This month we continue our series on the five domains of the Quality Standard in Imaging (QSI). The series is looking at the kind of areas that QSI examines to try to raise quality in our imaging departments.
We have reached the third domain which is: Facilities, Resources and Workforce – a game of three halves.
‘To do well in Facilities management, know your customers and know what they expect.’
So what do patients expect when they come into a radiology department, and is your department living up to that expectation?
The facilities and environment that are provided by a service significantly affect the experience of not just the patient, but also your staff and other professionals. Try walking around your department and pretend you’re a patient or actually shadow a few patients. Looking at your department through the eyes of patients may be a very eye-opening experience for you.
We have all experienced the frustration of being in a building where the toilets are difficult to find or the signs are hard to follow. This experience is made a whole lot worse if you are feeling ill or have disabilities. Could you do a mini audit of the patients you are treating in one day to ask them what they think of your facilities?
The waiting room - a haven of calm and order or the place where we stack patients waiting to be seen? It’s probably somewhere in between but waiting rooms are often complained about and Covid-19 has shown us that they can also be a place where illness spreads.
It’s so important that when patients arrive in the department that the waiting areas are clearly signposted and well-maintained. Having information in a variety of media formats will help greatly with equality of access. Seats should be plentiful, a variety of styles and hygienic with no rips in the covers.
‘If you don’t schedule time for maintenance your equipment will schedule it for you.’
Radiology departments use a lot of equipment and it is very important that this equipment is serviced regularly, maintained to a high standard and that Quality Assurance (QA) checks are carried out every day.
QA is something that can be squeezed into a busy day but I cannot stress the importance of them enough. QSI will expect that every piece of equipment has appropriate QA checks carried out by the appropriate qualified person such as radiographers or medical physics.
If you are not in a manager role you are perhaps not aware that there is a huge amount of paperwork and management needed around equipment such as procurement budgets, a rolling programme of replacement and service level contracts. All equipment should be listed on an asset register which should have details such as date of installation, type of equipment, expected working life and replacement value.
‘We are not a team because we work together, we are a team because we respect trust and care for each other.’
I loved the departments I worked for, not for the building or the facilities but because of my colleagues. The camaraderie of a team working together is a beautiful thing but teams change, grow, shrink, have disagreements and triumphs, and all of these not only need to be managed effectively but valued effectively too. The most valuable asset in your department is your staff.
QSI expects your staff to be qualified, skilled and competent to undertake the tasks they are employed to do. Training, including ongoing and mandatory training, must be up to date and relevant. Departments need a complement of staff in order to function efficiently and safely.
Do you remember your induction programme? I remember when I first qualified, sitting in a huge room being welcomed by the Trust chief executive along with admin staff, doctors, consultants, nurses, porters etc. I looked around and felt quite small and yet very proud that I was there. A good induction, which includes Trust and departmental information, is so important for new staff.
One area of induction which can often be overlooked is when a staff member is promoted. Does every band 6 know all the aspects of being a band 7? Achieving the promotion does not automatically mean they understand what is expected of them. It is important that departments ensure that all members of staff receive inductions into new posts.
One morning I came into the department to find half of it under water! Heavy rain had caused a drain to block up and, as we were at the bottom of the hill, all the excess water came into the department. We spent most of that day phoning patients, moving equipment and patient records and mopping floors.
Another time, during a huge thunderstorm, we had a power cut. No problem - we switched to emergency generators but then they also failed. What are your department’s emergency and major incident procedures? A major incident is one that has a significant effect on the ‘normal’ running of the department and might take many different forms. All staff should be aware of incident and action plans.
This domain is huge and I have only touched on a few of the areas that QSI examines. To read more, please go to either the ScoR or RCR website and search for QSI. There is a lot more information on there which you may find interesting. You are more than welcome to ask me any questions so please email me.
Quality Improvement Partner RCR/SCoR