ACR Bulletin

Covering topics relevant to the practice of radiology

Hive Mind

Jump to Article
Championing a team approach with frontline workers can define the patient experience.

"Without staff who are capable problem solvers — who know how to read patients — your practice is going to have problems."

—Michael A. Bruno, MD, FACR
November 01, 2019

Radiologists’ appreciation for the RTs, nurses, and front office staff who drive patient care in an imaging-rich healthcare system can make them better physicians. Building, sustaining, and strengthening relationships with frontline workers should be top of mind.

“Many radiologists don’t have a good grasp of what frontline staff do on a daily basis,” says Jennifer L. Kemp, MD, FACR, a diagnostic radiologist and body imaging subspecialist with Diversified Radiology in Denver. These are the people who actually see patients — directing the imaging workflow and guiding patient satisfaction. It behooves radiologists, Kemp says, to get to know frontline staff if they want to maximize the skills those workers bring to the table.

The challenges of building relationships with frontline workers vary from setting to setting — and are certainly nuanced between private practice and hospital-based and academic radiologists. Regardless, Kemp says, not taking the time to acknowledge frontline contributions is bad for business and can erode patients’ trust of radiologists.

First Contacts

“At my outpatient breast center, we constantly interact with frontline staff — we count on them,” says Stamatia V. Destounis, MD, FACR, clinical professor of radiology at the University of Rochester and partner at Elizabeth Wende Breast Care, LLC, in Rochester, N.Y.

Schedulers and front office staff make first contact with patients, Destounis points out. “They take all our calls, schedule appointments, collect reports for us, and make sure that anything the primary care doctor wants done, actually gets done,” she says. They are responsible for getting patients to the right place at the right time for the correct study. By walking patients through the imaging process and keeping track of the workflow, front office staff can bolster patient satisfaction and reduce the number of no-shows, she adds.

Beyond logistics, they meet the individual needs of radiology patients. “We get nervous patients or elderly patients who need assistance,” Destounis notes. “Our staff might help them find a private place to sit or get them a glass of water. They talk to patients about routine mammograms, answer basic questions, and explain next steps.”

Radiologists should be aware of front-end interaction with patients to ensure the imaging experience is beginning on the right foot. “You need front office staff who are friendly, efficient, and smart,” says Michael A. Bruno, MD, FACR, professor of radiology and medicine and vice chair for quality and safety at the Penn State Milton S. Hershey Medical Center. “Securing these types of workers is an investment in your future. Without staff who are capable problem solvers — who know how to read patients — your practice is going to have problems.”

Open Exchanges

Those skills are equally important for radiology nurses and RTs. Putting the clinical staff’s talents to optimal use requires efficient but constant communication with radiologists.

“When there is open communication between an RT and a radiologist, quality is top-notch,” says Erin Zubia, RT(R)(QM), lead mammographer at Gila Regional Medical Center in Silver City, N.M. RTs gather critical information and double-check why a particular type of exam has been ordered, she says. “We ask a lot of questions before an exam. This could include prior surgeries, family history of cancer, and so on. We document all of this for the radiologist in the PACS.”

Frontline staff should be empowered to call the radiologist when a patient presents with a potentially critical condition, such as a bone fracture or pneumonia, says Zubia. “When possible, we have the patient wait while images are read and results are reported to a patient’s ordering physician,” she says. “This allows the patient to get treatment sooner, instead of sending the patient home to get the results later the same day.” Cross training within your group is important, too, she adds, so that several people can handle different tasks when you are short-staffed. “We have department heads for each group — RTs, medical assistants, and front desk and call center staff — and they have weekly (sometimes daily) meetings with their staff to discuss concerns about process, workflow, and safety procedures,” Destounis says. The meetings provide a forum for an equal exchange of ideas for improving the patient experience — subsequently shared with radiologists.

Radiologists should continue to be advocates for frontline staff, Zubia believes. “We want them to be involved in our team and educate us. There is something to learn each day in our field,” she says. Monthly team meetings that include all imaging staff, not just radiologists and administration, keep everyone on the same page, Zubia says. “It helps us know what areas are working and how to improve workflow processes that ensure quality care throughout the hospital or clinic.”

Extra Duties

Radiologist guidance on performing exams can improve quality, minimize repeat exams, and save the radiology group valuable time. When given a chance to talk through processes and daily challenges, however, some frontline staff can be reluctant to speak up or challenge an existing workflow policy.

Nursing staff often accommodate heavy workloads. They communicate any special needs of patients to RTs, administer medications, monitor vital signs, assist with catheters, help with sedation, and generally attend to patients’ comfort. Staff shortages, walk-in patients, and keeping providers and referrers happy can add to the load.

Because radiology departments provide services to a wide variety of patients with diverse needs and little information to offer, radiology nurses work at an intense pace — and must have a high level of knowledge, expertise, and independence. Awareness of staff stress helps to build trust and can lead to a more constructive dialogue that benefits everyone. Studies of nurse staffing have shown that extended shifts can lead to burnout, fatigue, and, most importantly, can compromise patient safety.

All frontline staff at some point will face difficult patients while trying to stay focused on the quality of the care they are providing. A radiologist’s understanding of staff challenges is essential to ensuring patients get the best possible treatment. Encouraging real-time communication among frontline staff can expedite the transfer and management of patient information — with the goal of avoiding patient care delays and minimizing clinical and medical record errors.

Collective Counsel

“It’s easy to get caught up in your own work for the day, never stopping to think that what other staff are doing is an integral part of the imaging and care delivery process,” Kemp says. “It definitely crosses my mind to shadow one of our RTs for a day — to go into patient rooms with them. Daily tasks get in the way, but I’m determined to change that.”

Radiologists should be visiting the front lines not just when a problem needs to be resolved, Kemp says. Taking a walk to see what staff are up against can provide new insight on the type and quality of care patients receive, such as how many patients are waiting and how many scanners are in use. Moreover, it shows those staff your commitment to the process and your willingness to hear ideas and facilitate changes.

Some radiology groups employ messaging tools that allow radiologists to reach RTs with questions about patients, or front desk staff to check patient information with other departments. These types of tools can speed up workflow, but should never replace face-to-face conversations, Kemp says. Clinical decision support and AI applications can reduce human error and potentially free up radiologists’ time, she notes, and it is important to use that time to engage frontline staff.

“Joining hospital committees can also give radiologists an opportunity to interface with frontline workers — not only from their own department but from others,” Bruno says. Private practice radiologists can sit on committees and volunteers are always welcome, he adds. “It’s a chance for radiologists to hear staff voices and discuss barriers.”

These types of meetings can reveal problems that are happening outside your own department. “It’s imperative that radiologists get involved — and take leadership roles,” Bruno says. “If you don’t, you may have other committee members making decisions that could directly impact your group’s work.”

Delivering a good patient experience has taken center stage in radiology, and patient interactions with frontline professionals are paramount to a radiology group’s success. Keeping frontline staff happy is also important for continuity of care. Replacing staff is expensive, and some referrers are more comfortable with familiar voices and faces. A frontline worker who believes his or her work is acknowledged and appreciated is more likely to pay that forward to patients.

Most frontline staff understand the need to treat patients with empathy and respect — and that their willingness to do so feeds patient satisfaction. Staff may engage even more if radiologists take the time to stress how their service ties into revenue under a value-based system. Education among all members of the team will better serve the practice and patients.

Radiologists cannot be effective when they do their job in isolation. “We need those around us to make sure we’re doing the right things,” says Destounis. “The truth is that frontline staff keep radiologists at the top of our game — and keep our patients safe.”

Author Chad Hudnall,  Senior Writer, ACR Press