How do you measure caring in radiology?

My nephew recently offered to install an app on my smartphone that can count the number of steps I walk each day. Not quite knowing what I was getting into, I agreed. You see, when it comes to exercise, you could call me lazy. However, shortly after beginning to use this new app, I suddenly became conscious of every step I took—or didn’t take. I even felt a degree of anxiety and guilt on those occasions when I didn’t have my phone with me and my steps were not being properly recorded. Tallying those precious steps gradually became an obsession mixed with anxiety and more than a few grains of guilt.

In a world where not just our footsteps, but virtually every other parameter of life—the elements of our blood, the firmness of our mattresses, our work performance, our economy, our individual IQ, even our level of physical pain—can be quantitated on a numbered scale, how do we measure something like “caring” in the workplace?

The reason I raise this question is that, as the chief of radiology service at a VA facility, I have to choose a few criteria every year to evaluate my staff radiologists for their performance pay. Traditionally, we rate our staff radiologists on their RVUs (Relative Value Units), timeliness and accuracy of critical values reporting, accepting administrative assignments and their level of academic activities (publication, grants and teaching) etc. The American College of Radiology (ACR)¹ advocates quality standards based on efficiency, involvement in information technology (IT) and documented high patient satisfaction for radiologist’s performance pay.

The overarching values at my VA medical center are represented by the acronym “I CARE,” which stands for Integrity, Commitment, Advocacy, Respect and Excellence. Caring is generally defined as displaying kindness and concern for others. Caring is an integral part of quality in the workplace. Paul Spiegelman,² the Chief Culture Officer at Stericycle, believes, “A caring workplace matters as much as your annual budget.” Spiegelman promotes a caring culture in his company by creating a process to know what is going on with his staff, by acknowledging his people offline, by being sensitive to his staff’s needs, and by addressing those needs behind the scenes. As human beings, we are social individuals and human connection is one of our basic needs, Sheila Margolis writes on her blog.³ Margolis reminds us that typically we spend too much time at work. A caring workplace, an understanding environment, and healthy community interactions at the workplace support and nurture positive relationships. Senior leaders set the tone for “caring values” by showing genuine kindness and compassion toward their employees.³ The key to caring is forgiveness and avoiding bullying and retaliation. Caring does not necessarily require heroic measures. A simple smile or a cheerful greeting can make an employee or colleague’s day. Leaders have the power to initiate a caring culture that can trickle down through the ranks.

Conversely, leaders also have the power to trigger an atmosphere of fear and uncertainty in the workplace by bullying and creating unnecessary stress. Stressed-out employees lose the ability to display kindness and become incapable of caring for others.⁴ The stress reflects on their behavior in dealing with patients and coworkers. It should come as no surprise to learn that stressed out employees may even fail to be concerned with their own health issues and may stop exercising, leading to obesity, smoking, drinking, depression or worse.

How to show you care

Showing you care in radiology isn’t difficult most of the time. Often it’s just a matter of the basics: minimizing the radiation dose to patients by properly shielding their gonads and breasts during exams, or avoiding unnecessary exposure during fluoroscopy by using radiation safety measures. Raising the bar a notch, you can show you care by spending a few minutes on the phone educating the referring provider when canceling an inappropriate study and explaining why an alternative exam may be more beneficial.

Raising the bar even higher, showing you care in radiology at times may mean accommodating that desperate patient who is extremely late for her appointment. It may mean comforting a patient as you are about to relate unpleasant news. Caring may be displayed by educating patients to empower them to fight their illness and to employ preventive health measures. It may even mean spending hours on the phone with an insurance company that’s just denied your patient authorization for a lifesaving procedure or study you know they need.

After eight years at this job, I know who cares more or less on our service; however, the VA is principally data driven and wants to assess performance numerically. I honestly do not know of any metric by which to measure the wonderful quality of “caring” in radiology. I don’t think customer satisfaction surveys alone can meaningfully calculate this most valuable performance parameter. But as my smartphone steadily and faithfully counts my lazy steps, I can’t help but wonder if there’s an app for that.

Perhaps that’s something I could get my nephew to work on.

References

1. Moser JW, Wilcox PA, Bjork SS, et al. Pay for performance in radiology: ACR white paper. J. Am. Coll.Radiol.2006:3:650-664.
2. Spiegelman P. Why a caring workplace matters as much as your annual budget. http://www.inc.com/paul-spiegelman/why-a-caring-workplace-matters-as-much-as-your-annual-budget.html Dec. 21, 2011. Accessed August 5, 2016.
3. Margolis Sh. A caring workplace. http://sheilamargolis.com/core-culture-and-five-ps/the-five-ps-and-organizational-alignment/priorities/universal-priorities/caring/. Accessed August 5, 2016.
4. Smith MM. The art of cultivating a caring and compassionate workplace culture.http://www.eremedia.com/tlnt/mastering-the-art-of-cultivating-a-caring-compassionate-workplace-culture/ Dec 20, 2013. Accessed August 5, 2016.