COVID-19: 3 KEY CHALLENGES IN RADIOLOGY ADMINISTRATION

The COVID-19 pandemic has created multiple challenges for medical imaging: the primary ones being diagnosing and monitoring the disease, and infection control. Additionally, the tenacious virus has a significant impact on administration of the radiology department. Everything Rad interviewed several radiologists and radiology administrators for their insights. Read on to learn how they addressed three key challenges in radiology administration related to COVID-19:

• Decreased demand for diagnostic imaging and its impact on radiology staff
• Staff uncertainty and morale
• Planning for the unknown

Decline in imaging services impacts staffing levels and salaries

Many imaging services experienced a massive decline in exams when COVID infections peaked in their communities. The decline in revenue affected staff as well as the bottom line of the radiology department.

During the first wave of COVID, radiology staff at Witham Health Services had to be flexible if they wanted to maintain their hours and pay, explained Jason Scott, MBA CRA FAHRA CPXP RT(R) (MR), Chief Patient Experience Officer, and Director, Imaging/Respiratory/Neurodiagnostics/Wound Care. “If volumes were down in X-ray, we moved people somewhere else. Technologists needed to be willing to cross train. Also, we had to shuffle people around fairly often. We had rad techs and mammo techs taking patients’ temperatures and asking questions at the door. All this helped us see who the team players are. We saw those who stepped up and did things they weren’t 100 percent comfortable with to keep their hours.” 

Columbus Regional Health kept all its staff working but it took some creative approaches, said Bill Algee, Director of Imaging Services. “We shifted some radiology staff to other work, like cleaning. And we required everyone to take PTO (paid time off), myself included.”

At Cedars-Sinai in Southern California, the reduction in imaging was severe: down 75% at the worst, said Barry D. Pressman, M.D., FACR; and Chair of Academic Imaging. “Our imaging department took a tremendous financial hit. Fortunately, the hospital guaranteed salaries to all non-physician employees through the worst of it and did not do layoffs.”

In anticipation of a possible second wave of COVID-19, Witham Health Service has a hiring freeze and has yet to fill two openings for radiologic technologists, said Mr. Scott. “We don’t want to be in a position where we have to lay off people if we get another wave of COVID patients, so we are being very careful about staffing. But it makes it harder on our technologists who are here now to keep up with the workload.”

Managing staff trust and morale in the radiology department

Concerns about safety weighed even heavier on radiology staff than concerns about job security.

“The hardest part of all this for me has been trying to maintain a level of trust between staff, leadership, and the CDC – and to keep us all going in the same direction, especially at first when everything was changing so rapidly,” emphasized Mr. Algee. “In the beginning, it was all about ‘what kind of mask,’ ‘can you reuse masks,’ ‘what kind of PPE’– and the answers would change two times a day. It’s hard for staff to trust you when the answers are always changing. I just told them upfront, ‘this is what we know today and it might change’.”

Some of the uncertainty persists today, and so does the need for radiology administrators to continue to communicate and reassure staff in the radiology department as COVID-19 persists.

“As an imaging leader, you can only control what happens on your floor,” explained Mr. Algee. “But we have 1,800 people working here at the hospital. One of our techs went to a floor and saw someone doing something different with PPE. I raised the question during one of our ongoing command calls. Then I went back to my staff to reassure them that the person they saw was acting appropriately and why.”

Witham Health was fortunate to have enough PPE after placing a high order in anticipation of flu season, said Mr. Scott. “But still, the most important lessons we learned is you have to have an adequate amount of PPE – and you need to over order. Prices have gone up tenfold on PPE and it’s still difficult to find. I’ve been in healthcare since 1993 and I’ve never saw anything like this outbreak.”

Radiology administrators also need to advocate for their staff more than ever. “There was an assumption in the hospital that ‘front line workers’ meant doctors and nurses,” recalled Mr. Algee. “But every one of my technologists X-rayed COVID patients. At times they felt disrespected and not appreciated. I had to remind command sometimes that there is a bigger group working on the front lines. Rad techs needed to feel the love, too, and they should feel it.”

Planning for the unknown in radiology during COVID-19

A third challenge from COVID-19 for radiology administration is the need for intensive planning – for the unknown.

“I remember being on a call in the morning and talking about shifting our staffing matrix if exam volumes drop. Then at noon I was on a call where we talked about furloughing people, and at 3 p.m. we had a call about reopening. In one day, I had three calls about three different staffing scenarios,” recalled Mr. Algee.

“Later I had to find out about air exchanges so we could factor that in to how often we could turn over an imaging room,” he added. “I hadn’t thought about air exchanges before, but now I know about them. As leaders, we really have to think outside the normal space in times like this.”

“Planning and implementation of all plans must be meticulous,” added Dr. Pressman. “As soon as COVID started, my administrative director brought a big team of our people together to plan and put it all in writing. We put together implementation teams and training teams – not just for the imaging department but for every area in the hospital. We probably had hundreds of people- hours of meetings a day to get through all this.”

Roger S. Eng, MD, MPH, FACR, at Golden Gate Radiology in California, said “training, training and more training” was the priority. “Staying safe in an infectious disease environment was new to us. Putting on PPE properly was a new skill we had to learn. We had to learn how to keep a safe barrier between us and patients, and between staff members while still providing care. We had to learn how to keep imaging equipment and the department safe and sanitized.”

To help manage these challenges, administrators at Golden Gate and its affiliate, Chinese Hospital, worked closely with healthcare organizations and associations to understand emerging guidelines. Then different groups within the hospital took on the tasks of refining the guidelines and determining how to apply them in their respective hospital and imaging settings.

Having experienced the first wave of COVID-19 and adjusted – and readjusted – many healthcare providers feel better prepared for a second wave. Most feel satisfied that they did everything humanly possible the first time around. After all, how do you prepare for the unexpected?

“As a hospital, we are prepared for unexpected scenarios. But no one was prepared for ‘the world is shutting down and we need to X-ray everyone,’” summarized Mr. Algee.