As the U.S. begins the process of reopening, radiologists are taking stock — of what worked, what didn’t work, and how to move forward post-COVID-19. The Radiology Leadership Institute® (RLI) recently held a virtual town hall, “Leadership Town Hall: Leading in Times of Crisis,” during which several radiology leaders shared the changes they implemented during the pandemic — and what the road ahead may look like.
During the webinar, Geoffrey D. Rubin, MD, MBA, FACR, RLI board member and professor of radiology and bioengineering at Duke University in Durham, N.C., posed the following question: “What are the innovations that you think will have an important impact on you permanently going forward, and what are the changes that will be hard to be rolled back that you feel should be rolled back?”
Panelists discussed a shared concern over patients’ fears of physically returning to a medical facility, and what they can do to alleviate those fears. “We may be fighting a reputation as a place that’s treated COVID-19 patients for a while,” said J. Jacob Kazam, MD, vice chair for clinical operations at Weill Cornell Medicine’s radiology department. “Fighting those perceptions will be a battle and we’ll have to be very, very cautious about safety going forward.” Kazam noted that radiologists should consider ways to de-densify reading rooms and ensure patients can come in and go directly to their imaging. Other changes facilities may have implemented during the pandemic to prioritize safety — like making the switch to online scheduling and patient forms, having patients drink contrast before they come in for imaging, or having patients wait in the car and calling them when they’re ready to be seen — could be made permanent. “This will be better for patients in the long term,” Kazam said.“This could ultimately lead to a better patient experience that is more seamless.”
Panelists also spoke of the pandemic leading to action on some long-delayed projects or changes that were needed. Mahmud Mossa-Basha, MD, associate professor of radiology, vice chair of clinical operations, and chief of radiology at the University of Washington School of Medicine in Seattle, mentioned plans at his facility to accelerate some initiatives previously on the back burner — like programs to increase efficiency in MR, or shorten block times — to increase revenue and improve the bottom line. Judy Yee, MD, FACR, chair of the ACR Colon Cancer Committee and professor and chair of the department of radiology at Montefiore Medical Center in Bronx, N.Y., discussed the expedient transformation of space at her facility. “The rollout of construction at our multiple sites has really been very impressive,” she said. “Space allocation is one of the toughest things for a health system to do equitably. Here, we all function as one unit and one team. I gave up my auditorium and that became a command center; our grand hall became a patient medical ward. I think there is some space that wasn’t being used well for patients that will now be used well.”
“It's very interesting that you can fast-track some initiatives you've been trying to do for years,” said Dana H. Smetherman, MD, MPH, FACR, chair of the ACR Commission on Breast Imaging and associate medical director in the department of radiology at Ochsner Medical Center in New Orleans. “Things like home workstations or telehealth. Our neuro IR clinics are now all virtual. In 2019 our whole health system only did about 2,500 video visits for all of our clinicians. We now do more than 3,000 a day.”
This rapid transition to telehealth is a genie that will not be able to be put back in the bottle.
Daniel Ortiz, MD, a radiologist at Summit Radiology Services, P.C., noted that at his practice they’ve accelerated the acquisition of night and after-hours work, which they previously used teleradiology services for. They’ve also made the push for more standardized reporting for COVID-19 patients, which Ortiz thinks will help them grow a culture of more standardized reporting for other things. “Being in a private practice, a lot of our radiologists function and do things as they see fit rather than with a unified approach,” he said. “So that might change. We can use this culture of unified response and reporting.”
Panelists also noticed the benefits of more patient and referring physician engagement as a result of the pandemic. “One thing that I think worked well is engaging the patients and the ordering physicians in the process,” said Mossa-Bosha. At his institution, they implemented a text messaging system for patients to be in communication with their referring physicians to help rank elective imaging and determine time-sensitive or critical procedures. He hopes they’ll continue to increase patient and referring physician engagement, which will be particularly useful during crises when triage is paramount.
Panelists mostly spoke of constructive changes when it comes to process improvements, functionality, and patient communication and safety as a result of COVID-19. The proliferation of telehealth, however, was raised as a potential concern. “This rapid transition to telehealth is a genie that will not be able to be put back in the bottle,” Smetherman said. “I've jokingly said to my colleagues, ‘Okay, well, I guess the physical exam is dead!’ It has been surprisingly well-accepted in our institution by both the patients and by our clinical colleagues. I could envision a day when the people who are onsite at healthcare facilities are RTs, some IRs, surgeons, proceduralists like breast imagers, and everything else is done digitally. This digital disruption we've heard about in meetings for a decade basically happened in a week.”
Financial concerns are also top of mind for radiologists, as they prepare to navigate economic implications of COVID-19 and brainstorm ways to recoup losses. However, panelists reminded attendees that the challenges of these unprecedented times also provide fertile ground for leadership to blossom. “I really find these unexpected crises are equalizing events,” Ortiz said. “The traditional considerations of leadership hierarchy can be loosened a little bit and anyone can be a leader in their particular space.”
This article is the second of a five-part series in which the Bulletin will delve into key topics covered during RLI’s Leadership Town Hall: Leading in Times of Crisis. Read the first part, “Women Take Charge at COVID-19 Hot Spots,” here. To access the full recording of the webinar, visit bit.ly/RLITownHall_COVID.