Noninterpretive SkillsFree Access

Patient-centered Radiology

Jason N. Itri

Published Online:Oct 14 2015https://doi.org/10.1148/rg.2015150110

Abstract

Patient-centered care (ie, care organized around the patient) is a model in which health care providers partner with patients and families to identify and satisfy patients’ needs and preferences. In this model, providers respect patients’ values and preferences, address their emotional and social needs, and involve them and their families in decision making. Radiologists have traditionally been characterized as “doctor-to-doctor” consultants who are distanced from patients and work within a culture that does not value patient centeredness. As medicine becomes more patient driven and the trajectory of health care is toward increasing patient self-reliance, radiologists must change the perception that they are merely consultants and become more active participants in patient care by embracing greater patient interaction. The traditional business model for radiology practices, which devalues interaction between patients and radiologists, must be transformed into a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are reorganized around patients’ needs and preferences. Expanding radiology’s core assets to include direct patient care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient. This may yield substantial benefits in the form of improved quality and patient safety, reduced costs, higher-value care, improved patient outcomes, and greater patient and provider satisfaction.

^©RSNA, 2015

See discussion on this article by Funaki.

SA-CME LEARNING OBJECTIVES

After completing this journal-based SA-CME activity, participants will be able to:

■ List the dimensions of patient-centered care that are relevant to radiology departments.
■ Discuss the rationale for incorporating patient-centered principles at hospitals and outpatient imaging centers.
■ Describe interventions that promote a patient-centered environment.

Introduction

Patient-centered care is care organized around the patient, a model in which health care providers partner with patients and families to identify and satisfy patients’ needs and preferences. In this model, providers respect patients’ values and preferences, address their emotional and social needs, and involve them and their families in decision making. Health care services are coordinated such that critical information is reliably passed on to all members of the clinical care team, and clinical support services are designed around patients’ needs rather than physicians’ needs. Health care providers treat patients respectfully and use patient-centered communication skills, such as encouraging patients to talk about psychosocial issues and providing information and counseling. Patients are encouraged to ask questions and obtain the information necessary to help them make informed decisions about their health care, promoting an open and honest doctor-patient relationship in which patients are primarily responsible for their own health. The stress of illness is minimized by adequately controlling pain and providing a physical environment that promotes healing and well-being. These are the elements that matter most to patients and have the greatest impact on how quality of care is perceived by consumers of health care services.

Providing a conceptual framework that helps us understand the patient’s experience of illness and health care is a prerequisite to redesigning radiology-specific processes around patients’ needs and preferences. The conceptual model described in this article is adapted from the model of patient-centered care described by Gerteis et al (1), which is based on decades of interviews and focus groups involving patients, family members, physicians, and hospital staff. In this article, I discuss dimensions of patient-centered care adapted for radiology and opportunities for redesigning imaging processes to promote a patient-centered environment.

Dimensions of Patient-centered Radiology

Effective Communication

Technologists play a central role in the radiology department, and many of their responsibilities depend on effective communication with patients: taking histories, verifying patients’ identity and the procedure to be performed, screening for safety, providing instructions and ensuring that patients understand all instructions, answering questions promptly and accurately, explaining postexamination care, and coordinating patient care with efficient and effective use of resources (Figs 1, 2) (3). Because technologists play a central role, strategies that improve their communication skills are paramount for ensuring patient safety and a positive experience. The acronym AIDET (acknowledge, introduce, duration, explanation, thank you) refers to a set of skills that can be used to improve communication between patients and health care providers in a radiology department (4,5): (a) acknowledge: greet and welcome the patient, apologize for delays, and acknowledge concerns; (b) introduce: introduce yourself using your name and explain your role in the patient’s care; (c) duration: describe the amount of time the patient can expect to wait for a test or procedure; (d) explanation: describe what is going to happen to the patient and what he or she can expect; and (e) thank you: thank the patient for his or her cooperation and participation.

Figure 1. Diagram shows a patient-centered care model for radiographers. *ALARA* = as low as reasonably achievable. (Reprinted, with permission, from reference 2.)

Figure 2. Flow diagram shows the specific steps involved in undergoing computed tomography (CT) of the abdomen with intravenous and oral contrast material. IV = intravenous line.

Effective communication is fundamental to a successful patient-radiologist relationship; shifting the communication model to be more patient centered has been shown to improve both quality of care and patient satisfaction.

Examples of patient-centered communication skills include encouraging patients to talk about psychosocial issues, using the patient’s own words and language, and providing information and counseling rather than asking questions and giving directions. Attention to patients’ emotional concerns and explanations of procedures were identified by patients as aspects of care that could be improved during diagnostic imaging procedures such as double-contrast barium enema examination, mammography, abdominal ultrasonography (US), and vaginal US (6).

Harvey et al (7) provide an overview of how radiologists can convey to patients a new breast cancer diagnosis or the need for breast biopsy (Fig 3). Although their discussion is tailored for radiologists in breast imaging, the concepts are useful for any radiologist who performs procedures and may have to convey to patients and their family members that complications or other unfavorable outcomes have occurred. One of the fundamental principles of delivering bad news is the need to be truthful about the diagnosis and avoiding false reassurances while providing perspective on treatment and prognosis. Promoting effective communication involves allowing patients time to talk; avoiding medical jargon that can be confusing for patients; and using active listening skills such as repetition, reiteration, and reflection. Bad news should be delivered in an appropriate environment that is private, particularly when one is communicating by telephone.

Figure 3. Chart shows steps in conveying bad news, written for radiologists who perform breast imaging. (Reprinted, with permission, from reference 7.)

A critical point in this type of conversation is that much of what is said after the word “cancer” is not heard by the patient, and radiologists should pause and wait for the patient to process the information. The need for emotional and social support after a cancer diagnosis is a reason for the radiologist to involve the patient’s friends and family members; family members can take part in active listening, record details, and ensure that questions are answered. A patient-centered model for communicating bad news has been recommended in which the physician conveys information according to the patient’s needs, checks for understanding of provided information, and shows empathy (8–11).

Trust is the foundation of the doctor-patient relationship, and disclosure of medical errors through honest and open communication is a fundamental aspect of patient-centered radiology. The responsibility for disclosing a mistake or unanticipated event lies with the attending physician, although sometimes it may be appropriate to involve an institutional representative such as a hospital administrator, risk manager, or quality assurance representative in the disclosure. Mistakes made by physicians in training should be disclosed by the attending physician and the trainee together.

Mistakes should be disclosed at a time when patients are physically and emotionally stable; if a patient lacks the mental capacity to understand and appreciate the disclosure of a medical error, a family member or other effective decision maker should be informed. When mistakes or unanticipated events are being disclosed to patients, the following actions are recommended: (a) admit a mistake was made, (b) describe the situation leading up to the mistake, (c) describe the details of the mistake in the simplest language possible, (d) explain the consequences of the mistake, (e) describe what corrective action will be taken, and (f) address any questions or concerns the patient may have (3,12).

Patient Education

In an effort to improve health literacy regarding radiologic examination and treatment, the Radiological Society of North America (RSNA) and the American College of Radiology (ACR) collaborated in the development of a public information Web site, RadiologyInfo (http://www.radiologyinfo.org). This Web site provides information about radiologic studies in a standard format that describes various procedures, indicates common uses, explains how to prepare for procedures, and provides pictures of the equipment used during procedures. The Web site currently contains information on nearly 200 radiologic procedures and can be viewed in English or Spanish (13). Patients and their family members can download information directly from the site, radiology practices can download material and make it available to patients, and referring physicians can use the site to provide information for patients. Consumers are increasingly accessing Web-based resources to obtain information and knowledge about radiologic procedures, and it is important for radiologists and radiology organizations to play an active role in developing and maintaining these types of resources.

Physical Comfort

Aggressive pain management is essential to patient-centered radiology; yet, despite advances in the use of narcotics and other analgesics, pain control continues to be one of the most feared and debilitating aspects of illness and medical treatment (1). Studies assessing pain in various clinical settings indicate that a significant number of patients (20%–75%) continue to experience moderate to severe pain despite treatment with analgesics (14–18).

Factors that contribute to the difficulty observed in adequately managing acute pain include patients’ awareness and effective communication about pain to health care providers, a clinician’s or nurse’s accurate clinical assessment of pain, and administration of appropriate therapy using a process that is well timed relative to the onset and duration of the patient’s pain. Further complicating effective pain management is the clinician’s fear of overdose or addiction to narcotics, which is probably due in large part to overestimation of the risk for addiction and a lack of knowledge about the use of analgesics

(14,16,17,19,20). In situations in which a patient is able to indicate pain requiring analgesia, there is often a delay in the administration of medications because of the process of notifying the caregiver responsible for administering medication, assessing the patient’s pain, completing all documentation, acquiring the medication, and subsequently administering the medication.

For all invasive procedures, radiologists should consider performing a baseline assessment by asking patients to rate their pain (Fig 4), making regular and ongoing assessments of pain, and monitoring the effectiveness of pain control measures and side effects (21). General strategies that can improve pain management include educating patients about their right to pain relief; encouraging patients to take an active role in communicating and managing their pain; making pain assessment data more visible to caregivers; and educating staff about pain control protocols, which should include a discussion of misconceptions about narcotics and their risks and benefits (1). Use of conscious or moderate sedation for invasive procedures can reduce anxiety and pain, although there can be morbidity and mortality associated with sedation practices, and standards continue to be refined by professional societies to improve care (22). A summary of the Joint Commission standards regarding moderate sedation is shown in the Table; a comprehensive review of sedation, analgesia, and local anesthesia for general and interventional radiologists was recently published (24).

Figure 4. Wong-Baker FACES Pain Rating Scale. (Reprinted, with permission, from reference 21.)

**Summary of The Joint Commission Standards on Moderate Sedation**

Source.—Reference 23.

During focus groups conducted by the Picker Institute, cleanliness was the aspect of the environment that patients mentioned most prominently: “Even the most unsophisticated patient recognizes the relationship between cleanliness and health, and patients see neglect of this basic principle as a major failure” (1). The physical environment can have a significant impact on a patient’s experience, and a supportive environment may serve to help prevent illness and alleviate stress and depression (25). Humanizing the hospital’s physical environment can be accomplished through the use of windows, skylights, indoor plants, fountains with running water, and landscaping (1). To reduce ambient noise, beeper and telephone technologies are preferred to overhead speakers for paging. Waiting rooms should be designed to allow occupants to converse, watch television, and read or nap, with easy access to telephones, reading material, movable chairs and sofas, and special chairs for the elderly and handicapped (Fig 5). Patient-centered design features for diagnostic and treatment areas include placing nature scenes or relaxing images in the patient’s line of sight to provide distraction (Fig 6); using sheets and pillows to minimize patient contact with cold metal equipment; making available a variety of musical selections through earphones or headsets; monitoring room temperature so that patients are comfortable in gowns; and ensuring privacy before, during, and after examinations and procedures (26).

Figure 5a. Computer-generated drawings show a waiting room **(a)** and patient registration rooms **(b)** designed with several patient-centered features, including space to read or nap, easy access to movable chairs and sofas, and private areas for registration.

Figure 5b. Computer-generated drawings show a waiting room **(a)** and patient registration rooms **(b)** designed with several patient-centered features, including space to read or nap, easy access to movable chairs and sofas, and private areas for registration.

Figure 6a. Humanizing the patient care environment using soft colors **(a)** and nature scenes **(b)**. In these examples, patients can use a portable device to display nature themes, personal photographs, videos, or movies on the screens and select the lighting and music. (Reprinted, with permission, from reference 26.)

Figure 6b. Humanizing the patient care environment using soft colors **(a)** and nature scenes **(b)**. In these examples, patients can use a portable device to display nature themes, personal photographs, videos, or movies on the screens and select the lighting and music. (Reprinted, with permission, from reference 26.)

Emotional Support and Alleviation of Fear and Anxiety

A patient’s experience of illness includes the emotional and psychologic consequences of being ill, and health care providers must adequately address these subjective aspects of illness to provide the most effective care. Addressing patients’ emotional needs can influence their satisfaction with care, compliance with treatment regimens, side effects from drugs, recovery of function, need for pain medications, and length of hospital stay

(27–33). One patient describes her experience in a mammography unit as follows (1):

After we had our mammograms, we were told to go back to the waiting room, where they would call us in with the results. We all sat there in our gowns, scared, and one by one they’d call us back in. Some women would come back out crying miserably; some would be smiling. It was awful. You just sat there wondering which you’d be.

In their study of patients undergoing interventional radiologic procedures, Mueller et al (34) found that all patients significantly overestimated their anticipated pain and concluded that interventionalists should spend more time assessing patients’ fear of pain and attempting to reduce that fear rather than dwelling on the technical aspects of procedures. In a study by Williams et al (35) that assessed the needs and expectations of women who presented for hysterosalpingography following a period of subfertility, patients reported that (a) they received little support from health care providers; (b) written information did not meet all of their needs; and (c) properly focused, correctly administered, timely information reduces anxiety. When discussing imaging procedures with patients, it is important to provide specific information, along with realistic expectations. Research has shown that giving patients information about the sensory aspects of a procedure helps reduce anxiety, whereas inaccurate expectations about physical sensations (eg, pain) can be a significant source of distress (36–38).

Radiologists who have relationships with patients should develop behaviors that provide emotional support and convey a genuine sense of caring and concern. Radiologists should promote behaviors such as expressing concern and empathy, showing an understanding of the nature of the problem, calmly accepting the problem, and expressing optimism or hope (1). Patients differ in their need for support, and clinicians should ask patients about their fears and anxieties as well as what kind of emotional support they find helpful. There are a variety of approaches for reducing stress and relieving anxiety: (a) developing educational approaches that combine factual information about a patient’s clinical condition with short-term psychologic interventions designed to provide reassurance, address irrational beliefs, and relieve anxiety; (b) administering progressive muscle relaxation therapy; (c) training staff in crisis intervention; (d) developing a network of patients and family members who are willing to share their experiences with newly diagnosed patients and their families; (e) sponsoring support groups; and (f) providing access and information about self-help groups (1).

Respect for Patients’ Values, Preferences, and Expressed Needs

Showing respect for patients’ values, preferences, and expressed needs includes understanding and respecting patients’ cultural beliefs and practices, involving patients in their own care, and understanding and respecting patients’ therapeutic goals. These objectives are accomplished by using a shared decision-making model: Decision making always involves the health care provider and the patient but may also involve family members, relatives, and friends; all parties participate in the decision-making process; information is shared; and a shared treatment decision is made, to which health care providers, patients, and support providers agree (39,40). Shared decision making involves using guided-discussion tools such as flowcharts, videotapes, and interactive presentations that organize the disease information and treatment outcomes in language that is understandable to the patient (41). This model should improve patient knowledge of options as well as perceptions of risks and benefits and lead to clinical decisions that are consistent with patient values such as quality of life (42). For example, an evidence-based shared decision-making tool used for the management of hepatocellular carcinoma would communicate that interventional radiology–guided embolization therapies are associated with better outcomes and fewer side effects than are systemic therapies such as sorafenib administration (43,44).

Coordination and Integration of Care

Patients’ concerns with coordination of clinical care relate to not knowing who is in charge of their care, the sense that members of the clinical team are not communicating critical pieces of information to one another, and inconsistency in the message they are receiving from different members of the health care team. When an important piece of information is lost or overlooked, patients see that the people taking care of them are uninformed, efforts are needlessly duplicated, procedures are delayed, and tasks are left undone (1). Health care providers in radiology must be vigilant in obtaining the clinical information necessary to provide accurate, high-quality interpretations of imaging examinations, which can be accomplished by interviewing patients, reviewing patients’ electronic medical records or charts, and calling the referring physician’s office. Radiologists should obtain the information necessary to accurately interpret examinations and communicate important results to referring physicians. Staff should have the skills and knowledge needed to answer questions and provide help for the patient.

Involvement of Family and Friends

Families serve several functions in the setting of illness, including serving as caregivers or care partners, long-term promoters of health and well-being, and providers of essential social and emotional support (1). Given these important roles, family involvement is an important component of patient-centered radiology and should be encouraged and supported.

Radiologists can support family involvement in a patient’s care by including family members when providing information about imaging procedures or discussing abnormal findings. Including family members in the discussion of the risks and benefits of imaging procedures facilitates shared decision making and is an opportunity for family members to provide information about the patient and ask questions.

Family members caring for patients at home can help ensure that they follow postprocedural instructions, understand and identify warning signs to seek immediate care, and obtain necessary follow-up. Because family members serve as an important source of emotional and social support, involving them when delivering bad news may help patients cope with their illness. Family involvement may be a necessary component of providing appropriate and supportive care that addresses the patient’s emotional and psychologic needs. Concerns about violating Health Insurance Portability and Accountability Act (HIPAA) privacy and security rules often prevent the sharing of information with family members, although these rules do not prohibit health care providers from sharing information or partnering with designated family members (45).

Redesigning Radiology Processes

There are several key performance indicators within radiology departments that can be used to promote a patient-centered environment, including access, wait time, scheduling, registration, appropriateness, and patient satisfaction.

Access and Wait Times

Several approaches have been described to increase patient access and reduce appointment wait times for advanced imaging procedures in an environment of increasing demand and patient expectations. Boland et al (46) demonstrated that use of multiple technologists optimizes CT throughput and capacity. Evaluating workload patterns can help guide staff schedules for more effective alignment of workload with existing technical personnel resources (47). Zhang et al (48) used methodologies successfully applied in manufacturing and other service industries (eg, Lean Six Sigma) to redesign workflow and significantly improve patient access to magnetic resonance (MR) imaging examinations. A comprehensive program consisting of expanded hours of operation, a streamlined scheduling procedure, and a toll-free hotline for urgent scheduling or reports that was implemented after the installation of new imaging equipment resulted in significantly improved ratings for appointment wait time, scheduling, and patient convenience (49). Expanding the hours of operation into the evening and weekends can add significant capacity at relatively little cost (50).

Examination wait time is an important patient-centered performance metric that can be a significant cause of patient dissatisfaction in a busy radiology department. Patient focus groups and surveys reveal that the top satisfaction criteria for patients revolve around time—specifically, patients wanting quick access to scanners or study rooms (51). The patient’s perception of time elapsed between appointment time and procedure start time was found to be a significant predictor of overall mean patient satisfaction scores during a Lean Six Sigma project designed to improve hospital-based outpatient imaging performance (52). A performance improvement project focusing on reducing wait times and improving patient satisfaction with outpatient CT demonstrated a significant and sustainable decrease in examination wait times that correlated with improved patient satisfaction scores (Fig 7) (54).

Figure 7a. **(a)** Graph shows outpatient CT examination wait times from a Lean Six Sigma improvement project initiated in January 2014. The five red data points from August 2014 through December 2014 indicate a statistically significant increase in the percentage of patients being scanned within 5 minutes of their appointment time compared with the baseline. CEN = center line, LCL = lower control limit, LSL = lower specification limit, UCL = upper control limit. **(b)** Chart shows improvement in Press Ganey (South Bend, Ind) standard test and treatment scores that correlate with the decreased patient examination wait times seen in a. (Unpublished data in Fig 7 are from reference 53.)

Figure 7b. **(a)** Graph shows outpatient CT examination wait times from a Lean Six Sigma improvement project initiated in January 2014. The five red data points from August 2014 through December 2014 indicate a statistically significant increase in the percentage of patients being scanned within 5 minutes of their appointment time compared with the baseline. CEN = center line, LCL = lower control limit, LSL = lower specification limit, UCL = upper control limit. **(b)** Chart shows improvement in Press Ganey (South Bend, Ind) standard test and treatment scores that correlate with the decreased patient examination wait times seen in a. (Unpublished data in Fig 7 are from reference 53.)

Scheduling and Registration

Optimizing the scheduling and registration process is an important component of improving access and patient satisfaction. According to Mozumdar et al (55), online scheduling applications are becoming the preferred scheduling vehicle and can simplify the scheduling process. In the absence of a software solution, Seltzer et al (49) demonstrated that reducing the complexity of the scheduling process by reducing the number of questions asked by scheduling personnel from 14 to six improved ratings of the scheduling process. In this patient-centered approach, radiologists and technologists accepted responsibility for obtaining missing information necessary for performance or interpretation of the imaging examination. Cross-training the reception and scheduling staff members to perform centralized scheduling for all modalities in the radiology department can also improve the registration process (56).

Appropriateness

The Protecting Access to Medicare Act of 2014 (H.R. 4302) includes a provision requiring use of appropriate use criteria and clinical decision support (CDS) software for reimbursement of Medicare beneficiaries for advanced diagnostic imaging performed in the ambulatory setting. This mandate promotes scientifically valid, evidence-based care; implementation of CDS systems has been associated with substantial decreases in the use of high-cost imaging, including nuclear cardiology examinations, lumbar MR imaging for low back pain, head MR imaging for headache, and sinus CT for sinusitis (57,58). Incidental findings related to inappropriate imaging may contribute to delays in care, unnecessary additional medical evaluation, and complications from additional examinations or procedures. It is anticipated that widespread adoption of CDS will reduce health care costs, improve quality, and reduce unnecessary radiation dose to patients. Moreover, CDS provides an opportunity to replace preauthorization programs that are not evidence based and effectively shift costs from health care payers to hospital and providers (59).

Patient Satisfaction

Implementing a process to continually assess patient satisfaction is a core component of practicing patient-centered radiology. Although there are many internal and external customers of imaging services, patients are arguably our most important customer. The five key factors that determine customer satisfaction for a given service are reliability (the ability to provide the service that was promised and to do so dependably and accurately), responsiveness (the willingness and ability to help customers promptly), assurance (the sense of confidence, competence, and courtesy that providers offer), empathy (the degree of caring and attention to individual customers), and tangibles (the physical appearance of facilities and the quality of the equipment) (60,61).

Press Ganey’s Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) initiative provides a standardized survey instrument and data collection methodology for measuring patients’ perspectives regarding hospital care. The survey is composed of items that encompass critical aspects of the hospital experience, including communication with doctors and nurses, responsiveness of hospital staff, cleanliness and quietness of the hospital, pain control, communication about medicines, and discharge information (62). There is a growing trend toward more detailed public reporting of patient satisfaction data with benchmarking and links to financial reimbursements; hospitals that fail to report HCAHPS patient perspective survey results could receive an annual payment update that is reduced by 2%.

Radiology department staff and leadership should take an active role in adopting and promoting use of standardized survey instruments for assessing patient satisfaction in both inpatient and outpatient settings. Although there are legitimate concerns about the methodology used for survey design and the validity of collected data, practice managers and physician leaders can use the information to improve the patient centeredness of their practices by responding to patient complaints, obtaining benchmark and comparative data, and determining baseline performance to evaluate the impact of service and quality initiatives (Fig 8).

Figure 8a. **(a)** Press Ganey patient satisfaction survey for radiography and US performed in the outpatient setting. (Reprinted with permission of Press Ganey, South Bend, Ind.) **(b)** Press Ganey service report for patient satisfaction in the outpatient setting. The first column under “All Respondents” (“All Facility DB Rank”) refers to the national percentile ranking among all facilities administering Press Ganey patient satisfaction surveys. The second column (“UHC Facilities Rank”) refers to the percentile ranking among similar academic institutions in the University HealthSystem Consortium *(UHC)*. The third column (“OH Facilities Rank”) refers to the percentile ranking among state facilities in Ohio. DB =database, OH = Ohio, *Std* = standard.

Figure 8b. **(a)** Press Ganey patient satisfaction survey for radiography and US performed in the outpatient setting. (Reprinted with permission of Press Ganey, South Bend, Ind.) **(b)** Press Ganey service report for patient satisfaction in the outpatient setting. The first column under “All Respondents” (“All Facility DB Rank”) refers to the national percentile ranking among all facilities administering Press Ganey patient satisfaction surveys. The second column (“UHC Facilities Rank”) refers to the percentile ranking among similar academic institutions in the University HealthSystem Consortium *(UHC)*. The third column (“OH Facilities Rank”) refers to the percentile ranking among state facilities in Ohio. DB =database, OH = Ohio, *Std* = standard.

Conclusion

The emergence of consumers as the central decision makers in health care and the trend toward greater patient self-reliance will require a shift in the traditional business model of radiology practices toward a patient-centered model in which radiologists are reintegrated into direct patient care and imaging processes are redesigned around patients’ needs and preferences. This transition may entail a resetting of compensation for radiology or require greater personal effort for the same compensation, but the potential benefits include improved quality and patient safety, reduced costs with higher-value care, improved patient outcomes, and greater patient and provider satisfaction. Expanding radiology’s core assets to include direct patient care and utilizing the principles of patient-centered care may be the most effective deterrent to the threat of commoditization. As the assault on the growth of Medicare spending continues, with medical imaging as a highly visible target, radiologists must adapt to the changing landscape by focusing on their most important consumer: the patient.

Acknowledgments

I thank Eric Bakow, University of Pittsburgh Medical Center, for his invaluable help with our performance improvement project in improving patient wait times and satisfaction, as well as the staff of the Department of Radiology, University of Cincinnati Medical Center, who created the patient flow diagram shown in Figure 2.

For this journal-based SA-CME activity, the author, editor, and reviewers have disclosed no relevant relationships.

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Article History

Received: Apr 9 2015
Revision requested: May 18 2015
Revision received: May 31 2015
Accepted: June 4 2015
Published online: Oct 14 2015
Published in print: Oct 2015

Vol. 35, No. 6

Abbreviations

Abbreviations:
ACR	American College of Radiology
AIDET	acknowledge, introduce, duration, explanation, thank you
CDS	clinical decision support
HCAHPS	Hospital Consumer Assessment of Healthcare Providers and Systems
HIPAA	Health Insurance Portability and Accountability Act

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