In the past, the proximity and collegiality of the teams made it possible to control this behavior. With a team that worked in a common location—and often drank coffee together—cherry picking was easier to spot, and a sense of team camaraderie provided a natural deterrent. Today, a geographically dispersed team, combined with increased workloads and complex work lists, has made foraging more prevalent and more problematic. For an X-ray practice to run optimally, this is a problem that needs to be solved.
Discordance and complexity lead to pecking
Screening is often the result of a mismatch between the Labor Relative Value Unit (wRVU) credit given to the interpreting radiologist and the time, energy, and skill required to interpret a study. This happens due to flaws in the RVU system. The lack of complexity modifiers complicates the problem in radiology.
Another contributing factor to the selection problem is the size and complexity of the work list. With a long and complex list of cases needing attention and no clear system for designating case distribution, choosing is easier and more tempting.
Active, passive and perceived selection
Whether blatant or more subtle, pecking is likely to have a bigger impact than we realize. This might be the most active and obvious selection, in which someone bypasses the first four cases in the list and picks number 5 instead. There may even be a few in the group who treat it like a sport, playing with the system and choosing at every opportunity.
Less obvious is the cherry picker who sees a tough case at the top of the list and decides it’s time to use the bathroom and check his email. This passive cherry picker is often not alone in his wait-and-see approach – this study of the temporal bone might stay a little high on the list. Then, when someone finally picks it up, boom, boom, boom – numbers 2 through 6 are quickly grabbed as the passive boom lifts spring back into action.
There is also the concept of perceived selective sorting, in which group members skip cases because they are tasked with doing something special. Maybe they’re working on a research project related to kidney ultrasound. They’ll skip all the thyroids to get to the next kidney.
Potential impact on care, productivity and morale
At first glance, it may seem like cherry picking is frustrating but relatively harmless. However, it can have a profoundly negative impact on clinical care, productivity measures, and team morale.
If nothing is done, cherry-picking does the following:
- Increases risk to patient safety – pecking can lead to delays in patient care when high priority studies do not receive due attention.1
- Creates productivity challenges – it can be nearly impossible to effectively compare work effort using wRVU as a metric and challenge radiologist management analysis when some radiologists are selectively triaging. Those who play with the system have an artificial increase in their apparent effort while the radiologist who “plays by the rules” suffers from an apparent decrease in their effort. Additionally, the case selection process can cost each radiologist more than 15 minutes of time each day, creating an unnecessary decrease in productivity that multiplies to alarming levels in a large practice.
- Decreases staff morale – foraging can harm team dynamics and cause a huge amount of job dissatisfaction, leading to increased levels of burnout.
Use technology to adapt to higher workloads and increased complexity
Today’s business often includes multiple PACS, each with its own work list. Even if a consolidated worklist is present, it can be difficult for humans to optimally manage the workload of real-time exams on a dynamic workforce of diverse readers. To solve this problem, many PACS vendors offer some form of “autoserve” algorithm that distributes worklists to the appropriate groups of readers.
The most sophisticated tools choose the next case to be read by a radiologist based on the best interests of the company. Called “smart worklists,” these solutions can deliver huge productivity gains, eliminate “list anxiety,” and help speed up turnaround times.
However, even the most sophisticated of them still have shortcomings in today’s dynamic radiology environments. The best of them can provide an early warning when bottlenecks are anticipated and additional resources need to be called in, but many rely on assumptions that all drives are the same, lacking the ability to take into account the wide variety of readers. There must be a better way.
That better way is here. Newest from GE Healthcare PACS systems are designed to optimize your most valuable resource – your radiologists’ time – through integration with Quantum Imaging’s Helix Pace and Balance. This innovative and intelligent workload management solution can eliminate the picking and letting you properly credit radiologists for their work, while prioritizing optimal patient care.
Find out how GE Healthcare’s Intelligent Workload Manager can help your business tackle waste sorting and boost the productivity and morale of your radiologists. Contact us for more information.
Dr. Elizabeth A. Bergey is president and CEO of Quantum Imaging & Therapeutic Associates. Dr. Bergey joined Quantum in 2001 as a diagnostic radiologist. In 2005, she was elected to the board of directors and served as treasurer. In 2007, she was elected Chair of the Board of Quantum, President of the Physicians Group and CEO of the Professional Society.
The comments and observations expressed are those of the author and do not necessarily reflect the opinions of AuntMinnie.com.
- Chan, T., Howard, N., Lagzi, S. & Romero, G. (2018). Cherry-picking and service level spillover: Evidence from a radiology workflow platform.
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