Staffing and Productivity at Cardon Children’s
By Lynne Johnston, CRA
I have been a radiology manager for nine years, but after accepting my position as Assistant Manager at Connecticut Children’s, I realized that there are a different set of challenges associated with working at a children’s hospital. I was very fortunate to receive a Partners in Learning grant from GE and AHRA to visit Cardon Children’s Medical Center, a 248 bed hospital located in beautiful Mesa, AZ.
Health care reform, reduced reimbursement, and meeting regulatory standards are challenges for all health care institutions. It requires innovative thinking on the part of the entire health care team to maintain a balanced budget without sacrificing quality, safety, or services. At Cardon Children’s, just as at Connecticut Children’s, productivity is measures by the WHOPUOS (Worked hours per unit of service) productivity model. Staff have been educated as to the importance of the hospital remaining fiscally viable while they endure the stress of fewer staff, either by attrition or reduction of force.
I was particularly impressed with how the MRI department took personal responsibility for managing their productivity levels. Each day starts with a matrix of how many exams need to be performed based on the number of staff hours. That number is listed on a whiteboard, and as each technologist completes a study, they record the number on the board. As noontime approaches, it becomes evident if productivity measures will be met. If it is determined that they will not, a technologist goes home. Gladys, the MRI supervisor, stated that she also takes her turn to go home because she would never ask her technologists to do something she was not willing to do.
Cardon’s radiology department invests in the education and development of their modality supervisors with in-house management education opportunities. Not only are they expected to manage the day to day activities of their section, but they also take on added responsibilities such as process improvement for the ED or trauma certification. They are all CRAs, which demonstrates their dedication to personal and professional growth. Leaders are expected to demonstrate the core values and behaviors of the hospital at all times and are held to a high standard.
Ownership does not stop at the management level. As I went from modality to modality, I noticed the pride the technologists took in their work. In fluoroscopy, Jill told me that she always saw her exam through to completion, even if she had to stay past her shift. She felt that she needed to ensure that the patient experience was exceptional from beginning to end.
Having the right person for the right job is important for productivity as well. As the director, Lori, explained, there is no reason to pay a technologist to do something that a technologist assistant can do. As the file room went away and the digital world came into being, the file room staff was re-educated to perform in a new role as technologist assistants. They turn over rooms, help to transport patients, and perform many other functions so the technologists can remain highly utilized in their capacity.
One takeaway I have from this experience is an interest in developing my lead technologists to perform much like the supervisors at Cardon Children’s. Each one expressed their love of the job, appreciation of the opportunity they were given, and the desire to continue to do more. I am also eager to explore the idea of technologist assistants.
As we become more Lean, technologists are required to do more with less staff. One of the struggles that Connecticut Children’s has is keeping the MRI resource fully utilized. Oftentimes patients come unprepared, having not fasted, or without a history and physical for sedation. At Cardon’s, the anesthesiologist or a PA will do the H&P to avoid rescheduling the patient. If a patient has neglected to fast, they are given the opportunity to be put on the schedule at the end of the day. Likewise, if a patient is more than 15 minutes late, the next patient is brought into the scanner. If the patient does arrive, they also are given the opportunity to wait until the end of the day. This work flow process is one I’d like to contemplate for Connecticut Children’s.
I would be amiss if I did not mention Sarah, a senior manager who spent many hours showing me the department, introducing me to many staff, and making sure all my questions were answered. Her love for the profession shines through as she greets everyone with a smile. I am appreciative of having met her and know in the future she will be someone I can reach out to as we collectively work towards positive outcomes in our profession.
Overall, I came back with fresh perspectives on how we can improve upon our processes at Connecticut Children’s and how I can help to develop our current staff. I enjoyed my stay in Mesa and my time at Cardon Children’s, where medical excellence truly is provided by the best people, delivering the best care!
Lynne Johnston, CRA is the assistant radiology manager at Connecticut Children’s Medical Center in Hartford, CT. She can be reached at Ljohnston01@ccmckids.org.