1
Zoran Bojic, MHSc, PMP, CSSBB, CLA, ASQ-CMQOE
Ellen Charkot, M.R.T. (R.), BHA
Dr. Manohar Shroff, MD, DABR®, FRCPC
Department of Diagnostic Imaging
November 2014
RSNA 2014
2
� Radiologists
� Technologists / RNs
� Support Staff
� U of T
� Michener
� Mohawk
� 9 Imaging Modalities
� RIS / PACS
� Voice Recognition
� 130,000 Exams / Year
3
Legal and Regulatory
Compliance
Information
Management
Document
Management
Procurement
Management
Performance
Measurement
Human
Resources
Utilization
Management
Work
Environment
Education and
Training
Knowledge
Management
Risk
Management
Leadership and
Organization
Process
Management
Innovation
Management
Radiation
Safety
Operational
Controls
Service
Excellence
Technology and
Equipment
Continual
Improvement
Quality Management System Elements
5
� Affinity Diagram
� Benchmarking
� Bottleneck Analysis
� Brainstorming
� Cause and Effect Diagram
� Check Sheet
� Cognitive Walkthrough
� Control Charts
� DMAIC Problem Solving
� Fault Tree Analysis
� Five Whys
� Flowchart
� Force Field Analysis
� Gantt Chart
� Heuristic Evaluation
� Histogram
� Impact/Effort Matrix
� Interviewing
� Kano Analysis
� Mind Mapping
� Multivoting
� Nominal Group Technique
� Paired Comparisons
� Pareto Chart
� PDSA Cycle
� Project Charter
� Project Schedule
� Relationship Diagram
� Risk Response Plan
� Run Chart
� Scatter Diagram
� SIPOC Diagram
� Six Thinking Hats
� Solution Selection Matrix
� Spider Chart
� Stakeholder Analysis
� Usability Testing
� CTQ Requirements
� Kaizen
� Value Stream Mapping
� Standardized Work
� Error proofing
� 5S / Visual Management
� Kanban
� Single-Piece Flow
� Pull System
� Level Loading
� Spaghetti Diagram
� Rapid Changeover
� A3 Problem Solving
� Root Cause Analysis
� FMEA
� Stopping the Line
� Just-in-Time
� TPM
� MSA
� Design of Experiments
7
Improved
collaboration
Diminished
organizational silos
Consensus on key
priorities
Consistent execution of
projects
Effective allocation of
resources
Improved
communication
Increased capacity
for innovation
Enhanced organizational
capability
Systematic risk
management
Effective problem
solving
Better decision
making
Effective change
management
High return on
investment
Increased staff
engagement
Program
Management
Benefits
8
Pa
tie
nt
Sa
tisf
act
ion
Sta
ff E
ng
ag
em
en
t
Ed
uca
tio
n a
nd
Tra
inin
g
Faci
lity
De
sig
n
Mu
lti-
Mo
da
lity
Do
se
Me
asu
rem
en
t
Mo
dif
ied
MR
Se
qu
en
ces
Re
sea
rch
Pa
rtn
ers
hip
Re
sea
rch
Infr
ast
ruct
ure
Re
gio
na
l R
ep
osi
tory
of
DI
Ima
ge
s
Eq
uip
me
nt
Re
pla
cem
en
t
Ele
ctro
nic
Co
mm
un
ica
tio
n B
oa
rd
Pe
er
Re
vie
w S
oft
wa
re
Project Group 3
Service Excellence
Project Group 5
Advanced Technology
Project Group 4
Innovation and Research
Strategic Goals
Fall
Pre
ve
nti
on
MR
I S
cre
en
ing
Pro
cess
Ra
dia
tio
n D
ose
Re
du
ctio
n
Inte
rve
nti
on
al
Sa
fety
Ch
eck
list
Project Group 1
Patient Safety
Sta
rt o
n T
ime
MR
I Le
an
Pro
ject
Ro
om
Tu
rno
ve
r
Sta
nd
ard
ize
d B
oo
kin
g
Pro
cess
Project Group 2
Access to Services
Diagnostic
Imaging
Integrated Program
Management
9
Interpersonal
Dimensions
Communication
Appointment
Wait Time
Wait Time
After Arrival
Discharge
Instructions
Explanation
of the Exam
Preparation for
the ExamQuality of Care
Environment /
Facilities
Privacy and
Confidentiality
Activities for
Children
Parking, Food and
Directions
Factors
Impacting
Patient
Experience
10
IMPACT
EFFORT
HIGH
HIGH
LOW
LOW
���� Safety rounds
���� Focus groups
���� Daily huddle
���� Staff Coaching
���� Mentoring program
���� Customized surveys
���� Benchmarking
���� In-person interviews
���� Telephone survey
���� Website survey
���� Comment cards
���� Mystery shoppers
���� Engage volunteers
���� Ongoing communication
���� Simulation
���� Timely status updates
���� In-service sessions
���� Online education modules
���� Regular reviews of survey results
���� List of patient suggestions
���� Strengthen complaint process
���� Staff feedback in real time
���� Daily newspapers
���� Washroom cleanliness
���� Waiting room comfort
���� Q&S Leadership Walkarounds
���� New quality indicators
���� New staff orientation manual
���� TV program selection
���� DI website content
���� Information pamphlets
���� Exam Information translation
���� Pain management
ID Task Name
1 Provide timely status updates and improve
communication with patients and families
who are in the waiting room
2 Proactively reach out to patients and their families , lis ten
to their concerns and continue to keep them informed
while they are in the waiting room
3 Promptly explain reasons for delay and provide
estimates for their remaining waiting tim e
4 Review and prioritize suggestions for im provements
provided by patients and families
5 Provide staff education and increase
awareness about service excellence
6 Organize in-service session on service excellence for
all s taff
7 Encourage staff to complete the online service
excellence module
8 Ins titute regular review and communication of the NRC
Picker survey results
9 Strengthen the process for reviewing patient complaints
10 Provide coaching and timely feedback to staff who
interact with patients and families
11 Review the waiting area to ensure it is se t
up in a way that is comfortable for the
child as we ll as for parents/ guardians
12 Dis tribute daily newspapers to the waiting room s
13 Remove obsolete newspapers to prevent cluttering
14 Organize daily checks to ensure cleanliness of the
washrooms and waiting areas
Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct
4th Quarter 1st Quarter 2nd Quarter 3rd Quarter 4th Quarter
12
ID Project / InitiativeQ & S
Excellence
Enable
PeopleInnovate
Financial
HealthInfrastructure
Enhance
Systems
1 GTA West DI Repository (DI-r) X X X X
2 MRI Appointment Wait Times X X X X
3 CT Appointment Wait Times X X X X
4 Radiation Dose Reduction X X X X
5 Service Excellence X X
6 Quality Management Education X X
7 DI Q&S Leadership Walkarounds X X
8 2013 Accreditation X X
9 Report Turnaround Times (RTT) X X
10 IGT Equipment Replacement X X X X X
11 Simulation-Based Learning of CVL Insertion X X X
12 Innovative Procedures X X X
13 MRI Safety X X
14 Increasing OHIP Revenues X
15 Staff Engagement X X
16 International Benchmarking Project X X X
Diagnostic Imaging
2013/14 Strategic PrioritiesStrategic Directions
13
Appendicitis
US
+ -
+
TP
69
FP
9
-
FN
5
TN
94
Sn=sensitivity, Sp=specificity, PPV=positive predictive value, NPV=negative predictive value, Acc=accuracy
Sn= TP/TP+FN ---------------- 93.2%
Sp= TN/FP+TN ---------------- 91.2%
PPV= TP/TP+FP --------------- 88.4%
NPV= TN/FN+TN ------------- 94.9%
Acc= TP+TN/ALL ------------- 92.1%
Negative appendectomy rate= 2/73 = 2.7 %
66% of US requested ���� Normal
34.4% ���� Positive for appendicitis
Timeframe: 3 months; 206 consecutive requests; 105 daytime; 101 after hours; Follow up in 177
14
0
2
4
6
8
10
12
14Weeks
Policies Emergency Equipment
Screening Zoning Education
Safe MR Practices
15
Fire in MRI Suite - Emergency Procedure
Fire alarm is generated in a specified room in MRI Suite. Sprinklers are primed and
Fire Department is dispatched.
Hospital Emergency Response Team enters MRI Suite to investigate the area. Initial investigation for evidence of fire involves
looking through the window without entering the MRI magnet room.
Is there suspicion
of fire in the MRI magnet room
No
No need to enter the MRI
magnet room.
Yes
Properly screened individuals take the MR Safe fire extinguisher located outside the MRI magnet room and enter the MRI magnet room to check for evidence of
fire.
Is there an actual fire in the MRI magnet room?
No
No further action required
in the MRI magnet room. Lock the MRI magnet
room door.
Yes
Plant Operations in consultation with
Respiratory Therapy will assess the need to shut off oxygen source.
Has the fire been successfully extinguished?
No
Quench the magnet using the quench button. It may take 1-2 minutes for the
magnetic field to dissipate.
Fire fighters enter the MRI magnet room and extinguish the fire using
non ferrous equipment
Upon arrival, Protection Services informs Fire Department that the fire alarm originates from
MRI Suite
MRI technologist contacts the MRI system manufacturer to send MRI Field
Engineer ASAP
MRI technologist notifies On-Call MRI personnel of the system status
MRI Field Engineer completes service of MRI equipment
Resume normal operations
Attempt to extinguish the fire using MR
safe fire extinquisher
Properly screened fire fighters enter the MRI magnet room with
non ferrous equipment and confirm that the fire has been
extinquished
Yes
CONTACT LIST
Plant Operations: 7111
Protection Services: 7122
Locating: 7500
MRI Tech On-Call: 416-589-8514
DI Manager On-Call: 416-237-3795
WARNING:MAGNET IS ALWAYS ON
Anyone entering MRI magnet room must
be properly screened as per MRI
Screening of Non-Patients policy
Befere entering MRI magnet room,
remove all personal objects and contents of pockets such as cell phones, keys,
coins, etc.
Firefighters must not go beyond the sign
posted on the MRI magnet room door:
DANGER: MAGNET IS ALWAYS ON unless directed by authorized personnel.
AFTER HOURS
� Page MRI technologist On-Call and DI Manager On-Call to Locating
� Locating transfers calls to Protection Services at the site of fire in MRI Suite
� Protection Services Supervisor obtains the key and unlocks the MRI magnet
room.
Aug 25, 2014
Flood in MRI Suite - Emergency Procedure
Flood identified in MRI Suite
Plant Operations and Environmental
Services/Housekeeping proceed with appropriate corrective measures
as per hospital Flood Response
procedure.
Note: All areas outside MRI magnet room are accessible without exposure
to magnetic field
Resume normal operations
Plant Operations staff determine
source and extent of the flood.
Contact:
Plant Operations
Protection Services
Environmental Services/
Housekeeping
IF AFTER HOURS also contact:
CHS Admin On-Call
MRI technologist On-Call
DI Manager On-Call
In collaboration with MRI technologist,
Plant Operations and Environmental Services/Housekeeping proceed with
appropriate corrective measures as per
hospital Flood Response procedure.
USE MRI SAFE EQUIPMENT ONLY
WARNING:MAGNET IS ALWAYS ON
Anyone entering MRI magnet room must be properly screened
as per MRI Screening of Non-
Patients policy
Befere entering MRI magnet room,
remove all personal objects and contents of pockets such as cell
phones, keys, coins, etc.
MRI technologist contacts the MRI
system manufacturer to determine if
MR Field Engineer is required to
service MRI equipment.
Service required?
No
Yes
If required, Plant Operations will:
� Close water shut off valve
� Turn off all operating cabinets
and computers
� Tarp equipment
Arrange for MR Field Engineer to service MRI equipment
ASAP, and notify On-Call
Radiologist
Complete service of MRI equipment as required
If the water reaches the magnet, MRI
technologist or authorized individual
shuts down electrical power to the
magnet.
If it is necessary to stand in water to reach the power switch, call MR Field
Engineer to shut down power.
CONTACT LIST
Plant Operations: 7111
Protection Services: 7122
Environmental Services/Housekeeping: 416-530-7254
Locating: 7500
MRI Tech On-Call: 416-589-8514
DI Manager On-Call: 416-237-3795
LOCATIONS
Clinical MRI
Water shut off valve:
Room S750A (access through rooms
S747 – S747D – S750
Circuit breaker: Room S792CDIU
Water shut off valve: Room 4150B
Power button: MRI Control Room
Research MRI
Water shut off valve: Room S720A
(access through room S720)1.5T and 3.0T Power Buttons: MRI
Control Room
Equipment Room 1.5T: S725E
Equipment Room 3.0T: S721C (access
through room S721)
Redirect traffic as required
Does flood
extend into MRI magnet
room?
Yes No
Do not shut down power to the magnet and/or equipment
room without authorization
from MRI technologist
July 20, 2014
Magnetic field is still present
even after shutting down
electrical power to the magnet.