In 2002, a number of hospitals began exploring the feasibility of implementing a shared services approach to digital diagnostic imaging (DI). Many hospitals in the region were seeking opportunities to form strategic alliances. Most required access to the expertise and resources outside of their own settings to address the needs of their patients. Shared digital imaging fit perfectly with these objectives as it provided a way to access expert diagnosis without having to move the patient.
The GoalThe hospital leaders wanted to develop a cooperative initiative among hospitals to deliver digital imaging, rather than each hospital independently developing its own system. They agreed to initiate a pilot project to implement DI in eight of the hospitals in the region, some with multiple sites, commencing in early 2004 and finishing in the first quarter of 2006. Expected benefits included:
Enhanced patient care:
- Improving access to a range of services for patients in their own communities;
- Providing better access to radiologists, nuclear medicine physicians and other DI specialists;
- Enhancing the speed of treatment decisions;
- Reducing unnecessary repeat diagnostic procedures and patient transfers.
- Enabling multiple exams to be viewed simultaneously at multiple locations;
- Displaying prior studies and reports;
- Providing immediate, 24/7 access to images and reports;
- Producing clearer images that can be easily manipulated.
- Making the system more affordable to smaller communities by sharing infrastructure, support and maintenance;
- Eliminating film, processing and packaging materials, and paper reports;
- Reducing the time spent locating and transporting films.
The ProjectThe pilot was officially launched in early 2004. A governance/partnership agreement was developed to guide and govern the development of the shared imaging service. It included active participation from the stakeholders – the hospital leaders, five vendor partners, a federal government agency and the provincial health ministry.
In addition, a core team was created to guide the project. It included the Project Director, Core Clinical Coordinator, Technical Team Project Manager, Change/Knowledge Management Lead, Benefits Evaluation Lead, Regional Communications Lead, Financial Analyst, Communications Specialist and Clerical Support. This team also consulted with the DI Leads from each participating site.
The project focused on the following steps to achieve success:
- Build a data center with the highest level of availability and performance possible to support the electronic patient record (EPR) and on-line digital imaging. A secondary data center would provide for site disaster tolerance and ensure data availability 24/7 with a failsafe, seamless backup continuously available.
- Assess clinical needs, the digital imaging and report viewing requirements throughout the hospitals to determine who requires access, and what type of access they require.
- Assess modality (machine) upgrade requirements to determine whether the existing equipment could be upgraded or needed to be replaced. Also determine how workflows and processes needed to change and what was needed to support that change.
- Establish milestones that would satisfy the funding partners’ practice of reimbursing the project based on the completion of deliverables to their satisfaction.
- Work with the vendor partners to ensure the system that was built could be replicated and expanded based on common standards that allowed different suppliers and vendors to be involved.
- Capture knowledge as the project progressed. The funding partners required the development of case studies and lessons learned to assist future initiatives in other regions—both nationally and internationally.
- Manage change by ensuring education and communication supports were in place for those involved in the transition to digital imaging to help them embrace, support and sustain the change.
- Develop and offer training to best fit the needs of the learners.
- Evaluate benefits delivery based on selected indicators throughout the project.
- Ensure the privacy and security of patient information and was fully compliant with federal and provincial privacy legislation.
- Develop and implement the ongoing CDI (Cooperative for Diagnostic Imaging) business utility including the cost recovery model to sustain the shared services.
- Conduct research on compression technology to manage an estimated 20 terabytes of digital images annually and the related operational and legal issues.
The ResultsThis multi-million dollar undertaking successfully implemented the DI solution in the eight pilot sites. It was one of only five operating sites in the world using the full suite of GE Healthcare’s PACS (picture archiving and communication system) software. This gave multiple hospitals the ability to update and access digital images simultaneously in a highly reliable and available system. Further, the solution tightly integrated the PACS system, the Cerner Radiology Information System and the Lanier dictation system. This integration supported the high level of reliability, performance and availability required for the on-going operation of the system.
The project did not have quantitative measurements in place to track of the value realized by the eight pilot sites. However, surveys were used extensively to measure the perceptions of those involved with and affected by the change. Some key findings:
- The majority of radiologists and referring physicians indicated that their efficiency improved as a result of PACS implementation
- Several examples identified significant improvements in patient care:
- Access: Almost 40% of radiologists reported remotely to new sites
- Quality: 2/3rds of referring physicians reported that PACS had improved their ability to make decisions regarding patient care
- Some evidence that organizational efficiency has improved:
- 70% of referring physicians identifying reduction in duplicate exams
- Some support for reduction in patient length of stay
- Higher levels of satisfaction among radiologists and all users of the Hospital workstation in operating PACS
How a Great Project Management Team HelpedNormally, I talk about the things the project manager did, or could have done, to achieve a successful result. In this case, however, I’ll give credit to the entire core team for the pilot’s successes. Not only did they realize their goals, they left a legacy of lesson learned for the benefit of the hospitals that would follow their lead. Here are some of their findings:
- Leadership and sponsorship were acknowledged as key drivers in the success of the project. The leadership clearly articulated and continually reconfirmed the objectives and scope, successfully removed the barriers and ensured that all the objectives were met.
- The Core Clinical team moved from site to site. The team only got better as they went along; able to leverage their experiences and adapt processes to incorporate lessons learned.
- The strength of the project was communications, including
- The regional bulletin, a key communiqué to those in the field
- The community sites had direct ownership of the communication plan at their site.
- The stakeholder and target audience analysis laid the foundation for getting the details on identifying all the training targets.
- Different strategies worked at each site, according to their needs.
- DI Leadership forum (regular monthly meetings of the Diagnostic Imaging Managers) worked well to promote agreement and standardization across the regions.
- The eRoom provided a central online repository for the current and archived documents, readily accessible to all project team members.
- The regional bulletin, a key communiqué to those in the field
- From a financial point of view, good controls and good planning were in place. In addition, the project was well funded.
- The project teams were a combination of internal and external resources. The teams were ‘A’ players with the right skills. A recurring theme was that ‘Availability is not a skill.’
- The technical architecture workshops provided a forum for identifying and working through issues prior to contract signings.
- The Vendor Statement of Work was a process and a document that involved all vendors, promoted a single team approach and a commitment to results.
- The nursing units/departments had a positive experience with the ‘Last Call Walk Through’ process. This provided an opportunity to provide quick fixes and quick wins.
- Also key was the ‘Sweep Back Process’ prior to the project end.
- The Biweekly status meetings with stakeholders and the monthly Milestone summary sheets were very helpful.
So, if you find yourself in a similar situation, remember to consider Project Pre-Check’s three building blocks right up front and put these points on your checklist of things to do so you too can be a Great Project Manager, and your sponsor’s best friend.
In the interim, if you have a project experience, either good or bad, past or present, that you’d like to have examined through the Project Pre-Check lens and published in this blog, send me the details and we’ll have a go. And, new this month, if your project is selected and published, I’ll send you a free copy of my latest book, Project Pre-Check FastPath - The Project Manager’s Guide to Stakeholder Management.
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