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Quinte MRI, Inc. is a small international provider specializing in a variety of medical technologies including MRI. Quinte MRI’s founder, Dr. Syed Haider believes that the residents of smaller communities deserve the same level of health services as the residents of the larger urban centers.

Quinte MRI is experiencing difficulty in meeting the expectations of 2 scans per hour. As a result, productivity is declining and they losing the referral of many of their colleagues. The process is creating a lot of variability and uncertainties that Quinte MRI are dealing with.Solving the issue of the “bottleneck” will make the operation more effective and manageable. By assuming the role of David Wright and Kevin Saskiw, I will recommend a course of action that should be followed by the new Quinte MRI clinic that will reduce a long waiting list for its imaging services.

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Issue Identification Haider’s client, Benton- Cooper Medical Center (BCMC) has expressed concern over the fact that the MRI clinic was not meeting promises made by Haider and GE to scan patients at a rate of 2 per hour.The hospital’s administrators continue to complain about the MR machine’s low productivity, the strain resulting from the MR technologist’s heavy overtime schedule, and the loss of patient referrals from doctors within the hospital and in the surrounding area. Doctors expect to receive the transcription within 2 days of their request. The backlog has now exceeded 14 days, resulting in providing a poor quality of service to the patients. This backlog has put a strain on the relationship between BCMC and Quinte MRI and has lost referrals to the competing MRI clinics in attempt to obtain a more efficient timeframe for servicing patients.. The MRI clinic is experiencing some problems in the scheduling department.

Currently the MRI machine is scheduled for one scan per hour and they are having difficulty reaching that output. It was assumed that the clinic would achieve 2 scans per hour. Patients are being scheduled at incorrect times and are not being properly screened . There are people scheduled who have medical conditions that should be rejected and many patients are experiencing difficulty in getting the proper examination. Poor communication throughout the MRI clinic and its employees is very evident.

Lack of communication between the patient and the scheduling department seems to be at the forefront. There are times when patients fail to show up for their appointment or they are cancelling at the last minute. There appears to be some communication barriers between the radiologist and the MR Technologist as well.

The radiologist requires the images as soon as the patient is scanned but the MR Technologist has great difficulty in meeting this request. There is also concerns over employees being overworked. For example, the sole MR technologist, Jeff Sinclair was scheduled to work 40 hours per week.During the month of May, Jeff worked an additional 40 hours at a rate of 1. 5 times his regular wage. The manager of the radiology department, Monica Zimmerman, was concerned that Sinclair was working too hard and for too long. She began to pressure Wright and Saskiw to hire another MT technologist to aid in alleviating some of Sinclair’s workload with the hopes of improving lead times. Monica believed that the most appropriate move would be to add a partial second shift in the late afternoon and early evening hours.

Environmental and Root Cause Analysis Wright and Saskiw must provide recommendations and an action plan to deal with the process and productivity problem as it relates to extreme variability at BCMC. After just six weeks in operation at BCMC, the clinic developed a waiting list and physicians began referring patients to competing facilities due to the long lead times. In order to increase productivity and improve performance, the management of the clinic must make some decisions in order to properly manage the overall flow of the MRI’s process.By increasing capacity and introducing a balance in operations, the MRI clinic should begin to smooth out some of the bumpy roads it is currently traveling down. In order to achieve this success, Wright and Saskiw must first identify the bottleneck in the process. The MRI machine and the time it takes perform a scan is the bottleneck of the process.

Each scan can have different times associated with it depending on the type of scan that will be performed. This will limit the capacity of the overall process. For example, a scan without contrast will usually take 30 minutes.A scan that requires contrast will double that time to 60 minutes. According to exhibit # 2, in order to break even annually, the clinic will have to cover the total operating expenses of $690,000. That means that the clinic will have to perform 986 scan per year, or approximately 4 scans per day to achieve this goal. Considering that the equipment in the clinic is capable of much more, this operation should have no problem in reaching and exceeding its goal daily if proper measures are put into place. Improvements must start at the beginning of the process, as each step in the process is dependant upon the previous step.

One of the goals of the clinic should be in improving the process flow up to the point that the actual scan will take place. The clinic must also eliminate much of the variability and uncertainties in the scanning process which is ultimately making the process difficult to manage. The uncertainties negatively affect work scheduling and capacity utilization which reduces the overall efficiency of the clinic’s scanning process. Alternatives and/ or Options The administrators at BCMC believed that there was an opportunity to compete successfully with a third MR machine in Adelaide County.

There appeared to be enough demand (annual scan rate in the US: 68 per 1000 people). Many physicians in the area have become frustrated with the backlog at BCMC. 14 days in their opinion is too long to wait for MRI results. Most of these physicians are now sending their patients elsewhere which is taking $ 700. 00 away from the clinic each time they do so. The clinic currently experiences plenty of idle time.

For example, when a patient meets the technologist, the first thing that they do is qualifying. The technologist examines the patient to see if there are any medical conflicts that would prevent them from performing the scan.This takes approximately 5 minutes.

If so, the patient is sent home creating idle time. In addition to checking for possible health risks, the technologist also ensures that patients are not wearing clothes with metal components. If the patient is wearing clothing with a metal component, then they must change into a hospital gown, which will take approximately 4 minutes.In order to cease this idle time and loss in revenue, the clinic must put some new measures in place in order to make this investment prosperous. Dr.

 Syed Haider has acquired the services of David Wright and Kevin Saskiw to make recommendations on ways to improve the performance of the MRI clinic and to provide in detail an action plan.If I were Wright and Saskiw, I would begin my action plan by identifying ways to maximize capacity and reduce patient wait times. The goal of the clinic is to meet the expectation that the clinic can serve 2 scans per hour daily with a lead time of 48 hours between the scan and delivery of the results to the originating physician.By reducing wait times, the clinic would avoid losing patient referrals to competitors an become more competitive.

The action plan should include improvements in communication between all staff members. Beginning with reception through to the MR technologist. There is a lack of information between the patient and the scheduling department regarding appointment times. Good in- house communication will reduce many of the dysfunctions that the clinic is currently experiencing. A good action plan will allow the clinic to manage their operations more effectively and strategically.In order to achieve this the clinic must synchronize the flow of the process.

By implementing and performing these tasks, the clinic should become more patient and physician friendly, as well as more profitable for BCMC and Quinte MRI. Recommendation and Implementation Presently, the clinic receives many complaints from administration regarding its low productivity, the MR technologists heavy overtime schedule and the loss of patient referrals in and around the community. Starting at the beginning- the referral and scheduling of an appointment: Rules must be laid out for the patient from the beginning.Patients should be told that if for any reason they cannot keep their appointment at the clinic that they are obligated to contact the clinic with at least 24 hours notice. If the patient is late for their scheduled appointment, it must be known that they will lose there place in the schedule and have the option of re-scheduling or waiting for the next available spot that day. Reception and the schedulers can also aid in reducing much of the tedious work that is left up to the technologist. I am referring to the qualifying screening of the patient and the rules of the meeting as it pertains to clothing.

All of this information can be gathered and presented to the patient upfront before their visit, thus freeing up the technologist on appointment day and eliminating patients who will not qualify before they grace the clinic. This would reduce much of the idle time experienced in this sector and they should also determine the type of scan that will be required at their appointment so that the information can be processed much faster on the day of the appointment. Once these uncertainties have been reduced, the process can be simplified and thus become easier to manage.I personally believe that this clinic could benefit from some updated scheduling software that would make things more organized and presentable.

Hand written schedules can become messy and confused during a regular work day. This leads to mistakes which will lead to a loss of revenue and more bottlenecks in the daily flow of patients. Software could be incorporated that would automatically call patients with upcoming appointments as a reminder to contact the office with a confirmation of their appointment.Computerized software would also eliminate many scheduling conflicts created by human error. This would eliminate some problems and create better flow among the daily operations. I would recommend that Jeff Sinclair, the MR technologist, meet with management to discuss his concerns regarding the radiologists unrealistic requests in receiving the images. It is mentioned that he is working plenty of overtime and is overworked. This will only lead to stress in Jeff’s occupation and will eventually create a disgruntled overworked employee.

I see no reason why some of Jeff’s less meaningful tasks could not be reassigned to the receptionist. For example, the receptionist could escort patients to the magnet room. They could examine and verify that the patient is wearing the correct clothing for the procedure. They could also perform some of the data entry that bogs down his time when he could be devoting more time to preparing images for the radiologist. By implementing these procedures we can reduce Jeff’s workload and increase capacity while saving money on overtime expenditures.This would also aid in reducing the amount of time it takes to return images to the physicians. It may lead to BCMC achieving one of its goals- providing images within 48 hours.

I believe that there is room for improvement within this clinic in accepting more walk customers. Walk-in scans currently amount to 600 patients per year. That amounts to $420 000 in revenue annually. With the cancer rate in Adelaide County being slightly higher than the national average, perhaps the clinic could benefit from keeping a list of “walk-in” candidates nearby.If they anticipate some idle time or a cancellation, then they could begin contacting names on that list and begin to attempt booking some of those patients in the hopes of generating extra yearly revenue. If this clinic was working at full capacity, it would have the potential to generate 16 scan per day with a yearly revenue of $ 2 800 000. That would be substantial growth compared to the capacity it experiences today. Monitor and Control Realistically, any and all new procedures that will have to be practiced by employees should not take a long time to accomplish.

Educating the patient will probably take the longest to achieve. Staff could be fully trained on any new software in 2 weeks or less. Training of new duties for certain employees may take up to the same amount of time. I would recommend hosting quarterly meetings with the administrators of the hospital. They must be informed of improved performance results and they should receive feedback from employees and patients regarding the level of service the clinic provides.Another helpful measure that should be taken is to provide patients with surveys. By having your patients complete a survey the clinic will get a strong sense of where they are succeeding and where they need to improve while never missing an opportunity to improve customer satisfaction.

If all of the measures are meet with a level of success then the clinic should enjoy many years of profitable service while providing patients with a high quality level of service for years to come.

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