In this issue, we talk with David B. Larson, MD, MBA, newly appointed Chair of the ACR Commission on Quality and Safety and Professor of Pediatric Radiology in the Department of Radiology at Stanford University, about the specialty’s ongoing focus on quality and safety and the opportunities ahead for continuous improvement.
According to outgoing Chair Jacqueline A. Bello, MD, FACR, “I leave the ACR Commission on Q&S in good hands with Dr. David Larson at the helm. While no undertaking is guaranteed smooth sailing, I wish him calm seas and favorable winds, confident in his ability to adjust the sails in order to reach desired destinations!"
Says Larson, “I'm honored and delighted to be given this opportunity and humbled to be able to work with such a tremendous group of people across the board. The commission has an extremely talented staff and highly dedicated volunteers who work hard day in and day out for the benefit of our members and our patients. The quality and safety programs that have been established by the leaders of the Commission over many decades are a tremendous legacy and foundation on which I am grateful to help continue to build.”
Q&A With David B. Larson, MD, MBA, Professor of Pediatric Radiology in the Department of Radiology at Stanford University
Q. What are the opportunities ahead for improving quality and safety in radiology?
A. This is an exciting time for radiology. From its inception, our specialty has been one of almost continuous change, especially over the last several decades. The advent of AI presents many new opportunities in many areas, but as the hype starts to fade, I believe AI will end up being almost entirely about quality. It will give us the ability to measure what was previously unmeasurable. It will give us tools to easily and broadly apply content developed by the ACR over the last several years, such as the ACR Appropriateness Criteria® (AC), Practice Parameters & Technical Standards and the RADs programs. We will increasingly have both the ability and the expectation to improve our practices in meaningful and measurable ways.
Another major opportunity will be a greater emphasis on collaboration, both with each other as radiologists and with others in the medical community. This is partially facilitated by technology but also by a changing mindset within the field and across medicine. Those deepening collaborative relationships will be a true benefit both to radiologists and patients and provide a more exciting environment to practice in.
Q. What does continuous improvement mean in radiology?
A. Quality is about delivering consistent excellence. Continuous improvement is the dedication to the proposition that we can always become better. Continuous quality improvement is the processes of objectively evaluating our performance, continuing to set high goals for ourselves and pushing ourselves to meet those goals in tangible ways. The willingness to seek feedback and then act on that feedback to improve tools, processes and skills that go into creating excellence, are what drive continuous improvement.
Q. Looking back over the last five years, what have been the greatest accomplishments to come out of the Commission?
A. One thing that's really exciting is to see continued advancements of the various RADs programs. In the last few years, that process has moved quickly with the addition of several classification systems. Now we have an opportunity to look at those RAD development processes and see if we can make them even more systematic and useful.
In addition, the Practice Parameters & Technical Standards continue to become more refined and more relevant; they provide a strong foundation on which to build AC into practice. And a heroic effort has gone into making the AC available through clinical decision support.
The accreditation program has continued to grow and make a major impact on our specialty and patient care. This is a major driver in ensuring quality standards in practice across the country.
And, finally, the annual quality and safety conferences have been outstanding — and they keep getting better and better every year, with greater participation, offering greater networking opportunities and focusing increasingly on actionable improvement.
Q. Why is quality and safety in radiology more important than ever before?
A. We are currently at the intersection of several forces that are driving the need for a relentless pursuit of quality. Imaging technology is maturing and becoming increasingly complex. At the same time, our interfaces with other parts of the medical system are growing rapidly. Not surprisingly, we find that quality tends to break down at those interfaces. Third, practices are becoming large, bringing a different level of scale. And lastly, AI will offer the opportunity to develop quality improvement tools that were not previously possible. These forces together will bring both the motivation and the ability to increase consistency in excellent performance. But it will not build itself; we will need to work together to bring these changes about in a way that will ensure that the patient remains at the center of it all.
Q. What goals do you have as you take over the helm of the Commission?
A. First, I want to recognize two outstanding individuals who have agreed to serve as vice chairs, Dr. Jennifer Broder from Lahey Clinic and Dr. Matt Davenport from the University of Michigan. I couldn’t ask for a more capable and engaged team. Second, I want to recognize the leadership of Mythreyi Chatfield, PhD, Executive Vice President for Quality and Safety — who is incredibly talented and brings a wealth of experience under the supervision of Dr. Bill Thorwarth — with the support of a phenomenal staff.
My primary goal is to preserve and build upon the excellent structure that already exists. We have an outstanding staff, wonderful volunteers and tremendous programs. My goal is to help support and, hopefully, continue to advance those efforts.
On top of that, I would like to focus on increasing individual and organizational learning and improvement. For example, the field has begun a transition from peer review to peer learning; I would like to help facilitate that in a thoughtful way. I would like to help facilitate how practices learn from each other and how practices and hospital systems learn from their own performance and improve over time. I am also looking forward to partnering with other ACR commission chairs to see how our committee chairs and members can continue to collaborate across the College to learn from and support each other.
Q. What advice do you have for your colleagues about getting more involved in quality and safety?
A. I would say, especially to the younger members, that a career focused in quality improvement is extremely rewarding, albeit challenging. Quality improvement is something you can start early, but takes an entire career to master (and then some). It requires a diverse and complementary skillset —engineering, design, data science, cognitive and social psychology, systems management, project management and leadership. It will constantly challenge you, keeping you honest and humble. If it’s easy, you’re doing it wrong. But if you do it right, you can effect dramatic change that did not previously seem possible.
Come join the thriving, collegial community dedicated to continuous improvement in radiology. We teach each other, learn from each other and constructively push each other to constantly do and be better. There is no better training ground for leadership, no more collaborative community and no greater sense of accomplishment than what you will encounter in the field of quality improvement.