Summary drafted by:
Dr. Nicola Strickland
(Chairman, MIR, UK)
Prof. Philip Gishen
(Session Chair, UK)
Prof. tchoyoson Lim
Prof. Guy Frija
Dr. Sergei Nazarenko
Prof. Henrik thomsen
Prof. Michael Pentecost
This session was a novel venture staged for the first time at MIR 2007, Oxford, UK. Six well-known radiologists from different countries took fifteen minutes each to put forward their individual ‘ten Commandments’ that also reflected imaging management practices in their own countries. the session was then opened up to the floor and there was extensive discussion and contribution by the audience. the main additional points were collated in real time onto the overhead projector by Dr. Strickland, whilst Prof. Gishen hosted the overall session and directed the discussion, in this dynamic and highly entertaining session. Many of the speakers touched upon similar ideas, which we have summarised under headings below.
Focus on Manpower Issues
A variety of conclusions were gathered from presenters, as summarised below.
Prof. Gishen Stressed the Following Points:
• Imaging should be categorised into organ, disease and age-based (paediatric and neonate) specialists, rather than confined to modality-based specialists. All radiologists should have a working knowledge of the modalities needed to optimally image their specialist organ or disease system.
• Timetabling is vital to provide a robust service. Extended days are recommended, starting at 7am (or earlier, according to the preference of the radiologist) and ending routinely as late as 9 or 10pm. Radiographers and radiologists need not work longer, just smarter. IT technologies including PACS, remote electronic requesting, speech recognition and mobile communication have opened up the possibility for radiologists to work at times which suit them. Individual timetables are scheduled on an hourly basis, with every hour in the day assigned, with contact numbers and locations enabling the radiologist to be contacted directly. Provided the requisite amount of clinical activity is performed by the individual radiologist, the remainder of their time is organised into administration, research and teaching activities.
• Covering the on-call service is never a popular task, and is best achieved by interventional radiologists who are paid extra for their on-call duties. Proper remuneration increases the popularity of an on-call service.
• If a new procedure is introduced then at least two senior radiologists must be trained in this technique so that they can cover each other’s absence and offer continuity of service.
• Whilst frank exchange of views, and honest discussion of controversial issues is to be encouraged, “going to war with a colleague” should be avoided at all costs to preserve a good working environment.
Prof. Guy Frija From Paris, France Added the Following Observations:
• Productivity in managing an exemplary imaging service is three-pronged and requires assessment of quality of reports and imaging procedures, research output, and workflow turnaround times.
• Appropriate delegation can increase the efficiency of managing an imaging department, but only if those delegated to are properly supervised and supported.
• Current management of any department requires objective planning for the future.
Prof. Michael Pentecost from Washington DC, US Added:
• Human resources are the most important contributor to good management. Having a cohesive and competent staff is paramount.
• Imaging results must be distributed promptly and widely to all referring clinicians and other legitimately interested parties.
• All professionals must be respected, including those not directly responsible for clinical care: all members of the team contribute to good management.
• In an imaging department it is the radiologists (i.e. fully trained and qualified doctors) who perform, and are responsible for, all the imaging studies, interpreting the results and distributing the findings.
Prof. Henrik Thomsen of Copenhagen, Denmark Observed:
• A lack of radiologists in certain countries will necessitate the most efficient practices.
• Motivation is vital to the success of managing any imaging department. Small measures such as publishing personal successes and news in an internal newsletter can help to build a motivated team.
• Mutual trust between colleagues, founded upon honesty and respect, forms a firm basis for successful management.
Dr. Sergei Nazarenko of Tallinn, Estonia Reminded Us That:
• Good management depends upon optimal balancing of personnel, technology and a spectrum of skills.
• A “clash of civilisations”, especially in Eastern European countries, needs particular attention. A sudden influx of sophisticated technology into a new department, and the exposure to leading-edge practices needs to be assimilated with care and expertise.
Prof. Tchoyoson Lim from Singapore Stressed:
• Good training for all members of staff within the healthcare team is essential for good management. Team work can be helped by professional and social unity.
Session Emphasises Importance of Reward
All speakers agreed that rewarding success was extremely important, and that whilst criticism and self-improvement are to be valued, one must not forget praise where praise is due and the importance of small rewards for minor improvements.
Prof. Lim drew attention to the importance of generating revenue and managing expenses in a business-like fashion as an aid to good management. Prof. Gishen touched upon the sometimes sensitive issue of private practice, especially when this is carried out in a state healthcare system. Fair sharing out of the rewards of such private practice encourages all members to contribute to such a scheme. In a partnership not everyone does the same amount of work. Alternative rewards should also be offered, such as the possibility of having extra leave or time off instead of extra pay, which may suit some team members better than remuneration. Extra pay for on-call duties is an effective motivator.
Managing Research/Academic Departments
Prof. Gishen said that it was important to keep an upto- date list of the number of grants, peer-reviewed papers, invited lectures and proffered papers that are given by all members of the department. Personal contributions in this field must be recognised as part of good management
Prof. Frija divided this area into the subheadings of education, ethics approval, good statistics and publications. Prof. Pentecost reminded us that radiologists are great teachers, and generally love teaching (and collecting good cases!). They should be encouraged to educate colleagues and other clinicians; and management should concentrate upon providing them the IT facilities to carry out these activities in this digital age.
Prof. Thomsen echoed the importance of publications and education in this area. He also advocated motivating continuous education on a personal level, and the importance of organising and attending academic congresses.
Department Working Times
Prof. Gishen outlined the importance of patient and physician satisfaction resulting from good management of departmental working times.
• Zero waiting lists can be achieved by empowering radiographers (technologists) to be responsible for departmental turnaround time in their particular areas. Prof. Lim also explained how to achieve shorter appointment times and waiting times, with faster report turnaround. He too highlighted the importance of meeting the expectations of patients and clinicians.
• A communal reporting room with numerous PACS workstations and immediate reports via speech recognition has proved highly successful in Prof. Gishen’s case, in promoting informal double reporting, “a fun working environment” and promotion of social interaction and team building between colleagues.
• The overall philosophy is to work smarter not longer.
These sentiments were added to by Prof. Frija who drew our attention to the importance of trying to promote the quality of reports as well as their quantity and turnaround time. Prof. Thomsen reminded us how important it is for the Head of department to be visible and accessible to colleagues within the department.
All speakers felt this was an important issue for the management of a modern imaging department. Prof. Gishen outlined the advantages of having a managed service or external refreshment programme for leasing and acquiring all imaging equipment, so that radiologists were spared the constant treadmill of writing business cases, seeking approval, getting money for and choosing new imaging equipment. A managed purchase agreement with a single company ensures approximate state of the art of all equipment used in the department, with scheduled refreshes and upgrades, and repairs and installations all built into the service. Radiologists can then concentrate upon their prime function: imaging itself!
Professors Frija and Lim advised us that the most modern equipment is essential, although Prof. Pentecost cautioned never to buy “Version 1.0” but always to wait a little while to assess the marketplaces (and wait for bugged equipment malfunction to manifest itself!).