presents

1. presents

3. Scottsdale Medical ImagingMission To be nationally recognized as a premiere provider of service oriented patient care using medical imaging, image guided intervention, and state-of-the-art technology.

4. Mission To be leaders in medical imaging and intervention through clinical excellence, cutting-edge technology, innovation, and research. Serve our patients and referring clinicians in a collegial work environment.

5. Values Service: We are committed to providing excellent service and compassionate care with responsible stewardship of our resources and traditions. Integrity: We honor commitments and maintain the highest standards of behavior. Quality: We pursue excellence in patient care and service. Innovation: We improve quality of imaging services by adopting new technology and participating in research. Equity: We strive for equality of effort and benefit.

8. Quality Assurance18th Century Style(When reimbursement rates were a lot lower than today) “It is not only the admission of kindly warmth into the internal parts of the body, which prove advantageous, but it is a stimulus to excite irritability and restore the languid peristaltic motion of the intestines.” Royal Humane Society of London

10. Just as Treatments Change,So Does the Perception of Quality CareThe Tobacco Enema(circa 1790) Administered orally in conjunction: • Cordial mixture • Spirits of hartshorn • Camphorated spirits • Enemetic tartar

11. The State of Health CareQuality Today “Health organizations must embrace a culture of continuous measurement and quality improvement. Such a culture shift requires that health professionals be trained to minimize waste, decrease error, and ultimately improve quality of care. Educational experiences should be provided whereby health professionals define best practices by reviewing currently available information and literature; compare these with current practice to identify gaps in performance; develop policies, procedures, and standards to organize care around the best practices; and then continuously monitor these with the aim of improving care.” “Educating Health Professionals to Improve Quality of Care” Institute of Medicine

12. ARRS Mission Statement The mission of the Society is to advance medicine through the science of radiology and its allied sciences by enabling the creation and exchange of knowledge and information in the field through its journal, meetings and other means.

13. As the nation’s oldest radiology membership organization, the ARRS has been at the forefront of serving as a critical source of information for the rising tide of quality assurance and practice improvement. “Quality Assurance: an idea whose time has come.”AJR, 1979; 133:989–992

15. Coming Fall 2007 ARRS’ Online PQI Register

16. ARRS PQI Register …an inclusive repository for practical relevant information and links to information about: patient safety, quality assurance, practice improvement programs and reporting mechanisms in radiology with insightful opinions and commentary from ARRS leaders and industry experts.

17. We’re Not Trying To Tell YouHow To Achieve PQIWe want to provide you with the resourcesyou need to find the answersto your PQI questions Knowledge is of two kinds.We know a subject ourselves, or we know where we can find information upon it. Samuel Johnson

18. As in Medicine,Patient Safety Comes First ARRS PQI Register: A must-read article “The Delicate Balance between Radiation Exposure and Imaging Efficacy,” ARRS InPractice - Summer 2007

19. As in Medicine,Patient Safety Comes First As radiologists take a more visible role in today’s health care delivery system, the means and methodologies by which they treat patients have generated greater scrutiny, primarily in the critical areas of utilization and patient safety.

20. More Time,More Information • This is only the beginning. • As a key information and practice resource, the ARRS PQI Register will continually update its information with new links, fresh commentary, and the latest news. • Ensure that you and your practice meet whatever challenges you face in complying with the new generation of performance measures.

21. “Evidence-Based Quality Radiology” What is the “evidence” and where do we find it?

22. Medical Evaluation of Quality as a Disease! HISTORY – PHYSICAL – DIAGNOSIS – TREATMENT • When/Where Did This Start? (Hx) • What Does It Look Like? (PE) • To What Does This Apply? (ROS) • Whose Idea Was It Anyway? (SHx) • What Is The Treatment (Rx) • What Will It Cost Doctors? • Does My Insurance Cover It? • Is There Any Evidence Base – Cost /Benefit?

23. A Lot of Questions,Precious Few Answers • Whose data do we use? • Does it apply to me? • Is it “scientific?" • Is it “faith-based?" • Have the persons determining the evidence ever personally met a payroll, written a check for malpractice insurance premiums, or interpreted diagnostic images?

24. “Clinical medicine is awash in novelty, but without the capacity to distinguish what truly works…Our culture is embedded with the strong belief that more is better and that the physician knows best.The study of practice variations uncovers a very different, more nuanced reality.” John E. WennbergHealth Affairs October 7, 2004

25. With the exponential growth of medical imaging in recent years, much of it performed by nonradiologists, and the resultant scrutiny by federal and third-party payers, the issue of quality assurance has moved to the forefront among professional concerns.

26. As a profession, our quality agenda must extend beyond effective care and address unwarranted variation. We must identify—and remedy—weaknesses in the scientific basis for clinical decision making in our everyday practice.

27. As Radiologists,Quality Care is Not Our Goal. It is Our Responsibility.

28. Successful Doctors • Have the same pills and tools as others. • Deal with frustrations proactively. • Document/measure/monitor FAILURES. • Identify and implement small changes that make a difference. • Try to understand complexity and imperfection

29. “Increasingly, perceptive patients see radiologists and radiologic examinations as the core of the diagnostic process. Increasingly, it is critical that all of our constituents, but especially our patients, perceive that they receive great value and high quality when they come to us for help. Everyone should understand from the cleanliness of your work place; from the sincerity, kindness, and technical competence of each employee; and from your appropriate communication with your patient that you hope to move past quality service to your ultimate goal—excellence.” John K. Crowe, MD Value, Quality, Excellence: Our National PastimeAJR, Nov 2000; 175: 1223–1224

30. The Dependent Variables of Evidence-Based Medicine • Recruitment • Intelligence • Training • Retention • Reliability • Interest • Supervision • Leadership • Definition of Success

32. Knowledge is Power Francis Bacon

33. Knowledge is Power • POWER = Work / time • TIME is MONEY ($) • POWER = Work / $ • If KNOWLEDGE = POWER = Work / $ • Then K = W /$ or $ = W / K • Therefore: For equal work and twice Knowlege • W / K = 10 / 1 =$10 if 10 / 2 = $5 • LEAST KNOWLEDGE = MOST MONEY!

34. Possible FuturesRules & TriumphsQA“Works”FailsWhat are the metrics? How will we know?

36. Autopsy Rate Was about 50% Now less than 5% Autopsies show diagnostic errors in 10-40% of cases

37. What is Evidence that theABR has improved? Same Test Method since FDR was President Apprenticeship-Guild Length and Method of Training Enculturation

38. M-O-C P-Q-I M-O-U-S-E