June 13, 2023

The Impact of Patient-Centered Care on Quality and Safety

In this issue, Arun Krishnaraj, MD, MPH, FACR, discusses how tools and resources from the ACR® Commission on Patient- and Family-Centered Care (PFCC) can play an integral role in radiology practices’ quality and safety programs.

First off, what is patient- and family-centered care?
Patient- and family-centered care is an approach to the planning, delivery and evaluation of healthcare that is grounded in mutually beneficial partnerships among healthcare providers, patients and families. It redefines the relationships in healthcare by placing an emphasis on collaborating with people of all ages, at all levels of care and in all healthcare settings. In patient- and family-centered care, patients and families define their “family” and determine how they will participate in care and decision making. A key goal is to promote the health and well-being of individuals and families and to maintain their control.

What is the importance of the PFCC in helping radiology practices improve quality and safety of patient care?
Patient- and family-centered care is integral to providing high-quality imaging services. Without good communication and shared decision making, and the ability to speak up on behalf of patients and their families, the safety aspect of what we do will be compromised. The PFCC is at the heart of everything we do as radiologists. All of our protocols, all of our reporting, all of the equipment purchases, all of the training — all of it is intended to work toward the goal of providing the best patient care possible. If patient care isn't of high quality or if errors lead to injuries or poor outcomes, then the patient and their families suffer. To me, the overlap between quality and safety and patient- and family-centered care is natural.

Can you give us a concrete example of that impact?
I'm the Vice Chair of Quality and Safety for the radiology department at the University of Virginia. One of the roles I'm tasked with is following up on errors or issues that occur that result in poor patient outcomes or patient harm. When we conduct a root cause analysis to assess what didn't go as planned, our ultimate goal is to employ countermeasures, so it doesn't happen again. When an error is made, most patients and families want reassurance that the same issue won’t impact anyone else. And that is where quality and safety come into play. How do we create more reliable systems? How do we share the learning process from an event across an organization to mitigate and hopefully prevent those errors from ever occurring again?

Tell us about the priorities for the PFCC and what’s in store for the future.
One key thing is, we want to continue to build on current successes — specifically the toolkits and resources we've made freely available to help members of the College improve the patient experience, including a new series of patient-friendly animations designed to help patients participate in shared decision making with their physicians for imaging services. We want to disseminate those resources as widely as possible. To that end, we’ve partnered with radiologyinfo.org, and we want to work with more patient advocacy groups, so that any time someone's in a waiting room or browsing the internet and they're worried about whether or not they should get an imaging exam, they will find our resources and make more informed decisions.

What are some of the other noteworthy initiatives of the PFCC?
We are continuing to push forward with our focus on lung cancer screening efforts. Lung cancer screening trails well behind screening for breast, cervical and colorectal cancer, but we know that it's effective in helping to save lives. One new effort that we accomplished was to establish National Lung Cancer Screening Day, which encourages people to get scanned. This year it will fall on Veterans Day, which is especially timely since many veterans have a history of smoking. We want to get that population screened and identify cancers as early as possible, when treatment options are still good and the chance for a cure and normal life expectancy still exists.

Another initiative is leveraging AI to enhance our abilities to identify and follow up on incidental findings. We have a wealth of information available on scans, but it is currently not being communicated to patients or referring physicians. As these AI tools come on board, we will be able to rapidly identify incidental findings, disseminate them and ensure that patients get follow-up. That is going to be a big new opportunity for radiologists. And we see the PFCC as a way to inform our patients that this might be coming and raise expectations about what is possible with imaging. What’s more, as radiology reports are increasingly released directly to patients, it raises another concern, because most patients are not prepared to interpret the reports, as they’re not designed to be patient facing. We've done a lot of work in advancing patient-friendly reporting, which can be provided without adding to the time or burden of the radiologist creating that report.

What are the benefits to radiologists in engaging with the PFCC and using the resources?
Right now, imaging volumes are skyrocketing, and radiologists are overwhelmed. Many of them are burned out. In addition to increasing volumes, there is often a disconnect between the radiologist and the impact of the radiologist's work. With PACS and digital imaging, that gap is growing. By accessing PFCC resources and implementing patient-focused programs — like assembling a patient and family advisory council, for example — we can help radiologists reconnect the care they provide to the patient directly.

What are some actionable steps that radiologists can take to become more engaged with patient- and family-centered care?
First, visit the PFCC resource hub on the ACR website. Take a look at what other practices or departments are doing. Access available toolkits, videos, case studies and content. Connect with other radiologists who are doing this important work to learn and share ideas.

Second, if you are attending the 2023 ACR Quality & Safety + Informatics Conference in October, be sure to look for the PFCC/Quality and Safety session on the agenda.

Third, connect with the PFCC to see how you can engage with other like-minded colleagues who are working to ensure that we, as radiologists, remain connected and continue to impact positively the health and wellness of the patients that entrust us with their care. If you feel like you are slipping further and further away from that with increasing pressure to produce more and more RVUs under shorter and shorter turnaround times, know that there is a group of folks at ACR who are working hard to try to ensure we don't lose that north star of patient care. Your participation is important, and I’m sure you’ll find something to work on that will bring you great joy and fulfillment. Remember, this is a team sport, and everybody can find their voice to contribute to this effort.

In the Spotlight

Krishnaraj Headshot 

Chair of the Commission on Patient- and Family-Centered Care Arun Krishnaraj MD, MPH, FACR, is professor of radiology and medical imaging at the University of Virginia, where he serves as Vice Chair for Quality and Safety, Director of the Division of Body Imaging and Director of Body Procedures.

In these leadership roles, he has implemented several innovative measures, including infographic-rich, patient-centered radiology reporting and a process for patients to provide direct feedback to the radiologist on radiology reports.

Dr. Krishnaraj is a recognized leader within organized medicine. Notably, he is among the youngest-ever elected member of the ACR Board of Chancellors, President of the Virginia Radiological Society and Vice President of the International Society for Computed Tomography. He is a recipient of the prestigious American Medical Association Foundation Excellence in Medicine Award and the Dean’s Clinical Excellence Award at the University of Virginia. He was also featured as a Changemaker by the ACR for leading efforts toward greater patient-centered care.