Presentation
HE8 - Enhancing Workflow Through Human Factors Analysis in the Radiology Department at a Diagnostic Imaging Center in Ghana – Africa
SessionPoster Session 1
DescriptionBackground
Over the past few decades, advancements in diagnostic imaging technology have revolutionized healthcare, leading to improved patient care through more detailed views of organs and various body regions [1]. This technological growth has brought undeniable benefits, but it has also introduced certain risks. While radiation exposure has been extensively studied, other patient safety concerns in diagnostic imaging have not received as much attention [2], [3] Quality care in medical imaging requires timely, safe, and accurate services delivered through effective communication and sustainable practices by skilled professionals in patient-centered, efficient, and equitable facilities [4]
In Ghana, medical imaging systems have evolved from traditional film-screen radiography to computed radiography and, more recently, digital radiography, particularly in major cities. Today, Ghana is one of the few African countries equipped with advanced imaging modalities such as 1.5 T magnetic resonance imaging (MRI) machines, 640-slice computed tomography (CT) scanners, digital mammography systems, fluoroscopy, and sophisticated ultrasound machines. However, as these services have expanded, so have patient complaints regarding the quality of care [4].
The application of Human Factors Engineering (HFE) in healthcare to enhance patient safety and optimize workflow marks a significant step forward in improving the delivery of healthcare in Ghana. To increase awareness of HFE and support its integration into healthcare, the project was undertaken to engage healthcare workers in an HFE project to assess and enhance the current workflow within the radiology department. Therefore, the radiology department's efficiency and accuracy are crucial for effective patient treatment and care.
The project utilizes human factors analysis to assess and understand the current workflow within the radiology department. The project seeks to identify obstacles, inefficiencies, and areas for improvement. The goal is to enhance workflow, reduce turnaround times, improve satisfaction for both patients and staff and uphold high standards of diagnostic accuracy.
Methods
The radiology department at the study site is equipped with state-of-the-art imaging technologies, including digital X-ray, Magnetic Resonance Imaging (MRI), Computed Tomography Scan, Orthopantomogram (OPG) dental X-RAY, Electromyography (EMG) for Nerve and Muscle Study, Ultrasound, and C-ARM Fluoroscopy for procedures.
From May to August 2024, the project team engaged in a multi-phase approach to collect and analyze data. The team included two biomedical engineering graduate students supervised by an HFE Researcher. A combination of semi-structured interviews, direct observations, and workflow analysis tools such as the spaghetti diagram and task analysis were employed for system analysis. The system was also analyzed under the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) framework [5]. This approach allowed for a comprehensive understanding of the radiology department’s workflow.
Data Collection
Interviews were conducted with patients, receptionists, nurses, and two radiographers at the department. During the interviews, key questions were aimed at uncovering insights into workflow and task completion processes. Patients were asked to share their experiences navigating the department and to provide feedback on the quality of care they received.
Age and gender segmentation and type of procedure data were also collected from the Electronic Health Record System. The patient sample included both walk-ins and in-house patients.
Observations focused on the reception area, where initial patient interactions with the receptionist took place. The team shadowed the radiographers during various procedures to gain insights into task completion times, work practices, and patient interactions. Time for each task was recorded throughout the project to quantify delays and assess the impact of identified issues on overall workflow efficiency.
The team also employed direct observation, drawing on methods from [6] which emphasizes training for direct observation in healthcare settings.
The data was collected using a combination of traditional methods (paper and pen) and digital tools (iPad) before being organized into spreadsheets for analysis.
Data Analysis
The data collected was analyzed using the People, Environment, Task, and Tools (PETT) scan [7], which focuses on identifying facilitators and barriers in healthcare workflows. This approach helped in systematically evaluating various elements of the workflow in the radiology department.
A process map was used to create a visual representation of tasks within the radiology department, detailing each step from patient registration to imaging procedures and post-imaging procedures such as image process and documentation. By mapping out the flow of tasks, this method provided an in-depth examination of each stage, allowing the identification of redundancies, delays, or inefficiencies that could be addressed through redesign.
Also, a spaghetti diagram was employed to track the physical movement of staff and patients within the department. This visual tool illustrated the paths taken during daily operations, focusing on how individuals moved between different stations, rooms, or areas. The spaghetti diagram was particularly useful for identifying excessive or inefficient movement, highlighting areas where layout adjustments could improve the flow of both people and tasks.
Results
From EHR, the patient data during the project period included both in-house patients (27) and walk-in patients (60). Out of 87 patients assessed, the most common age group were aged 35-50 (42%), with 55% being female and 45% male. The department handled 81 MRI procedures, 25 X-ray procedures, and 30 CT scans highlighting a significant patient load and the critical need for efficient workflow management, particularly for MRI Procedures.
Spaghetti Diagrams revealed that wayfinding challenges were found to contribute significantly to patient delays. On average, these delays added 5-10 minutes per patient, particularly for those unfamiliar with the hospital layout or lacking assistance. From the task analysis, another concern was the unclear design of the MRI checklist and informed consent forms. It was evident that patients and radiographers were often signing in incorrect areas of these documents, which raised concerns about the validity and clarity of consent. PETT findings identified communication issues between departments regarding the timing of contrast procedures that led to further delays. When nurses were not promptly alerted, a 15–20-minute delay in initiating contrast-based imaging procedures was recorded. This delay was compounded when software limitations prevented automated notifications, forcing staff to rely on the receptionist to inform the radiographer in person, further contributing to inefficiencies and prolonging patient wait times.
Task analysis revealed a high level of stress and excessive workload on radiographers, contributing to delays and decreased satisfaction.
Based on the findings, several workflow optimizations were proposed and implemented:
1. Revised protocol for contrast procedures: Nurses were alerted earlier to ensure that preparations for contrast imaging (e.g., MRI, CT) were completed promptly, reducing patient wait times.
2. Clearer labelling system for gowns: To avoid confusion between used and new gowns, a revised labelling system was introduced. This small but effective change reduced the risk of cross-contamination and improved workflow efficiency.
3. Revised consent forms and MRI checklists: These forms were updated to improve clarity and completeness, ensuring that patients were fully informed before procedures.
4. Feedback from staff: Continuous feedback loops were established with radiographers and other staff members to assess the effectiveness of the implemented changes and identify areas for further refinement.
Presentation Overview
The presentation will start with the project's background, followed by an outline of the project goals, methodology, and data collection techniques, which include interviews and observations. It will then present key findings, identifying inefficiencies, workflow improvements, and implementation outcomes, concluding with lessons learned and future recommendations
Over the past few decades, advancements in diagnostic imaging technology have revolutionized healthcare, leading to improved patient care through more detailed views of organs and various body regions [1]. This technological growth has brought undeniable benefits, but it has also introduced certain risks. While radiation exposure has been extensively studied, other patient safety concerns in diagnostic imaging have not received as much attention [2], [3] Quality care in medical imaging requires timely, safe, and accurate services delivered through effective communication and sustainable practices by skilled professionals in patient-centered, efficient, and equitable facilities [4]
In Ghana, medical imaging systems have evolved from traditional film-screen radiography to computed radiography and, more recently, digital radiography, particularly in major cities. Today, Ghana is one of the few African countries equipped with advanced imaging modalities such as 1.5 T magnetic resonance imaging (MRI) machines, 640-slice computed tomography (CT) scanners, digital mammography systems, fluoroscopy, and sophisticated ultrasound machines. However, as these services have expanded, so have patient complaints regarding the quality of care [4].
The application of Human Factors Engineering (HFE) in healthcare to enhance patient safety and optimize workflow marks a significant step forward in improving the delivery of healthcare in Ghana. To increase awareness of HFE and support its integration into healthcare, the project was undertaken to engage healthcare workers in an HFE project to assess and enhance the current workflow within the radiology department. Therefore, the radiology department's efficiency and accuracy are crucial for effective patient treatment and care.
The project utilizes human factors analysis to assess and understand the current workflow within the radiology department. The project seeks to identify obstacles, inefficiencies, and areas for improvement. The goal is to enhance workflow, reduce turnaround times, improve satisfaction for both patients and staff and uphold high standards of diagnostic accuracy.
Methods
The radiology department at the study site is equipped with state-of-the-art imaging technologies, including digital X-ray, Magnetic Resonance Imaging (MRI), Computed Tomography Scan, Orthopantomogram (OPG) dental X-RAY, Electromyography (EMG) for Nerve and Muscle Study, Ultrasound, and C-ARM Fluoroscopy for procedures.
From May to August 2024, the project team engaged in a multi-phase approach to collect and analyze data. The team included two biomedical engineering graduate students supervised by an HFE Researcher. A combination of semi-structured interviews, direct observations, and workflow analysis tools such as the spaghetti diagram and task analysis were employed for system analysis. The system was also analyzed under the Systems Engineering Initiative for Patient Safety (SEIPS 2.0) framework [5]. This approach allowed for a comprehensive understanding of the radiology department’s workflow.
Data Collection
Interviews were conducted with patients, receptionists, nurses, and two radiographers at the department. During the interviews, key questions were aimed at uncovering insights into workflow and task completion processes. Patients were asked to share their experiences navigating the department and to provide feedback on the quality of care they received.
Age and gender segmentation and type of procedure data were also collected from the Electronic Health Record System. The patient sample included both walk-ins and in-house patients.
Observations focused on the reception area, where initial patient interactions with the receptionist took place. The team shadowed the radiographers during various procedures to gain insights into task completion times, work practices, and patient interactions. Time for each task was recorded throughout the project to quantify delays and assess the impact of identified issues on overall workflow efficiency.
The team also employed direct observation, drawing on methods from [6] which emphasizes training for direct observation in healthcare settings.
The data was collected using a combination of traditional methods (paper and pen) and digital tools (iPad) before being organized into spreadsheets for analysis.
Data Analysis
The data collected was analyzed using the People, Environment, Task, and Tools (PETT) scan [7], which focuses on identifying facilitators and barriers in healthcare workflows. This approach helped in systematically evaluating various elements of the workflow in the radiology department.
A process map was used to create a visual representation of tasks within the radiology department, detailing each step from patient registration to imaging procedures and post-imaging procedures such as image process and documentation. By mapping out the flow of tasks, this method provided an in-depth examination of each stage, allowing the identification of redundancies, delays, or inefficiencies that could be addressed through redesign.
Also, a spaghetti diagram was employed to track the physical movement of staff and patients within the department. This visual tool illustrated the paths taken during daily operations, focusing on how individuals moved between different stations, rooms, or areas. The spaghetti diagram was particularly useful for identifying excessive or inefficient movement, highlighting areas where layout adjustments could improve the flow of both people and tasks.
Results
From EHR, the patient data during the project period included both in-house patients (27) and walk-in patients (60). Out of 87 patients assessed, the most common age group were aged 35-50 (42%), with 55% being female and 45% male. The department handled 81 MRI procedures, 25 X-ray procedures, and 30 CT scans highlighting a significant patient load and the critical need for efficient workflow management, particularly for MRI Procedures.
Spaghetti Diagrams revealed that wayfinding challenges were found to contribute significantly to patient delays. On average, these delays added 5-10 minutes per patient, particularly for those unfamiliar with the hospital layout or lacking assistance. From the task analysis, another concern was the unclear design of the MRI checklist and informed consent forms. It was evident that patients and radiographers were often signing in incorrect areas of these documents, which raised concerns about the validity and clarity of consent. PETT findings identified communication issues between departments regarding the timing of contrast procedures that led to further delays. When nurses were not promptly alerted, a 15–20-minute delay in initiating contrast-based imaging procedures was recorded. This delay was compounded when software limitations prevented automated notifications, forcing staff to rely on the receptionist to inform the radiographer in person, further contributing to inefficiencies and prolonging patient wait times.
Task analysis revealed a high level of stress and excessive workload on radiographers, contributing to delays and decreased satisfaction.
Based on the findings, several workflow optimizations were proposed and implemented:
1. Revised protocol for contrast procedures: Nurses were alerted earlier to ensure that preparations for contrast imaging (e.g., MRI, CT) were completed promptly, reducing patient wait times.
2. Clearer labelling system for gowns: To avoid confusion between used and new gowns, a revised labelling system was introduced. This small but effective change reduced the risk of cross-contamination and improved workflow efficiency.
3. Revised consent forms and MRI checklists: These forms were updated to improve clarity and completeness, ensuring that patients were fully informed before procedures.
4. Feedback from staff: Continuous feedback loops were established with radiographers and other staff members to assess the effectiveness of the implemented changes and identify areas for further refinement.
Presentation Overview
The presentation will start with the project's background, followed by an outline of the project goals, methodology, and data collection techniques, which include interviews and observations. It will then present key findings, identifying inefficiencies, workflow improvements, and implementation outcomes, concluding with lessons learned and future recommendations
Event Type
Poster Presentation
TimeMonday, March 314:45pm - 6:15pm EDT
LocationFrontenac Foyer
Digital Health (DH)
Simulation and Education (SE)
Hospital Environments (HE)
Medical and Drug Delivery Devices (MDD)
Patient Safety and Research Initiatives (PS)