By Dr. Syed F. Zaidi

Innovation can be a messy word because many disagree on its definition when it comes to their own organization. Innovation for one may be using a digital tablet for an intake form, while another may believe using artificial intelligence to help read clinical images is the baseline for innovation. Both examples may be new to an organization, thus, both may be deemed “innovative”.

It’s likely that the broad borders of innovation may cause anxiety because there is too much focus on the end-product and not the process. Large amounts of frustration can be ironed out by homing in on the hurdles involved in a workflow.

That’s why we here at Radiology Associates of Canton, when looking to refresh internally, to improve workflow and increase patient satisfaction, focused on smoothing operations through the use of “hassle maps”. It’s been an eye-opening project that can serve as an example for those looking to innovate within their own practice. Focus on the process with the end result as a guide.

Scanning for pain points
Radiology Associates of Canton is a Radiology Partners practice located in the Canton, Ohio metropolitan area. In late 2016, we set out to document the hassles that patients and referring providers encounter when interacting with the practice. The purpose was to recognize and mitigate pain points in the processes.

The project was born out of a suggestion by the leadership of Aultman Hospital, which has a co-management agreement with our practice, to look for opportunities to simplify our process for patients to navigate. Working with Kristen DeDent, executive director of process improvement at Aultman, we decided hassle maps could be an effective way to see where these opportunities exist.

For those first hearing that term, hassle maps are a visual or written documentation of problems, no matter the size, that individuals experience when using a product, or in our case, a service. These maps are then used to reduce those pain points and simplify the process of services.

For example, this is a hassle map for transferring money virtually in the year 2000:

Drive to the bank → Purchase a money order → Buy an envelope and a stamp → Send money order to individual via physical mail carrier → Recipient receives money order → Recipient drives to bank → Recipient deposits money into bank account

That sounds exhausting just thinking about it. The process also took days to complete. Here’s what a hassle map for the same event in 2018:

Two parties download the Venmo app → One individual sends money electronically to recipient → Recipient electronically receives money and starts bank transfer in-app → Recipient receives funds in bank account

The process is over and done within minutes and the transfer more often than not hits the recipient’s bank account the next morning. Although the end result may be the same both ways the process was made simpler and more convenient for all parties involved in the second hassle map. For our practice, the goal was to recognize areas for improvement that would simplify processes and recognize friction areas that could be improved.

There’s a lot yet to be learned in healthcare in the way of meeting patients’ experience expectation. Consumeristic principles are increasingly important for the health of a business as patients have started exercising their purchasing power by selecting providers based on a variety of factors from cost to convenience to experience. That’s why it was imperative for us to begin to identify roadblocks for patients as they interact with our practice and the providers caring for them.

Plotting our map and getting directions
If there’s anything to take away before you begin your own hassle map, it’s this: Buy-in is crucial from those stakeholders who will be affected by the resulting changes. It makes the transition easier as well as strengthening relationships and instilling trust when the staff feel their voices were taken into consideration.

When beginning the hassle map process, it’s important for everyone to be honest with themselves and each other to identify pain points. Without that, you’re setting the project up for failure by not accurately identifying what needs to be solved.

Therefore, it was important to us that we create a safe place for people to discuss the department issues without fear of being reprimanded. We also asked providers for their feedback to show that we valued their opinions as we restructured our workflow.

Radiology leaders worked for two months to collect feedback. Through this process, 12 unique hassles were identified. Hassles ranged from challenges associated with parking, to difficulty obtaining lab results, to insufficient patient education prior to examination. The hassles were then bucketed into three groups (patients, physicians and staff) and short- and long-term solutions were identified.

Once finalized, the map was shared with everyone so the whole practice understood their feedback was heard and was being addressed.

Mapping out change and why every practice should create hassle maps
Once we identified what was to be done, we got to work. We found an immediate win within our walls. We had identified that navigation for patients to and through the department wasn’t ideal. To help patients find their way to the rooms and places they needed to go to, we color-coded the corridors and installed more directional signs.

Another opportunity arose in how quickly patients got their results. Some referring physicians wanted radiologists to wait one month before posting imaging results on the hospital’s patient portal. However, the radiologists wanted to post the results almost immediately. We came to a compromise, and now we’re posting the results around the 10-day mark.

Change and innovation are continuous
This “Hassle Map” process has made the whole organization more comfortable with, and more open to, honest evaluation in the name of improvement. In fact, it’s the new standard. Across the organization we are committed to working on improving operations for the good of our patients and staff. As pain points come off the work list, hopefully, fewer will appear. But we know we will never be done. Our pursuit of excellence is constant.

The hassle map process is industry agnostic. Your organization isn’t perfect – just as ours isn’t – but with trust and buy-in, you can build out your own hassle map to build a pathway to improvement.

About the author: Dr. Syed F. Zaidi is vice president of clinical operations and growth of Radiology Partners, the largest physician-owned and physician-led radiology practice in the U.S. Prior to joining Radiology Partners, he served as president of Radiology Associates of Canton in Northeast Ohio. Dr Zaidi is heavily involved in leadership roles with the American College of Radiology, including being chair of the Population Health Management Committee of the Patient and Family-Centered Care Commission.