Francis Health's Approach to Radiology Improvement

Over recent years, Francis Health has worked with a number of organisations in Australia, New Zealand and UK as they seek to develop, configure and improve Radiology services.  

In every instance it is essential to first develop a thorough understanding of service performance, the constraints and opportunities that exist and the opportunities.  All too often organisations pursue solutions before truly understanding the nature of the complex issues which confront what is a crucial and multi-faceted service area.

Only once performance is properly understood can the way forward be illuminated, and this can only be accomplished meaningfully with the involvement of all system stakeholders: radiologists, clinicians, internal service ‘customers’ as well as management.  This same multi-disciplinary team approach is necessary for the challenging implementation process.

Our tailored approach

1. Explore

Our work typically involves two streams of investigation with a strong focus on data analysis as it is the evidence base which provides the foundation for all improvement initiatives.

Quantitative Analysis

The key focus is to develop a cost and productivity analysis of the service and in general this will comprise four main activities:

  • Data model development:  we invest time up front to develop relational data models and to validate our initial results to ensure our analytics align to local systems and data capture practices.
  • Understanding the unit cost of production based on annual activity volumes and general ledger information
  • Department-level reporting including (but not limited to) asset utilisation, labour productivity, flexed budget analysis and reporting, marginal costing, volume analysis by modality/ordering clinician
  • Benchmarking unit cost of production against workload measures aligned to funding/price (e.g. the Australian Medicare Benefits Schedule).

Qualitative Analysis

This work is focused on service delivery aspects of the service and will consider information sourced via a series of structured interviews and/or working sessions with key stakeholders (including both service providers and internal service ‘customers’ – the Emergency Department for example).

The output from this work-stream will be a summary of the current state and identified opportunities and demands for process redesign and improvement.  At the conclusion of this process, a summary of the current state findings will be presented for validation and feedback.

2. Design

The results of the both work streams define the current state of the Radiology service and lay the foundation upon which a programme of improvement can be developed, both at the internal department level and at the customer service delivery level.  We work with a multidisciplinary service team, clinicians and managers, to assess the implications of the analysis and consider how to improve performance by working differently.  

3. Deliver

The chief deliverable from our diagnostic is an Improvement Portfolio for the Radiology service.  This portfolio is comprised a set of change recommendations, prioritised for phased implementation to ensure that the quotient of change is manageable for staff, whilst delivering significant service improvements from the outset.  In order to support meaningful handover and knowledge transfer, the Francis Health team provide an implementation roadmap as well as the project plan(s) and structure to support effective implementation of identified initiatives.

Our Joint Solution

Highlights of our recent experience include:

Westmead Hospital Imaging Services Diagnostic,

Western Sydney LHD (2013)

The review was commissioned to investigate the reasons behind significant cost growth in recent months at the hospital level, as well as within the modality cost centres in the General Ledger.  

Over a 10 week period the Francis Health team conducted a thorough programme of cost and activity analysis to assess current levels of performance and to identify and quantify the opportunities for service improvement.  The cost of production was benchmarked against peer facilities to provide a comparative assessment of current service performance.

The review identified a marked variance in the FTE required for production between Westmead and the comparator sites and indicated a significant opportunity for realisable savings.  The recommendations within the improvement portfolio were accepted by the Sponsor for implementation – including a significant departmental restructure process. 

Radiology Improvement Programme,

Nottingham University Hospital NHS Foundation Trust (2013)

Francis Health was engaged to conduct a comprehensive diagnostic review of the Nottingham University Hospital (NUH) Radiology service which was disaggregated over 11 facilities across the Trust.  The key to the project was our ability to take a holistic, Trust-wide view of service performance and through a process of detailed cost, activity and utilisation analysis, identify productivity opportunities and cost benefit within Radiology.

Our team created and delivered a plan to realise the identified benefits within a short timeframe, the result was an increase in performance levels and fully-realised cost savings.

Francis Health was further engaged for a second phase of work to assist with implementation of the improvement portfolio and to provide on-going analytical support and to coach and mentor key stakeholders to lead the change process internally.

Radiology Services Review,

Counties Manukau District Health Board (2012)

Francis Health was commissioned to develop a new radiology strategy to enable it to be more proactive and participative in service integration developments within the DHB.  Our team developed and led a transparent strategy review and development process which considered the local, regional and national impacts of this integration strategy on radiology.  

Francis Health supported integration across the hospital by engaging the views of senior managers and clinical directors and promoted successful implementation by ensuring the strategy was mandated by key decision makers.  The resulting Radiology Strategy and Action Plan provided the direction for the next five years and is leading regional radiology strategy development.

Radiology Options Analysis,

Southern NSW Local Health District (2013)

Southern NSW LHD formerly operated two different service contract models and sought to standardise Radiology service provision to a single vendor/single model solution.  The Francis Health team undertook a programme of market research and cost model analysis to inform the development of the business case and to provide a range of service scenario model options for the consideration of the Executive. 

This options analysis enabled Southern NSW LHD to take a risk management approach to the procurement process. Our assessment of the potential service configurations also highlighted the cost implications and likely impact on service provision for rural and remote communities across the District.