The organizational structures managing imaging - MIR-Online
The organizational structures managing imaging - MIR-Online
The organizational structures managing imaging - MIR-Online
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<strong>The</strong> <strong>organizational</strong> structure<br />
<strong>managing</strong> <strong>imaging</strong>:<br />
Who manage whom, and how<br />
Jarl Å. Jakobsen, MD, PhD, MHA<br />
Professor, Senior Consultant Radiologist<br />
University of Oslo<br />
Faculty of Medicine<br />
Institute of Clinical Medicine<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
THE IMAGING / RADIOLOGY PRODUCT [R]<br />
A<br />
X X X X X €<br />
[R]= Area x People x IT x Machine x Patient x Money<br />
• Can be used as an outline for systematic thinking<br />
• If one factor changes, corrections must be made to other factors to maintain<br />
the product [R] , or [R] has to be changed<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
MODELS FOR ORGANISING A DEPARTMENT<br />
Den radiology procedure:<br />
Recept.<br />
Planning<br />
Exam<br />
Read<br />
MDT<br />
Office<br />
Result<br />
sent<br />
Organ model<br />
Cardio-pulm.<br />
Chest<br />
x-ray<br />
CTA<br />
Chest<br />
PET-<br />
CT<br />
Speciality/modality matrix:<br />
UL MR INTV<br />
Rad.<br />
CT Angio US MR<br />
Etc...<br />
Neuro<br />
Card.<br />
Pulm.<br />
Abd.<br />
Dr. X<br />
Dr. X<br />
Dr. X<br />
Hald<br />
1. Aaløk<br />
2. Kolb<br />
Dr. X<br />
Bakke<br />
Vatne<br />
Dr. Y<br />
Dr. X<br />
Dr. X Dr. <br />
1. Smith<br />
2. Due-T.<br />
Jak.<br />
Modality model<br />
CT<br />
Neuro Uro Chest<br />
Ped.<br />
Etc...<br />
Dr. <br />
Dr. X<br />
Gastro Angio Ped.<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
ORGANIZATIONAL LEVELS<br />
Organizational charts:<br />
HEAD OF DPT.<br />
Staff<br />
Economy<br />
HR<br />
Quality<br />
Patient<br />
adm.<br />
Secretaries<br />
Body<br />
CVS<br />
Ped MS MR<br />
+ Interv<br />
Neuro<br />
Tech<br />
Rad IT<br />
Radiographers<br />
Patient flow through the hospital:<br />
In<br />
Workup<br />
Operation<br />
Postop<br />
Out<br />
Information flow:<br />
DPT DPT DPT<br />
Patient flow in Imaging Dept.<br />
AppOff<br />
Office.<br />
Appointment<br />
Planning<br />
Exroom<br />
Interpret<br />
Transscript<br />
Dem.<br />
MDT<br />
Answer<br />
distrib.<br />
Radiol<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
L 1<br />
L 2<br />
THE LINKING-PIN-PRINCIPLE<br />
(overlapping management teams)<br />
L 1<br />
L 2<br />
L 3<br />
L 4<br />
L 5<br />
L 3<br />
L 4<br />
L 5<br />
Drawn after Fig. 3.3 in Haaland og Dale: På randen av ledelse, Gyldendal 2006<br />
5<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
MANAGING TOGETHER WITH WHOM - 1<br />
COLLABORATION AND INTERDEPENDENCE SCORECARD<br />
MdImx Surg Onc Card Pulm Ane Lab Microb Pat<br />
Activity 9 9 4 6 2 1 0 0<br />
Competence<br />
and<br />
procedures<br />
8 8 5 5 1 0 0 0<br />
Economy 9 9 4 3 0 0 0 0<br />
Etc.<br />
Capacity,<br />
investments,<br />
patient logistics<br />
6 3 2 2 0 0 0 0<br />
SUM 32 29 15 16 3 1 0 0<br />
Teams working together directly with the patient<br />
Scale from 0-10<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
MANAGING TOGETHER WITH WHOM - 2<br />
MEDICAL SERVICES DIVISION<br />
MdImx Lab Microb Pat<br />
SUM 1 0 0<br />
• A big semantic deception creating true dysfunction in hospital management!<br />
• Collaboration and interdependence close to zero<br />
• Division leadership meeetings<br />
o Mr. G. Kenning would have enjoyed himself according to his <strong>The</strong>sis 3: Job<br />
knowledge is not a manager prerequisite. Managers, as managers, can<br />
manage anything (Died 1988)<br />
o Typical on the agenda in a medical service division leadership meeting:<br />
HR rules and tools, economy and procurement, quality systems, general<br />
management, etc.<br />
o Not on the agenda:<br />
Medical strategy, co-ordination with clinicians, radiology development,<br />
radiology availability, relevant IT, service design, etc)<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
ORGANIZING MULTISITE STRUCTURES<br />
Model 1<br />
Top management<br />
Corporate staff<br />
Model 2<br />
Top management<br />
Corporate staff<br />
Division Managers for<br />
MedService, Surgery, etc..<br />
Hospital A<br />
Hospital D<br />
Surg IntMed<br />
MdImx Ane<br />
Hospital B<br />
Surg IntMed<br />
MdImx Ane<br />
Onc<br />
Lab<br />
Hospital C<br />
Onc<br />
Ane<br />
IntMed<br />
R&D<br />
Pat<br />
MdImx Lab<br />
Tx<br />
Surg<br />
Ane &<br />
IntCare<br />
Surg<br />
Card<br />
Pulm<br />
Lab<br />
Microb<br />
MdImx 1 MdImx 2<br />
Pat<br />
Onc<br />
Imm<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
SOME BASICS ABOUT HOW TO MANAGE<br />
• Authority and accreditation = Responsibility<br />
• Autonomy - Economy<br />
• Structure - Communication<br />
• Human resources, human management<br />
• IT-influence<br />
• Medical technology<br />
• Space<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
10<br />
INFORMATION AND COORDINATION<br />
Requests, patients and<br />
referring units<br />
Wards, outpatient<br />
clinics<br />
and patients<br />
logistics<br />
PI<br />
Clinical leaders,<br />
head of clinical<br />
functions, clinical<br />
departments<br />
Head of<br />
radiographer<br />
section<br />
Head of<br />
radiologist<br />
section<br />
Internal co-ordination,<br />
internal resources,<br />
organisations, radiological IT,<br />
etc.<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
MODELS FOR INFORMATION FLOW<br />
Longeast et al.<br />
11<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
SUMMARY: Who should manage whom, and how<br />
This is important:<br />
• Structure of [R]<br />
• Same patient tasks organized together<br />
• Size of organization<br />
• Same or different location<br />
• Structure of organization<br />
• Sensible communication<br />
• Sense and professionalism!!<br />
Department of Radiology and Nuclear Medicine – Rikshospitalet<br />
jåj
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