Please tell us about your professional career.
Prof. Yaker: I specialised in interventional radiology techniques during four years of training in Paris in the public sector, and then returned to introduce interventional radiology to Algeria. Since 1993, I moved to the private sector and founded the Centre of Medical Imaging of Algiers (CIMA), which offers all imaging exams, including nuclear medicine. Our technology capabilities include a 1.5T MRI, a 16-slice CT, five workstations, two gamma cameras, a digital mammography unit, four ultrasounds, two digital radiology tables, an osteo-densitometry unit and a digital dental panoramic imager. In addition, we have five workstations, a PACS, and a RIS. The centre employs 13 radiologists and two anaesthesiologists among 90 staff. We performed 80,000 exams during last year. In addition to my daily work as a radiologist, I am the Medical Director. In this context, I orientate the radiologists’ activity towards a specialisation by organ and encourage the continuous improvement and the regular updating of our work practices.
F. Tala-Ighil: After graduation in a French management school (EDHEC Lille), I worked in an international pharmaceutical company in Algeria as a sales manager in charge of import and distribution of medicines. I managed 180 employees working in three distribution centres. This taught me a lot about how to manage and motivate people and showed me the power of a motivated staff. I began to work in the CIMA as a Financial Director first then as General Manager since 2008. My main mission as a manager is to make 90 individuals work as a team, like musicians form an orchestra. Success lies in alchemy and taking pleasure in teamwork, but this requires the ability to listen and to show respect for others.
What sorts of qualifications does one require to work as a business manager in a department of medical imaging in Algeria?
F. Tala-Ighil: A business manager needs to have management qualifications from a business school or equivalent institution that provide strong knowledge of accounting and finance, human resources, organisation, marketing, quality assurance, information systems, and so on. In a medical imaging centre, the relationship between the medical staff and the manager is very specific and delicate to manage. It is not a hierarchical one and it needs to be built up step by step. In Algeria, public medical care is still free of charge. It’s why Algerian patients used to think that a private service must be better than a free one and they are very demanding concerning service quality.
How is cooperation organised between the Chairman and the Business Manager?
Prof. Yaker: It’s built around formal monthly meetings where the manager presents quantitative results of the activity and informal daily meetings where we talk about current problems and the different possible solutions.
F. Tala-Ighil: I have six administration direct reports (from human resources, accounting, IT, QA, stock management and sales) and five other medical direct reports (from MRI, CT, X-ray and US, Nuclear Medicine and Mammography). I meet each once a week for a review of the problems and an overview of work in progress. I also often work with them in their own environment; it gives me an opportunity to better understand their specific problems.
Can you tell us how budgeting and financial issues are decided and implemented in the department?
F. Tala-Ighil: Prof. Yaker and I decide budgeting and financial issues. The accounting and finance manager is in charge of accounting, preparing business plans, budgets, salaries, equipment inventories, and so on. We’ve also set up a cost accounting system since January 2012. Our equipment is financed by bank loans.
Is there a dedicated manager for staff and human resources?
F. Tala-Ighil: We have a human resources manager in charge of selecting CVs and interviewing candidates when we recruit, following career advancement, organising staff planning, resolving internal conflicts within the centre, managing hygiene, security and safety. She has a crucial role: she’s listening daily to employees’ problems and collecting suggestions. She and the department managers are the main people who make the staff participate in the centre’s management.
What about waiting lists?
F. Tala-Ighil: We’ve worked these few last years to optimise patient workflow. We’re able now to receive almost all the patients without appointment. We’ve maintained appointments only for MRI and few other exams for medical reasons (HSG, myocardial scintigraphy, biopsy, interventional radiology). To minimise the time spent by the patient and the waiting list in the MRI department, we’ve adopted the following measures:
- Two MRI beds available to prepare patients outside the MRI room;
- All the coils are duplicated;
- Offer 7/7 working time due to increasing demand, by streaming our five technicians into three combined teams and recruiting a new full-time radiologist, and
- A dedicated telephone reception facility for MRI appointments.
Thanks to this, activity increased by 30 percent in 2011.
What sort of methods do you use to monitor quality control?
F. Tala-Ighil: Quality control must be based on measurable quality criteria. Currently, all our efforts are focused on measuring the delays because the first patients’ demand is to minimise them and to respect the appointment time. The main tool to measure delays is the RIS. It gives the information below through three steps: appointment (see fig. 1), examination (see fig. 2) and results delivery (see fig. 3) In the MRI department, the patient sends their request for an appointment by mail, phone or by moving to the centre. The request is dealt with by receptionists who schedule a date. Therefore, we need to reduce both the delay to phone back the patient and give him an appointment (D1) and the time between the request and the appointment (D2). After the examination, we give the patient a promised date for the results delivery. This date is entered into the RIS and compared later to the real time where the results were delivered.
Why should management be an important part of the education of a radiologist, and do you think that this belief is growing?
F. Tala-Ighil: Actually, radiologists are often both radiologists and managers. When one recruits or invests in new equipment and need to ask the bank for a loan, when one buys software solutions, etc, that person is in a manager’s role and not in a radiologist’s one and needs therefore good qualifications to do it well.
How can the Chairman of the medical imaging department balance their workload, between managerial duties and scientific ones?
Prof. Yaker: In our centre, the importance of management requires a specific competency that a Medical Director couldn’t have; he spends his main energy on medical and scientific activities. A manager and a sufficient number and level of administrative staff are essential to the management of the centre, which is a real company in the economic sense of the term, because of the importance of the investments and the significant number of employees.
Finally, please share your top pieces of advice for the optimal management and administration of a medical imaging department, with our readers.
F. Tala-Ighil: My advice would be to entrust management to a professional manager, but recognise the necessity of the radiologists’ involvement in management; and to use two strong tools when commencing new business activity. These are employees’ motivation, which involves respect, interesting wages, opportunities for career progression, good working conditions, a participatory management, and finally great organisational skills.