title: Improving Efficiency Using Time-Driven Activity-Based Costing Methodology.
abstract: OBJECTIVE
  The aim of this study was to increase efficiency in MR enterography using a time-driven activity-based costing methodology.
  
  
  METHODS
  In February 2015, a multidisciplinary team was formed to identify the personnel, equipment, space, and supply costs of providing outpatient MR enterography. The team mapped the current state, completed observations, performed timings, and calculated costs associated with each element of the process. The team used Pareto charts to understand the highest cost and most time-consuming activities, brainstormed opportunities, and assessed impact. Plan-do-study-act cycles were developed to test the changes, and run charts were used to monitor progress. The process changes consisted of revising the workflow associated with the preparation and administration of glucagon, with completed implementation in November 2015.
  
  
  RESULTS
  The time-driven activity-based costing methodology allowed the radiology department to develop a process to more accurately identify the costs of providing MR enterography. The primary process modification was reassigning responsibility for the administration of glucagon from nurses to technologists. After implementation, the improvements demonstrated success by reducing non-value-added steps and cost by 13%, staff time by 16%, and patient process time by 17%. The saved process time was used to augment existing examination time slots to more accurately accommodate the entire enterographic examination. Anecdotal comments were captured to validate improved staff satisfaction within the multidisciplinary team.
  
  
  CONCLUSIONS
  This process provided a successful outcome to address daily workflow frustrations that could not previously be improved. A multidisciplinary team was necessary to achieve success, in addition to the use of a structured problem-solving approach.
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota. Electronic address: tibor.laura@mayo.edu.
authors.forename: Laura C
authors.initials: LC
authors.lastname: Tibor
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Stacy R
authors.initials: SR
authors.lastname: Schultz
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Ronald
authors.initials: R
authors.lastname: Menaker
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Bradley D
authors.initials: BD
authors.lastname: Weber
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Jay
authors.initials: J
authors.lastname: Ness
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Paula
authors.initials: P
authors.lastname: Smith
authors.affiliation: Department of Radiology, Mayo Clinic, Rochester, Minnesota.
authors.forename: Phillip M
authors.initials: PM
authors.lastname: Young
mesh_terms: D000553:Ambulatory Care / Q000191:economics*; D003365:Costs and Cost Analysis; D017598:Efficiency, Organizational / Q000191:economics*; D017050:Episode of Care; D006801:Humans; D008279:Magnetic Resonance Imaging; D008910:Minnesota; D010559:Personnel Management / Q000379:methods*; D017064:Process Assessment, Health Care / Q000191:economics*; D058996:Quality Improvement; D016526:Workload
keywords: MR; TDABC; efficiency; enterography; time-driven activity-based costing