SCENARIO (slide 2) RESULTS RESULTS CHOICE A (best) You are the manager of a medical imaging department and have received several complaints from referring doctors’ offices that the overall turnaround time for radiology reports is too long. The process behind the reports is as follows: Order is placed. Radiologic technologist takes x-ray. Radiologist reads exam. Transcriptionist types up report. Radiologist approves and signs the typed report and it is immediately faxed to the referring doctor’s office. In this activity, you will determine the root cause and address the problem(s) that are causing the delay. The first step is to figure out what type of data you should consider. You look at the: CHOICE A (best) Time the x-ray was ordered and time the report was faxed. CHOICE B (OK) Number of reports typed up by each transcriptionist. CHOICE C (worst) Number of exams read by each radiologist. RESULTS Since the problem is with turnaround time, looking at the total time the process takes is a good choice. RESULTS The problem is not with the number of reports, so this data isn’t what you should be looking at. TRY AGAIN RESULTS The number of exams read hasn’t been an issue. You need to look elsewhere for data. TRY AGAIN Now that you’ve determined the data you need to gather is time, you have to figure out where to find the relevant information. What would you do next? CHOICE A (best) Look at the computer logs to see at what time each step of the process was done. CHOICE B (ok) Ask the radiologic technologists, radiologists, and transcriptionists how long the step each is responsible for takes. CHOICE C (worst) Watch the process a few times to see how long it takes from start to finish. RESULTS This will give you an accurate view of the time it takes to complete the process, and which parts of the process take the longest. RESULTS This won’t give you an accurate idea of time because it’s based on each person’s memory and opinions. It also won’t give you specific information about previous cases. TRY AGAIN RESULTS This will take up a lot of your time and won’t give you good data because you can only follow a few orders to completion at a time. It also won’t give you information about previous cases. TRY AGAIN To determine which part of the process is causing the delay, you randomly select 100 radiology exams that have already been completed. For each one, you look up the time ordered and the time the x-ray was performed. Your standard for this is 1 hour. You find that:   80% of the x-rays were performed within 1 hour of the order being placed 15% were performed within 2 hours 5% were performed within 3 hours Based on this information, you decide: CHOICE A (best) The time between the order and x-ray is not the root cause, so you need to look at other parts of the process. CHOICE B (ok) The 1 hour time limit is the root cause and more time should be allowed for x-rays. You set a new standard of 2 hours. CHOICE C (worst) The 1 hour time limit is the root cause and x-rays should be taken sooner. You set a new standard of 30 minutes RESULTS Most of the x-rays are being taken within the time limit. This isn’t where the delay is occurring, so you should look at other steps in the process. RESULTS X-rays are taken within the new time limit, but you get even more complaints because now the process is taking even longer to complete. TRY AGAIN RESULTS The technologists are unable to complete x-rays within that limit. They begin to complain, and you continue to receive complaints about the overall turnaround time TRY AGAIN . Having decided to examine the entire process, you then look at how much time each step takes, from the order being placed until the time it’s sent. You find the biggest lag occurs between the x-ray being taken and the radiologist reading it, with the next biggest lag between the time the radiologist reads the x-ray and the transcriptionist types it. You decide to: CHOICE A (best) Hire another transcriptionist and modify the radiologists’ schedules so another one is available during busy times. CHOICE B (ok) Change the schedule so transcriptionists and radiologists work slightly longer hours and more are available at any given time. CHOICE C (worst) Fire the slowest radiologist and transcriptionist. RESULTS Turnaround time decreases, justifying the added expense of another transcriptionist. You still have some issues related to staff members who don’t work as quickly, but overall the situation has improved. RESULTS Turnaround time decreases slightly, but transcriptionists and radiologists complain about the longer work hours and you fear some of them may quit. TRY AGAIN RESULTS Having fewer staff members has made the turnaround time even longer and the remaining radiologists and transcriptionists complain about the extra work. TRY AGAIN