue to keep them informed

    while they are in the waiting room

    3 Promptly explain reasons for delay and provide

    estimates for their remaining waiting tim e

    4 Review and prioritize suggestions for im provements

    provided by patients and families

    5 Provide staff education and increase

    awareness about service excellence

    6 Organize in-service session on service excellence for

    all s taff

    7 Encourage staff to complete the online service

    excellence module

    8 Ins titute regular review and communication of the NRC

    Picker survey results

    9 Strengthen the process for reviewing patient complaints

    10 Provide coaching and timely feedback to staff who

    interact with patients and families

    11 Review the waiting area to ensure it is se t

    up in a way that is comfortable for the

    child as we ll as for parents/ guardians

    12 Dis tribute daily newspapers to the waiting room s

    13 Remove obsolete newspapers to prevent cluttering

    14 Organize daily checks to ensure cleanliness of the

    washrooms and waiting areas

    Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct

    4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter

  • 11

    Service

    Excellence

    PDSA

    PDSA

    PDSA

    PDSA

    PDSA

  • 12

    ID Project / InitiativeQ & S

    Excellence

    Enable

    PeopleInnovate

    Financial

    HealthInfrastructure

    Enhance

    Systems

    1 GTA West DI Repository (DI-r) X X X X

    2 MRI Appointment Wait Times X X X X

    3 CT Appointment Wait Times X X X X

    4 Radiation Dose Reduction X X X X

    5 Service Excellence X X

    6 Quality Management Education X X

    7 DI Q&S Leadership Walkarounds X X

    8 2013 Accreditation X X

    9 Report Turnaround Times (RTT) X X

    10 IGT Equipment Replacement X X X X X

    11 Simulation-Based Learning of CVL Insertion X X X

    12 Innovative Procedures X X X

    13 MRI Safety X X

    14 Increasing OHIP Revenues X

    15 Staff Engagement X X

    16 International Benchmarking Project X X X

    Diagnostic Imaging

    2013/14 Strategic PrioritiesStrategic Directions

  • 13

    Appendicitis

    US

    + -

    +

    TP

    69

    FP

    9

    -

    FN

    5

    TN

    94

    Sn=sensitivity, Sp=specificity, PPV=positive predictive value, NPV=negative predictive value, Acc=accuracy

    Sn= TP/TP+FN ---------------- 93.2%

    Sp= TN/FP+TN ---------------- 91.2%

    PPV= TP/TP+FP --------------- 88.4%

    NPV= TN/FN+TN ------------- 94.9%

    Acc= TP+TN/ALL ------------- 92.1%

    Negative appendectomy rate= 2/73 = 2.7 %

    66% of US requested ���� Normal

    34.4% ���� Positive for appendicitis

    Timeframe: 3 months; 206 consecutive requests; 105 daytime; 101 after hours; Follow up in 177

  • 14

    0

    2

    4

    6

    8

    10

    12

    14Weeks

    Policies Emergency Equipment

    Screening Zoning Education

    Safe MR Practices

  • 15

    Fire in MRI Suite - Emergency Procedure

    Fire alarm is generated in a specified room in MRI Suite. Sprinklers are primed and

    Fire Department is dispatched.

    Hospital Emergency Response Team enters MRI Suite to investigate the area. Initial investigation for evidence of fire involves

    looking through the window without entering the MRI magnet room.

    Is there suspicion

    of fire in the MRI magnet room

    No

    No need to enter the MRI

    magnet room.

    Yes

    Properly screened individuals take the MR Safe fire extinguisher located outside the MRI magnet room and enter the MRI magnet room to check for evidence of

    fire.

    Is there an actual fire in the MRI magnet room?

    No

    No further action required

    in the MRI magnet room. Lock the MRI magnet

    room door.

    Yes

    Plant Operations in consultation with

    Respiratory Therapy will assess the need to shut off oxygen source.

    Has the fire been successfully extinguished?

    No

    Quench the magnet using the quench button. It may take 1-2 minutes for the

    magnetic field to dissipate.

    Fire fighters enter the MRI magnet room and extinguish the fire using

    non ferrous equipment

    Upon arrival, Protection Services informs Fire Department that the fire alarm originates from

    MRI Suite

    MRI technologist contacts the MRI system manufacturer to send MRI Field

    Engineer ASAP

    MRI technologist notifies On-Call MRI personnel of the system status

    MRI Field Engineer completes service of MRI equipment

    Resume normal operations

    Attempt to extinguish the fire using MR

    safe fire extinquisher

    Properly screened fire fighters enter the MRI magnet room with

    non ferrous equipment and confirm that the fire has been

    extinquished

    Yes

    CONTACT LIST

    Plant Operations: 7111

    Protection Services: 7122

    Locating: 7500

    MRI Tech On-Call: 416-589-8514

    DI Manager On-Call: 416-237-3795

    WARNING:MAGNET IS ALWAYS ON

    Anyone entering MRI magnet room must

    be properly screened as per MRI

    Screening of Non-Patients policy

    Befere entering MRI magnet room,

    remove all personal objects and contents of pockets such as cell phones, keys,

    coins, etc.

    Firefighters must not go beyond the sign

    posted on the MRI magnet room door:

    DANGER: MAGNET IS ALWAYS ON unless directed by authorized personnel.

    AFTER HOURS

    Page MRI technologist On-Call and DI Manager On-Call to Locating

    Locating transfers calls to Protection Services at the site of fire in MRI Suite

    Protection Services Supervisor obtains the key and unlocks the MRI magnet

    room.

    Aug 25, 2014

    Flood in MRI Suite - Emergency Procedure

    Flood identified in MRI Suite

    Plant Operations and Environmental

    Services/Housekeeping proceed with appropriate corrective measures

    as per hospital Flood Response

    procedure.

    Note: All areas outside MRI magnet room are accessible without exposure

    to magnetic field

    Resume normal operations

    Plant Operations staff determine

    source and extent of the flood.

    Contact:

    Plant Operations

    Protection Services

    Environmental Services/

    Housekeeping

    IF AFTER HOURS also contact:

    CHS Admin On-Call

    MRI technologist On-Call

    DI Manager On-Call

    In collaboration with MRI technologist,

    Plant Operations and Environmental Services/Housekeeping proceed with

    appropriate corrective measures as per

    hospital Flood Response procedure.

    USE MRI SAFE EQUIPMENT ONLY

    WARNING:MAGNET IS ALWAYS ON

    Anyone entering MRI magnet room must be properly screened

    as per MRI Screening of Non-

    Patients policy

    Befere entering MRI magnet room,

    remove all personal objects and contents of pockets such as cell

    phones, keys, coins, etc.

    MRI technologist contacts the MRI

    system manufacturer to determine if

    MR Field Engineer is required to

    service MRI equipment.

    Service required?

    No

    Yes

    If required, Plant Operations will:

    Close water shut off valve

    Turn off all operating cabinets

    and computers

    Tarp equipment

    Arrange for MR Field Engineer to service MRI equipment

    ASAP, and notify On-Call

    Radiologist

    Complete service of MRI equipment as required

    If the water reaches the magnet, MRI

    technologist or authorized individual

    shuts down electrical power to the

    magnet.

    If it is necessary to stand in water to reach the power switch, call MR Field

    Engineer to shut down power.

    CONTACT LIST

    Plant Operations: 7111

    Protection Services: 7122

    Environmental Services/Housekeeping: 416-530-7254

    Locating: 7500

    MRI Tech On-Call: 416-589-8514

    DI Manager On-Call: 416-237-3795

    LOCATIONS

    Clinical MRI

    Water shut off valve:

    Room S750A (access through rooms

    S747 – S747D – S750

    Circuit breaker: Room S792CDIU

    Water shut off valve: Room 4150B

    Power button: MRI Control Room

    Research MRI

    Water shut off valve: Room S720A

    (access through room S720)1.5T and 3.0T Power Buttons: MRI

    Control Room

    Equipment Room 1.5T: S725E

    Equipment Room 3.0T: S721C (access

    through room S721)

    Redirect traffic as required

    Does flood

    extend into MRI magnet

    room?

    Yes No

    Do not shut down power to the magnet and/or equipment

    room without authorization

    from MRI technologist

    July 20, 2014

    Magnetic field is still present

    even after shutting down

    electrical power to the magnet.

  • 16