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PAUL NAGY, PhDQUALITY MATTERS

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uilding a Community of Practice for Quality

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regularly scheduled meeting oronference is a straightforward andffective activity to help build a cul-ure of quality in your department.his gathering should bring to-ether interested parties across thepectrum of radiology care deliverynd include radiologists, technolo-ists, nurses, clerical staff members,nd administration. The diverseature of the group will provide aolistic perspective to understand-

ng system processes that invariablyross boundaries of responsibility.his forum can help fulfill radiolo-ists’ ABR Practice Quality Improve-ent Maintenance of Certification re-

uirements [1]andresidents’ACGMEV systems-based practice require-ents [2] and can assist in departmen-

al preparations for a Joint Commis-ion visit [3]. More important, auccessful meeting can provide a valu-ble open channel of communicationithin a department and act as both an

arly warning system concerning sys-emic failures and an important bridgeo maintaining healthy relations be-ween the hospital staff and the physi-ian practice. Another important pur-ose is to narrow the authority poweristance and acknowledge the equaloles of the all department members inatient safety.

In July 2005, a quality and patientafety meeting was initiated in theepartment of Radiology at thehildren’s Hospital of Philadelphia.he primary goal of this 1-houronthly multidisciplinary confer-

nce was to promote an open andonpunitive departmental culture ofuality improvement (QI). Continu-ng medical education credit for phy-icians attending the conference wasrranged to enhance attendance and

oard of Medicine’s biennial require-ent for physicians for 12 hours of

ontinuing medical education in pa-ient safety or risk managementhttp://www.dos.state.pa.us/med). Aight breakfast was provided. Eachonference began with a “patientafety moment,” in which a patientafety activity was discussed and con-luded with the review of an anony-ous “missed” case. Other agenda

tems included an educational com-onent as well as QI and quality as-urance (QA) departmental initiativepdates.

Early on, the educational com-onent constituted a significantortion of the conference, focusingn definitions and methods specifico the area of QI, Joint Commis-ion regulations and activities (eg,ational Patient Safety Goals), and

epartmental and hospital policiesnd initiatives. The number andypes of departmental QI and QAnitiatives grew, often as the resultf discussions that had occurred athe conference. As the number ofI and QA initiatives grew, so did

he number of radiology staff mem-ers presenting at the conference.oday the monthly agenda in-

ludes updates by general radiol-gy, interventional, and MR tech-ologists, a radiology nurse, and aadiologist, as well as presentationsy guest speakers including the ra-iology liaison from the Children’sospital of Philadelphia Depart-ent of Quality and Patient Safety.The conference has served as a

orum on hospital quality and pa-ient safety activities, and when theospital announces new initiatives

n these areas, radiology has a readyechanism to discuss and dissemi-

ate this information. The confer- p

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nce also has a favorable impact onepartment morale by flatteninghe hierarchy and providing aenue for all department memberso raise quality and patient safetyssues on equal terms in an opennvironment, often with lively andnimated discussions. (Perhaps theest evidence of the conference’success is the fact that it continueso be well attended despite the dis-ontinuation of breakfast!) Fur-hermore, it has stimulated depart-ent-wide QI and QA activities,ith staff members now requesting

he opportunity to present at theonference so they can informther department members of theirarticular quality and patient safetyctivities.

Although the conference was in-tituted at an academic hospital,his approach would be equally ef-ective in a hospital-oriented pri-ate-practice setting. It simply re-uires one or two departmentaleaders who are interested in pro-

oting quality and patient safety4]. Having a multidisciplinary ap-roach not only improves confer-nce dynamics but also allows theonference responsibilities to behared. To begin such a conferencen your department, start with a ba-ic agenda that includes a short ed-cational component, a review ofxisting or any particularly trouble-ome departmental or hospital pol-cies and procedures, and updatesn turnaround times and otherimilar data that are available fromhe radiology information system,nd end with an anonymousmissed” case. There are growingnline resources and literature onuality in radiology to help you

© 2010 American College of Radiology-2182/10/$36.00 ● DOI 10.1016/j.jacr.2010.06.012

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Quality Matters 809

ents, and you will even learn onhe fly [5]. Be sure to keep the at-osphere open and nonpunitive,

nd over time you will find that theeeting will take a course of its own

s people become more fully en-aged and want to participate inuality and patient safety activities.

Building a “community of prac-ice” around quality and a qualityonference can have a profoundmpact on the working culture of aepartment. A community of prac-ice can help its members share best

ng proficiency in QI and practiceanagement takes just that: prac-

ice. Sharing experiences and cele-rating successes with a group of

ike-minded individuals provides aatalyst to attack and react to a po-entially error-permissive environ-ent and move toward a proactive

nd forward-looking culture.

EFERENCES

. Strife J, Kun LE, Becker GJ, Dunnick NR,Bosma J, Hattery RR. The American Boardof Radiology perspective on maintenance of

provement in diagnostic radiology. J Am CollRadiol 2007;4:300-4.

. Mainiero MB. Incorporating ACR PracticeGuidelines, Technical Standards, and Appro-priateness Criteria into resident education.J Am Coll Radiol 2004;1:277-9.

. Donnelly L. Performance-based assessmentof radiology practitioners: promoting im-provement in accordance with the 2007 JointCommission standards. J Am Coll Radiol2007;5:699-703.

. Campbell D, Thompson M. Patient safetyrounds: description of an inexpensive but im-portant strategy to improve the safety culture.Am J Med Qual 2007;22:26-33.

. Nagy P. Online radiology quality resources.

ames S. Meyer, MD, is from the Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, and the University ofennsylvania School of Medicine, Philadelphia, Pennsylvania. Paul Nagy, PhD, is from the University of Maryland, Baltimore,aryland.aul Nagy, PhD, University of Maryland School of Medicine, Department of Diagnostic Imaging and Nuclear Medicine, 22outh Greene Street, Baltimore, MD 21201; e-mail: pnagy@umm.edu.