Radiology process redesign, the theory of constraints

In almost all US hospitals, in-patient radiology examinations are not scheduled. Instead, they are performed when equipment and patients are simultaneously and serendipitously available.

Martin Bledsoe MSPH
Martin Bledsoe MSPH

While this flexibility may optimise patient flow for radiology under current conditions, it introduces variability and inefficiency into broader hospital operations, which may result in increased length of stay. In an environment with fixed reimbursement per admission, a decrease in length of stay of even a few hours over an entire hospitalisation can create tens of millions of dollars of revenue opportunity if the newly created capacity can be utilised.
This presentation shows how the Johns Hopkins Department of Radiology analyzed its in-patient workflows with the intention of redesigning them before moving into its portion of a new 1.6 million square foot in-patient facility. The presentation includes a brief review of a management concept concerning throughput known as the theory of constraints. Some of this concept’s principles are then applied to the process of an in-patient hospitalisation, which leads to the conclusion that to maximise throughput, hospitals must deploy new systems for patient tracking, universal scheduling, and real time systems performance monitoring. These systems have been widely deployed in other industries but for the most part specific applications for healthcare have not been developed.
One key principle of the theory of constraints is that maximising the throughput of a microsystem often slows throughput of the macrosystem. In the context of an in-patient hospitalisation, radiology can be regarded as a microsystem and given hospitalisation itself the macrosystem. Because throughput has always been important in radiology due to large capital investment in equipment, it is a logical place for early proof of concept work in designing the new healthcare applications. However, as a next step in developing and testing these new applications it will be necessary to perform simultaneous pilot work across all hospital microsystems, including other diagnostic areas, treatment areas, and in-patient nursing care, in order to capture throughput efficiencies at the macrosystem level. Only then can hospital management create the revenue opportunity provided by a length of stay shortened by a few hours.


CV: After gaining a degree in Nursing and a qualification as Nurse Practitioner, Martin Bledsoe MSPH worked in Kentucky, USA, for 11 years. He then attended the University of North Carolina, gaining an MSc in Public Health, and joined Johns Hopkins Medicine. His roles there included various top administrative roles prior to his current appointment as Chief Administrator for the Russell H Morgan Department of Radiology and Radiological Science at Johns Hopkins Medicine. In this role he manages about 1,000 employees.
He has been actively involved in the leadership and programme development for the Association of Administrators of Academic Radiology, of which he is currently  President-elect. He is a consultant and published author of articles on imaging business operations.

01.03.2008

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