title: Focused process improvement events: sustainability of impact on process and performance in an academic radiology department.
abstract: OBJECTIVE
  To evaluate sustainability of impact of rapid, focused process improvement (PI) events on process and performance within an academic radiology department.
  
  
  METHODS
  Our department conducted PI during 2011 and 2012 in CT, MRI, ultrasound, breast imaging, and research billing. PI entailed participation by all stakeholders, facilitation by the department chair, collection of baseline data, meetings during several weeks, definition of performance metrics, creation of an improvement plan, and prompt implementation. We explore common themes among PI events regarding initial impact and durability of changes. We also assess performance in each area pre-PI, immediately post-PI, and at the time of the current study.
  
  
  RESULTS
  All PI events achieved an immediate improvement in performance metrics, often entailing both examination volumes and on-time performance. IT-based solutions, process standardization, and redefinition of staff responsibilities were often central in these changes, and participants consistently expressed improved internal leadership and problem-solving ability. Major environmental changes commonly occurred after PI, including a natural disaster with equipment loss, a change in location or services offered, and new enterprise-wide electronic medical record system incorporating new billing and radiology informatics systems, requiring flexibility in the PI implementation plan. Only one PI team conducted regular post-PI follow-up meetings. Sustained improvement was frequently, but not universally, observed: in the long-term following initial PI, measures of examination volume showed continued progressive improvements, whereas measures of operational efficiency remained stable or occasionally declined.
  
  
  CONCLUSIONS
  Focused PI is generally effective in achieving performance improvement, although a changing environment influences the sustainability of impact. Thus, continued process evaluation and ongoing workflow modifications are warranted.
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York. Electronic address: Andrew.Rosenkrantz@nyumc.org.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Rosenkrantz
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York.
authors.forename: Kirk
authors.initials: K
authors.lastname: Lawson
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York.
authors.forename: Rosina
authors.initials: R
authors.lastname: Ally
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York.
authors.forename: David
authors.initials: D
authors.lastname: Chen
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York.
authors.forename: Frank
authors.initials: F
authors.lastname: Donno
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Rittberg
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York.
authors.forename: Joan
authors.initials: J
authors.lastname: Rodriguez
authors.affiliation: Department of Radiology, NYU Langone Medical Center, New York, New York.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Recht
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D017598:Efficiency, Organizational / Q000706:statistics & numerical data*; D017146:Models, Organizational; D009518:New York; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D011872:Radiology Department, Hospital / Q000458:organization & administration*; D017749:Total Quality Management / Q000379:methods / Q000458:organization & administration*
keywords: Radiology; performance metrics; process improvement; radiology practice