SUCCES STORIES

Department of Radiology and
Imaging Sciences at Rigshospitalet

We are a large department with about 450 employees covering a wide range of professions, and our motto is that the system belongs to the employees. The most important thing is that it works well for them in their daily work routines, says Quality and Radiation Protection Coordinator Kenneth Thybo Reff.

”Better quality for the money”

“When it came time for two large and highly specialised hospital departments to merge, it was a perfect opportunity to digitise the existing paper-based systems. The digital quality management system has become a natural tool in the daily work of the employees at the Department of Radiology and Imaging Sciences at Rigshospitalet. The Quality and Radiation Coordinator, Kenneth Thybo Reff, discusses the system below; it streamlines their work, improves quality, and provides a better overview in a decentralised and complex organisation.”

Kenneth Thybo Reff's 3 tips for choosing a management system

1. Formulate a clear requirement specification describing what the system has to be able to do as a minimum

2. Invite several suppliers to present different systems

3. Ask a neutral party or someone who already has the system about their experience with it

Why do you have a digital quality management system?

Radiology is a highly regulated field with extensive legislation. We work with ionising radiation, which can harm patients and employees if it is used incorrectly. That is why we have to comply with the Danish Radiation Protection Act, which is overseen by the Danish Health Authority.

The department also works with diagnostic imaging using ultrasound and MRI scans, which don’t involve ionising radiation.

The legislation has to be implemented and quality assured right up to the individual X-ray machine, and this is where the quality management system comes into play. We need a system that ensures that all the processes in a course of treatment are described so that it complies with the applicable laws, rules, and guidelines in the field.

We use the system in many ways in our daily work. All of our protocols can be accessed here in the form of manuals describing, for example, how to perform a CT scan of the head. Or it could be in the form of bone manuals or manuals that explain our medical devices or how to make rounds.

It also has guidelines for everything you need to ask patients about and make sure of before starting treatment, and we also use it for training and communication.

Is the department certified?

There are no specific certifications in the field of radiology. The legislation is what sets the standards we have to comply with here.

For a number of years here in the Capital Region of Denmark, we followed the Joint Commission, which is an American organisation that sets standards for hospitals around the world.

Then came the Danish Quality Model, which was a national system for quality development across all sectors of the healthcare system. We followed these practices for a few years.

Now we are audited on the basis of the Radiation Protection Act and the two associated executive orders. The Danish Health Authority carries out inspections, some announced and some unannounced, and the points they inquire about include whether our documentation is in order and how our employees are instructed in using guidelines, etc. This is rather difficult to do without a digital system, and the management system provides a good way to meet the requirements of the authorities.

Department of Radiology and Imaging Sciences, Rigshospitalet

About 450 employees carry out diagnostics and treatment at a highly specialised level here. The department is a close partner with the clinical departments at Rigshospitalet and therefore plays a central role in providing standardised cancer treatment regimens.

Using ultrasound, X-rays, and MRI (magnetic resonance imaging), the Radiology and Imaging Sciences department carries out invasive and non-invasive radiological diagnostics and therapeutic interventions for patients in clinical departments and outpatient clinics at Rigshospitalet.

What were some important considerations when you chose the system?

The need for a digital system arose when Rigshospitalet and Glostrup Hospital were set to merge their operations. We were at a crossroads. The department in Glostrup already had a system they were happy with, while the department on Blegdamsvej was still using a paper-based system with folders. So we needed to get things systemised – also to support the merger with new functions and a joint system for controlling the merged department.

We had various suppliers come and present their systems. First and foremost was the importance of the system being easy and user-friendly, also for us as administrators. The ability to adapt the system and put our own unique mark on it was also important. We wanted an innovative system with room for further development. It was and is important that we shape and develop the system and not the other way around.

The possibility of getting support was also an important point, and this has turned out to be a great help.

In the end, we went with D4InfoNet and today the system runs across the departments in Glostrup and on Blegdamsvej. We have the same overall structure and access to shared materials, but there is room for customisation and adaptation. For example, the patient group in Glostrup has a different makeup than at Blegdamsvej, and this of course is reflected in the system. I definitely see that as a quality.

How do you make sure that the system meets your needs?

First of all when choosing a system, it is a matter of focusing on the flexibility of the system and the options for customisation. But we are innovative as well and we do a lot to make sure that it is well suited to our particular department’s needs and functions.

We work in three different shifts and we need to be able to pass on information from one shift to the next. In the past, we used a board in the hallway where we would write a note if a device was not working, for example. Now this is done electronically. The board has now been replaced by a screen, and when we report faulty equipment via the system, the next shift can see which device is affected and whether a technician has been ordered.

This reduces mistakes and misunderstandings and keeps us from duplicating our efforts with multiple people reporting the same issue. This saves a lot of time – for us and for the technicians.

We have also created checklists– just like the ones that pilots use before take-off – to make sure that our treatment rooms are in order. Is the vacuum working? Check. Are the needed hoses in place? Check. We have a different form for each room and employees carry out quality checks on a daily basis. If anything is missing, it will be reported and we can take corrective action.

Utilising the technology in this way provides a clear boost to quality. We have a lot of gears in motion at any given time and our tasks often involve several departments. That is one of the reasons it is important for us to have the tools we need for coordination and to provide a good overview.

Other than that, it is essentially a matter of keeping track of our documentation and keeping it updated at all times. It is much easier than using files and folders on a shared drive.

The Danish Radiation Protection Act

Quality management at the Department of Radiology and Imaging Sciences at Rigshospitalet is established on the basis of the Danish Radiation Protection Act. It consists of an act and two executive orders describing the use of radiation-generating devices.

The purpose of the legislation is to protect workers, patients, and the general public from injuries caused by ionising radiation.

The Act is administered by the Danish Health Authority, which is also the supervisory and advisory authority in connection with the use of X-rays.

- The Danish Ministry of Health’s Act no. 23 of 15 January 2018 on ionising radiation and radiation protection (the Danish Radiation Protection Act)
- The Danish Health Authority’s executive order no. 669 of 1 July 2019 on ionising radiation and radiation protection
- The Danish Health Authority’s executive order no. 671 of 1 July 2019 on the use of radiation-generating devices

What do employees say?

We involve our employees in the process so we can find out what they need in the system at the local level and especially to make sure they can find all the guidelines and manuals they need.

The system also links out to the rest of the world so employees can find the regional guidelines for a given area, for example. But the idea is to have a single overall system that communicates with other systems so we can guide employees in their work as efficiently as possible.

Our employees show a lot of support for the system, and I think this is largely due to the fact that so many of them are able to influence it.

How does communication and training work in your system?

People have different learning styles. Some people learn by reading while others are more visual. Using a digital platform makes it easy to distribute guidelines and training activities in different ways.

Among other things, we have training videos stored in the system. The videos cover issues like how to use an EpiPen if a patient is having an allergic reaction and needs an antihistamine. Or how to use mobile devices – such as mobile X-ray machines that can be moved into a hospital room or a treatment room if patients are too ill to be moved to an X-ray room.

We even have a training programme for radiography students who need IV contrast guidelines.

When people sign off on this, we know that they have read and understood the material and we have the documentation in place when the Danish Health Authority carries out its inspections or when we are audited.

Has the system created a greater focus on quality in the department?

Everyone is probably used to the system by now so they don’t think about it as a specific quality tool, even though that is exactly what it is. But it has become a natural part of our daily work routines and everyone is generally good at using it because it’s so efficient and easy to navigate. So I don’t know if it has increased people’s focus on quality as such, but we definitely get more quality for the money.

The fact that we have put our processes and guidelines into a system is reassuring to me. I feel really good about that. You know exactly where to find things, or you can easily search for them, and you get automatic emails when something needs to be updated. That’s pretty convincing.

What we put in the system and the way we use it makes our daily work routines easier and improves the quality of our work and this, in turn, means that the system also supports patient safety. It makes sense all the way around.

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