Rationale and Objectives
The study aimed to assess perceptions of reading room workflow and the impact separating image-interpretive and nonimage-interpretive task workflows can have on radiologist perceptions of workplace disruptions, workload, and overall satisfaction.
Materials and Methods
A 14-question survey instrument was developed to measure radiologist perceptions of workplace interruptions, satisfaction, and workload prior to and following implementation of separate image-interpretive and nonimage-interpretive reading room workflows. The results were collected over 2 weeks preceding the intervention and 2 weeks following the end of the intervention. The results were anonymized and analyzed using univariate analysis.
Results
A total of 18 people responded to the preintervention survey: 6 neuroradiology fellows and 12 attending neuroradiologists. Fifteen people who were then present for the 1-month intervention period responded to the postintervention survey. Perceptions of workplace disruptions, image interpretation, quality of trainee education, ability to perform nonimage-interpretive tasks, and quality of consultations ( P < 0.0001) all improved following the intervention. Mental effort and workload also improved across all assessment domains, as did satisfaction with quality of image interpretation and consultative work.
Conclusion
Implementation of parallel dedicated image-interpretive and nonimage-interpretive workflows may improve markers of radiologist perceptions of workplace satisfaction.
Introduction
In an increasingly complex and cognitively demanding work environment, the modern radiologist must often balance a myriad of competing responsibilities as an imaging expert and interpreter, physician consultant, educator, and interventionalist . Although these responsibilities conceptually span a wide range of clinical activities, they can be broadly categorized into image-interpretive (IIT) and nonimage-interpretive tasks (NIT), and as previous work has shown task dichotomization leads to decreased reading room disruptions and interruptions and facilitates gains in workflow efficiencies . These observations at our institution and others have informed a local quality improvement intervention in our practice where discrete image-interpretive and nonimage-interpretive workflows resulted in fewer disruptions and increased time for both image interpretation and trainee education.
The analysis of and subsequent improvements to the radiologist’s workflow environment also require a careful analysis of individual workloads and the impact individual workloads have on the overall efficiency of a workflow process. These examinations also afford a more nuanced exploration of the impact workflow design has on individual operators. Whereas workflow represents the sequence of processes through which a piece of work passes from start to finish, workload represents the actual amount of work to be done. Workload, at the individual level, is not an absolute quantity and is variably dependent on numerous intrinsic factors (such as individual experience and skill) and extrinsic factors (such as interruptions and system failures), which all contribute to the overall perception of individual workload . The NASA Task Load Index (NASA TLX) is a widely used comprehensive multidimensional assessment tool in human factors research that captures individual perceptions of individual workload across six domains. Survey instruments such as the NASA TLX allow researchers to capture the interplay among individuals, cognitively demanding tasks, and complex work environments. These assessments can then help researchers understand the relationships between workload and job performance, job satisfaction, and in the healthcare environment potential downstream effects on patient care . Using the NASA TLX as a foundation, we developed a tailored survey instrument to assess radiologist and trainee perceptions of (1) workplace disruptors, (2) mental effort required to complete daily workload, and (3) overall workplace satisfaction before and after the implementation of a dichotomized workflow in our reading room. Complementing previous work from our group on workflow design, our results highlight the impact that workflow design has on individual workload and concomitant perceptions on workplace disruptions and radiologist workplace satisfaction.
Materials and Methods
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Study Setting and Population
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Survey Development
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Table 1
Study Questionnaire Design
Assessment Category Questions Interruptions
To what degree do interruptions in the neuroradiology reading room adversely affect:
Workload
Please rate the following as they apply to your work in the current neuroradiology reading room setting:
Satisfaction
In the current neuroradiology reading room setting, how satisfied are you with:
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Statistical Analysis
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Results
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Table 2
Interruptions
Preintervention Postintervention_P_ Value Average Rating Standard Deviation Response Count Average Rating Standard Deviation Response Count To what degree do interruptions in the neuroradiology reading room adversely affect: Your ability to interpret imaging studies? 3.78 0.53 18 2.21 0.86 14 <0.0001 The quality of your image interpretations? 3.39 0.83 18 2.00 0.76 14 <0.0001 Your ability to address non-imaging interpretation tasks (consultations, protocols, monitoring studies, procedures, etc)? 3.28 0.56 18 1.79 0.67 14 <0.0001 The quality of consultations you are able to provide to referring providers? 3.06 0.62 18 1.71 0.70 14 <0.0001 The quality of trainee education? 3.61 0.76 18 1.93 0.70 14 <0.0001
Likert scale: 1 = none, 2 = minimal, 3 = mild, 4 = moderate, 5 = severe.
Table 3
Workload
Preintervention Postintervention_P_ Value Average Rating Standard Deviation Response Count Average Rating Standard Deviation Response Count Please rate the following as they apply to your work in the current neuroradiology reading room setting: Mental effort required to concentrate on your work 3.71 0.82 17 2.79 0.77 14 0.0034 Stress experienced while performing your work 3.24 0.64 17 2.36 0.61 14 0.0005 Effort required to achieve your desired level of performance 3.65 0.68 17 2.79 0.67 14 0.0006 Effort required to accomplish everything you’re asked to do in the reading room 4.12 0.68 17 2.79 0.67 14 0.0001
Likert scale: 1 = very low, 2 = low, 3 = medium, 4 = high, 5 = very high.
Table 4
Satisfaction
Preintervention Postintervention_P_ Value Average Rating Standard Deviation Response Count Average Rating Standard Deviation Response Count In the current neuroradiology reading room setting, how satisfied are you with: Your ability to interpret imaging studies? 3.29 0.82 17 4.38 0.49 13 0.0002 The quality of your image interpretations? 3.41 0.84 17 4.31 0.46 13 0.0017 Your ability to address non-imaging interpretation tasks (consultations, protocols, monitoring studies, procedures, etc)? 2.35 0.59 17 4.54 0.50 13 0.1768 The quality of consultations you are able to provide to referring providers? 3.35 0.59 17 4.46 0.63 13 0.0358 The quality of trainee education? 3.00 0.84 17 4.31 0.61 13 0.0849
Likert scale: 1 = completely dissatisfied, 2 = somewhat dissatisfied, 3 = neutral (neither satisfied nor dissatisfied), 4 = somewhat satisfied, 5 = completely satisfied.
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Preintervention Survey Data
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Postintervention Survey Data
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Discussion
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