Two-Year Impact Following Transformation Into an Enterprise-Wide Imaging Modality-Based Radiology Management Structure.

Abstract

Market consolidation has created large health systems arising from multiple legacy operating units. Achieving benefits of scale, including effective standardization and coordination, relies on successful systematization. We evaluated the impact of a transition to a novel enterprise-spanning imaging modality-based radiology management structure. We describe our experience in a large academic health system moving from an operating unit-centric radiology technical operations management structure to a service-line approach organized by, and with direct reporting through, seven enterprise-spanning imaging modality-specific directors. Workforce, operational efficiency, patient access, productivity, and quality and safety metrics were prospectively tracked from baseline, at 1 year, and at 2 years. Two years following reorganization, our health system's annual radiology staff turnover improved by 55.0% with 10.5% net staffing growth; employee sense of belonging increased from 78% to 82%. Capacity utilization of ultrasound, CT, and MRI assets increased from 59% to 75% (weekdays) and from 15% to 47% (weekends). Outpatient access within 10 days across all modalities improved from 73% to 78%. Ambulatory practice classification relative value units across all imaging modalities increased by 19.0%. Leader review of safety events within 5 days improved from 46.4% to 94.2%, and unreviewed policy rates decreased from 20% to 0%. Observed trade-offs were related to coordination and communication with operating units. An enterprise-wide modality-based management structure leverages business knowledge and unique considerations inherent in each imaging modality, providing benefits over traditional operating unit-centric structures. This model should be considered as health systems grow, recognizing and mitigating resultant trade-offs.