External reviews are used to evaluate a department on a routine basis or prior to reappointment or recruitment of a department chair. The Society of Chairs of Academic Radiology Departments (SCARD) developed a template that outlines important components of an external review report and a table that outlines the objective information that can be requested from the institution/department prior to the reviewer’s site visit. The template is meant to facilitate a high-quality review and serve as a guide to a chair who is preparing for his/her first review, chairs who serve as external consultants, and institutional officials seeking review of a radiology department.
Purpose of external reviews
External reviews are used to evaluate a department on a routine basis or before reappointment or recruitment of a department chair. The goals of such a review are to: (1) document the department’s achievements and progress, (2) assess gaps, opportunities, and strengths as a framework for strategic planning, (3) establish goals and priorities for the future, (4) foster continuous improvement of programs and services, (5) provide feedback to the department regarding its performance and the relationship of that performance with institutional expectations and national benchmarks, (6) educate the institution as to the status, directions, and needs of the department, (7) provide expert advice to both the institution and the department, (8) provide a mechanism by which the members of a department can express their views concerning the competence and responsiveness of the chair (and other department leaders) and confidence in their leadership, and (9) serve as the basis for dialog between the chair, dean, and hospital leadership . Chairs of academic radiology departments are accountable for their department’s performance in meeting the tripartite mission of patient care, education, and research. Depending on the particular institution, a wide variety of stated and unstated expectations exist regarding the performance targets in each of these three domains.
Many radiology chairs are asked to serve as external consultants to review departments at other medical schools. Participating in external reviews can be viewed by the chair as an important service to the radiology community, a mechanism to provide guidance or mentorship to a fellow leader in radiology, an opportunity for self-development and to compare one’s own department with others, and to learn things that may benefit the reviewer’s department. The Society of Chairs of Academic Radiology Departments (SCARD) views external reviews as a tool that when optimally used can foster the success of an individual chair and academic department and ultimately contribute to continual process improvement across the field of radiology. SCARD developed a template ( Appendix ) that outlines important components of an external review report and a table ( Table 1 ) that outlines the objective information that can be requested from the institution/department before the reviewer’s site visit. The template is meant to facilitate a high-quality review process by outlining standardized elements based on the best practices. It may further serve as a guide to a chair who is preparing for his/her first review, chairs who serve as external consultants, and institutional officials seeking a review of a radiology department. Although no approach fits all institutional needs, the review process should reflect the unique context and individual circumstances of the institution and the department under review, and the availability of a comprehensive standardized template can be valuable. Objective criteria are critical for measuring a department’s progress and comparing a department’s performance with national benchmarks. These objective metrics should be considered in concert with subjective data to create a report that reflects a department’s strengths and weaknesses and provides specific actionable recommendations for performance improvement. A complete description of the operational aspects of a radiology department and metrics that can be used to judge a department’s performance are beyond the scope of this article and can be found elsewhere . A detailed process for radiology services review is also available from the Royal College of Radiologists in London, England .
Table 1
Information to Request Before Radiology Department Review Site Visit
Overview Department Chair self-evaluation, summary of department changes over the past 5 years, including both current and recent past departmental goals and major initiatives Chair’s personal performance Clinical activity (type and schedule) Scholarly activity (number and brief description of grants, publications, national presentations, and teaching activities) Service activity (number and description of local, regional, and national committees, society officerships, editorial boards, and study sections) Organizational structure Faculty full-time-equivalents (FTEs) (number and percentage of women and other minorities and rank distribution) Curriculum vitae of all faculty members Department organizational chart showing the titles and names of the Chair, Vice Chairs, Directors, Section Chiefs, other faculty, and staff, and their reporting structure List of department committees Roles of department members in hospital and medical school committees (e.g., promotions, medical executive, quality ,and safety), including any reporting structures of departmental faculty to extradepartmental entities Description of how faculty mentoring is provided and how professional development opportunities are communicated to faculty Description of formal faculty evaluation process Methods of communication (e.g., department website, department newsletter, department e-mail notices, department digital signage, faculty meetings, and external communication outlets) List of department support personnel (e.g., business administrator, administrative assistants, billing/coding staff, department budget analyst, department research assistants, program coordinators, and information technology support staff) Description of faculty clinical scheduling process and sample schedules Vacation and meeting policy Description of faculty academic time (education, research, scholarship, and administrative) Financial performance List of revenue sources (e.g., clinical, college, hospital, state, grants, endowments, other) Description of department budgeting process Five-year history of actual revenues and expenses versus budget Description of department reserves, endowments, and ongoing philanthropic efforts Faculty compensation plan document (description of plan/process, components such as base/incentive/call coverage) Mean salaries for each rank compared to national benchmarks Travel and expense allowance policy Clinical performance Faculty work relative value units adjusted for FTE, per section and department total, compared to national benchmarks (e.g., Medical Group Management Association [MGMA], University HealthSystem Consortium [UHC], and Association of Administrators in Academic Radiology [AAARAD]/Society of Chairs of Academic Radiology Departments) Number of examinations by modality and site for past 5 years Description of the range of diagnostic and therapeutic services and any deficiencies Method of 24/7/365 faculty coverage (e.g., faculty available on or off-site, teleradiology) Equipment inventory with dates of purchase Description of capital budget process Equipment purchase and maintenance process Radiology information system, picture archiving and communication system, and voice recognition equipment and support Description of how physical space and facilities are maintained and renovated Description of quality, safety, and efficiency initiatives (e.g., American College of Radiology [ACR] accreditation, dose reduction and monitoring, ACR General Radiology Information Database, days to appointment, complication rate, decision support integrated with computerized physician order entry, and meaningful use participation) Patient satisfaction survey results for past 2 years Ordering provider satisfaction survey results for past 2 years Samples of department dashboards Report of department report turnaround times for past 2 years Educational programs Institutional model for funding teaching Description of medical student clerkship (mandatory or voluntary, length, and curriculum) Medical student evaluations of clerkship for past 2 years Description of core residency program (number approved and current number, funding source/s) The most recent Radiology Review Committee report The most recent resident survey results The most recent internal residency program review Residency match results for past 5 years American Board of Radiology pass/condition rate List of resident publications and presentations over past 5 years Description of fellowship programs (accredited versus nonaccredited, type and number, number of fellows in each program over past 5 years, the most recent RRC site visit reports, number of fellow publications and presentations over past 5 years) Description of department-sponsored Continuing Education Programs Research/scholarly activity Description of laboratories and other dedicated research space List of grants over past 5 years (federal, foundation, society, and internal) to include salary support and percent effort Submitted grants in past year Number of faculty presentations in past 5 years Number of faculty publications in past 5 years (listed as peer-reviewed and nonpeer-reviewed) Number of faculty committee memberships (local, regional, and national), society officerships, editorial board memberships, and study section memberships over past 5 years Awards, honors, and distinctions of faculty/department/staff/students
Review process
The “classic” department review typically occurs at regular intervals (usually every 5–7 years), is directed by the medical school dean, and is conducted by both an internal review committee and external advisors who produce a formal report . Internal and external reviewers can work separately or as a combined committee. Some schools of medicine have begun to rethink the traditional departmental review process, citing “too much data and too little plan” . Other criticisms of reviews have included a little long-lasting benefit as perceived by the department and dean’s office, lack of follow up of the report’s recommendations, ineffective strategic planning resulting from the retrospective analysis of the department, and limited incentive by reviewers to document weaknesses, if the review is seen primarily as an opportunity to request additional resources. Additionally, reviews are costly to an institution in terms of actual expense and staff time. The Stanford University School of Medicine estimated the average cost per review to be $20,000 for honoraria, travel, and supplies, and $20,000 for dean’s office staff time; the additional costs of Radiology department faculty and staff time was not calculated . The University of Michigan Medical School estimated the annual cost of conducting reviews to be up to $240,000 . In an effort to gain a greater return on investment, they revised their departmental review process to link strategic goals, performance measures, evaluation systems, and rewards . The final report is a strategic plan containing a SWOT (strengths, weaknesses, opportunities, and threats) analysis and strategic goals for the department, with related action plans. The Michigan model employs outside experts from the same as well as from a different medical discipline and from a nonmedical discipline (e.g., strategic planning expert).
The review of a department should include an assessment of the overall leadership and management performance of the department chair, presence of good faculty development practices, integrity of the teaching programs, excellence of the research program and associated research infrastructure, and quality and effectiveness of the clinical programs . Similarly, there should be a stated understanding of favorable or unfavorable trends in the department, including the evolving nature and structure of the department and its effectiveness over time in addressing the tripartite mission. Although chair job expectations may vary from institution to institution, there is a general agreement on the main areas of accountability. The American Association of Chairs of Departments of Psychiatry established a tool kit for new chairs that included key issues and responsibilities of a chair and benchmarking information on other psychiatry departments nationally .
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Summary
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Appendix
Radiology Department Review Report Template
Overview
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Chair’s Personal Performance
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Organizational Structure
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Department Finances
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Clinical Performance
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Educational Programs
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Research/Scholarly Activity
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Tools and Templates (the examples listed are not meant to represent a complete list)
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References
1. Association of American Medical Colleges: The successful medical school department chair: a guide to good institutional practice, Module 3: Performance, evaluation, rewards, renewal, Chapter 2, Examples of good practice in departmental reviews.2003.Association of American Medical CollegesWashington, DC
2. Yousem D.M.Beauchamp N.J.Radiology business practice: how to succeed.2008.Saunders/ElsevierPhiladelphia, PA:
3. Board of the Faculty of Clinical Radiology. The Royal College of Radiologists, College review of radiology services, 3rd ed. The Royal College of Radiologists. http://www.rcr.ac.uk/docs/radiology/pdf/College_review_third_edn.pdf . Accessed February 2012.
4. 2012.Board of the Faculty of Clinical Radiology. The Royal College of Radiologists http://www.rcr.ac.uk/docs/radiology/pdf/Process_SRC_final.pdf Accessed August 10, 2013
5. Hitchcock M.A., Stritter F.T., Bland C.J.: Faculty development in the health professions: conclusions and recommendations. Med Teach 1992; 14: pp. 295-309.
6. Monro S.A.: Tool kit for new chairs. Acad Psychiatry 2006; 30:
7. Wolverton M., Ackerman R., Holt S.: Preparing for leadership: what academic department chairs need to know. J High Educ Policy Manage 2013; 27: pp. 227-238.