Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Health care is ultimately a social enterprise

Christine A. Sinsky, MD
Physician
May 15, 2014
Share
Tweet
Share

Have you ever thought of an x-ray technologist as a key player in promoting high-value, cost-conscious care?

Recently, an x-ray tech saved one of my patients from unnecessary imaging.  Here is the story. Last fall we had set up a 6 month follow-up ultrasound to check on a patient’s abdominal aortic aneurysm, an aneurysm that was too small to require surgery, but too large to ignore. The day before the ultrasound the tech called and asked if we still wanted the test, as an abdomen CT had just been done by another physician for a different reason. Since a CT is as good or better at looking at the aorta, we didn’t need the ultrasound. Test cancelled. Patient saved another trip and co-pay. Overall spending reduced. Good call on the technician’s part.

The next day we received a call on a different patient, this time the tech asking if we wanted to add a CT of the neck to the CT chest we had ordered. She had listened to my dictation and heard about swelling in the neck and thought we could save the patient a second trip if we added cuts through the neck as well as the chest. It was a good idea.

So what is going on? It turns out that at the direction of their departmental manager, Tina Stillmunkes, the x-ray technicians have begun reviewing the clinical scenario of each patient on the next day’s schedule, the radiology equivalent of the “visit prep” my nurses do for each of our clinic patients. The technician reviews the indication for the test, any previous related imaging and the relevant laboratory studies, and obtains outside images if need be. If anything seems out of line or questionable, s/he brings it to the radiologist’s attention, and then calls the nurse on the clinical team.

This way we take better care of our patients and we order tests more appropriately. The radiologists and the x-ray technicians are the experts in their field, and their functioning as thoughtful professionals as opposed to just carrying out orders, has improved the care in our organization. And it could decrease overall health care spending as unneeded tests are caught before they are performed.

It is a sign of professionalism: Our x-ray department now staffs 3 CT technicians, rather than the previous 2, with one technician assigned to chart prep.  This extra staff time could result in less revenue to the department, as some studies are cancelled. But it also results in more appropriate testing and fewer delays in diagnosis.

How did this happen? It took staffing changes (increased staffing to cover the new duties), technology changes (computer stations with speakers so the techs could listen to any dictation that had not yet been transcribed) and cultural changes (the techs had to feel comfortable approaching the radiologists and the radiologists had to be committed to educating the techs).

What does this show? To me it shows the power of human relationships. Health care is ultimately a social enterprise. We can reduce it down to a series of electronic steps and lose the humanity. Or we can leverage the professionalism among the people who come to work every day. When the oncology nurse talks with the family medicine nurse care is more tightly woven together for patients and families.  When the surgeon talks with the pulmonologist errors are less likely. When the internist talks with the pharmacist medication choices are optimized.

It shows the power of “relational coordination,” a term coined by Jody Hoffer-Gittel.  The core concept of relational coordination, originating in the airline industry, is that highly functional work environments require strong conduits for communication, as well as respect and relationship between different roles within the organization.

In health care there is a linear correlation between the degree of relational coordination within an organization and the outcomes the organization achieves. Higher relational coordination — the more likely workers of different roles are to greet each other, respect each other or speak to each other — the better the outcomes. The more likely gate agents are to greet the pilots, the more likely the planes will run on time. The more comfortable surgeons are speaking with circulating nurses the better the operation room outcomes.

Similarly, in my view, when an x-ray technician is encouraged to learn, think and question, and is empowered to approach the radiologist and then the clinical team, the care is better.

Relational coordination depends on participants having a high degree of shared knowledge regarding each other’s tasks and on having shared goals.  In an organization with strong relational coordination pharmacists know the role of a nurse and have no barriers to communicating. Nurses understand the responsibilities and share the goals of safe, efficient patient care with radiology technicians. Laboratory personnel feel respected and able to communicate with physicians.

Gittell relates, “When participants know how their tasks fit together with the tasks of others in the same work process, they have a context for knowing who will be impacted by any given change and therefore for knowing who needs to know what, and with what urgency.”

ADVERTISEMENT

The solution to our health care costs and quality is not always electronic, it will not always come from a new technology-imposed constraint or policy mandate, operationalized through a series of hard-stops and drop down boxes. In many, often better ways, I believe, quality will be greater and costs lower when individuals work within a system that supports agency, connection and a professional commitment to the needs of patients. It really is all about culture, and you can’t command culture through rigid decision support and mandated physician order entry. But you can support and nurture culture with good processes, communication and leadership. Hats off to Tina Stillmunkes for showing us how this can be done!

Christine Sinsky is an internal medicine physician who blogs at Sinsky Healthcare Innovations. 

Prev

Incorporate other hobbies and passions into physicians' daily lives

May 14, 2014 Kevin 1
…
Next

For better or worse, doctors are human

May 15, 2014 Kevin 4
…

Tagged as: Primary Care

Post navigation

< Previous Post
Incorporate other hobbies and passions into physicians' daily lives
Next Post >
For better or worse, doctors are human

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Christine A. Sinsky, MD

  • a desk with keyboard and ipad with the kevinmd logo

    This is what patient safety means to me

    Christine A. Sinsky, MD
  • a desk with keyboard and ipad with the kevinmd logo

    An optimist’s view of primary care

    Christine A. Sinsky, MD
  • a desk with keyboard and ipad with the kevinmd logo

    Primary care is broken: Here are ways to fix it

    Christine A. Sinsky, MD

More in Physician

  • When doctors forget how to examine: the danger of lost clinical skills

    Mike Stillman, MD
  • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

    Anonymous
  • The man in seat 11A survived, but why don’t our patients?

    Dr. Vivek Podder
  • When did we start treating our lives like trauma?

    Maureen Gibbons, MD
  • Medicalizing burnout misses the real problem

    Jessie Mahoney, MD
  • Why some doctors age gracefully—and others grow bitter

    Patrick Hudson, MD
  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

View 3 Comments >

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • 2 hours to decide my future: How the SOAP residency match traps future doctors

      Nicolette V. S. Sewall, MD, MPH | Education
    • Why removing fluoride from water is a public health disaster

      Steven J. Katz, DDS | Conditions
    • When did we start treating our lives like trauma?

      Maureen Gibbons, MD | Physician
    • In a fractured world, Brian Wilson’s message still heals

      Arthur Lazarus, MD, MBA | Physician
    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • How doctors took back control from hospital executives

      Gene Uzawa Dorio, MD | Physician
  • Past 6 Months

    • Why tracking cognitive load could save doctors and patients

      Hiba Fatima Hamid | Education
    • What the world must learn from the life and death of Hind Rajab

      Saba Qaiser, RN | Conditions
    • The silent toll of ICE raids on U.S. patient care

      Carlin Lockwood | Policy
    • Why shared decision-making in medicine often fails

      M. Bennet Broner, PhD | Conditions
    • My journey from misdiagnosis to living fully with APBD

      Jeff Cooper | Conditions
    • Why we fear being forgotten more than death itself

      Patrick Hudson, MD | Physician
  • Recent Posts

    • When doctors forget how to examine: the danger of lost clinical skills

      Mike Stillman, MD | Physician
    • When your dream job becomes a nightmare [PODCAST]

      The Podcast by KevinMD | Podcast
    • Finding healing in narrative medicine: When words replace silence

      Michele Luckenbaugh | Conditions
    • Why coaching is not a substitute for psychotherapy

      Maire Daugharty, MD | Conditions
    • When the white coats become gatekeepers: How a quiet cartel strangles America’s health

      Anonymous | Physician
    • Why doctors stay silent about preventable harm

      Jenny Shields, PhD | Conditions

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Health care is ultimately a social enterprise
3 comments

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...