Background
Wells Medicine is a public, not-for-profit health system that comprised an 800-bed academic medical center, a children’s hospital, and several community hospitals that together earn more than $2 billion in annual revenues. The main campus, located in a busy metropolitan area, is ranked as one of the top hospitals in the United States, attracting patients from around the globe.
Wells Medicine is a nationally recognized leader in clinical services, research, innovation, and teaching, all of which are components of the system’s vision.
The healthcare system attracts employees from many geographic areas, ranging from the local, poor, inner city to other states and countries. It recruits talent from local universities, community colleges, trade schools, high schools, and placement agencies. Especially because Wells Medicine is one of the largest employers in its financially challenged location, the city and county governments are great supporters, providing job placement and development programs.
Wells Medicine’s radiology department prides itself on employing internationally renowned physician faculty and using the latest technology to provide the highest-quality care. Annually, the department performs more than 400,000 exams and generates $200 million in revenue. In addition, the department has consistently been ranked one of the top radiology programs in the United States. To run this 166,000-square-foot department, 1,000 fulltime employees are required.

Imaging Customer Service Center
The radiology department recently established the Imaging Customer Service Center (ICSC) to provide a central location in which patients and physicians can request and receive duplications of radiology images. Other services offered include image duplication for employed physicians and patients, stat orders typically for inpatients, and troubleshooting when something is wrong with an image order. The ICSC is located at the bottom level of Wells Medicine’s main inpatient tower and has been open for one year. Patients and physicians can fill out an order form either directly at the center or online, and images can be picked up in person or by a third party or can be mailed to an individual or a doctor. Customer groups that obtain services at the ICSC include patients, patient-designated representatives, physicians, and physician offices; each of these groups can be internal or external to the system.
Outside image processing is a service that the ICSC offers to patients who request from the system’s prestigious radiologists a secondary interpretation or reading of their results. Outside reads generate substantial revenue, in the form of professional fees, for the physician practice owned by Wells Medicine. Figure C2.1 highlights the growth in outside-read transactions processed at the ICSC, versus at hospitals within the system; order volume has more than doubled in the first year of ICSC operation.
The process of duplicating an image consists of three primary actions:
order entry, order processing, and order delivery. ICSC employees are expected to perform all three functions within the center and provide excellent customer service, given that the ICSC is the first thing that inpatients see when they enter the radiology department. For convenience, the ICSC is open 24 hours a day, 7 days a week, 365 days a year.

The initial goal of the ICSC was to implement the following strategic initiatives:
• Create a single point of contact for radiology patients • Cross-train radiology employees • Reduce film costs • Transform the role of film clerks into an information technology (IT)
role; doing so aligns these workers with the department’s overall business focus For cross-trained employees to have the ability to work at any station, the original layout of the ICSC was designed with a one-size-fits-all mentality.
With this mentality, all workstations are supposed to be cross-functional and multipurpose. Unfortunately, however, technology limitations made this concept almost impossible. The current workstations are not truly multipurpose, forcing employees to constantly shift stations and wait for the appropriately equipped station to open up. The other part of the cross-training goal is for employees to stay current in the imaging field and be able to help any coworker at any time. To do this, employees must rotate roles.
Perhaps most important was the goal to have every employee always present his or her best face to the customer. Unfortunately, the ICSC ran into unforeseen time constraints and opened for business prematurely. This rapid start left gaps in the development of policies and procedures, training, and support that have impeded efficient, customer-focused staffing.

The Situation
As the administrator of the radiology department, Robert Walker just finished a meeting with the interim committee that manages daily operations in the department in the absence of a full-time administrator of operations. The former administrator of operations left six months ago to pursue opportunities at one of Wells Medicine’s facilities abroad. The interim committee was then formed to ensure that operations, billing, and customer service in the radiology department continue to function smoothly until a replacement administrator can be hired.
During the meeting, Meg Johnston, manager of diagnostic radiology and leader of the interim committee, discussed the progress of moving film storage off-site and outsourcing film management. Although that project is moving along well, several other issues needed to be resolved that involve the supervision and performance of the ICSC staff. Ms. Johnston is responsible for the ICSC as a leader of the interim committee. Also, she is among the internal and external candidates applying for the administrator of operations..........

Discussion Questions
1. Prioritize the multiple challenges in this case. What will you address first, and how will you address it?
2. What are the underlying causes of the issues discussed?
3. What resources will you need to meet the 60-day turnaround target?
4. What are the key human resource and management issues, and how do they relate to the process and IT problems?
5. Who needs to be involved in developing and implementing solutions?

Transcribed Image Text:

FIGURE C2.1 Growth in Outside Image Orders 800 700 600 500 400 300 200 100 O Outside Reads via ICSC vs. All Hospital Outside Reads Oct Nov Dec Jan Feb Mar Apr May All Hospital ICSC Jun