Improved Quality of Care as the Major Goal for the Merger of Pathology and Radiology

I recently returned to the topic of merging pathology and radiology after a thirteen year hiatus (see: Increasing Interest in Merging the Specialties of Pathology and Radiology). This caused me to reflect on the question of why this idea has remained dormant despite the fact that (I believe) it's worthy of serious consideration. This question, in turn, caused me to think about the factors that serve as incentives for major changes in hospitals and healthcare. I came up with the following four drivers for change emanating from either the C-suite or hospital physician leadership. These factors may operate singly or in combination with each other.

1. Anticipated high profit margins for some new line of business such as cancer immunotherapy.
2. Political and financial events such as hospital mergers and acquisitions.
3. Changes in the regulatory landscape mostly at the federal level such as the mandate to deploy EHRs linked with federal subsidies.
4. New science, technology, and innovation leading to new programs. Knee and hip replacement come quickly to mind in this category.

Note that I have omitted from this list the pursuit of quality in healthcare. When creating the list, I was reminded of discussions I have had over the years with various hospital executives. All told me that they would support new quality initiatives as long as there was minimal budget implications. The drift of their arguments was that it's the physicians and nurses who drive quality through their daily decisions and service to patients. With regard to the current discussion, I thus believe that the major driver for merging the specialties of pathology and radiology will be to improve the quality of diagnostic reporting from both departments. Absent a groundswell of support for this change from pathologists and radiologists, there will be no such change.

This discussion, in turn, causes consideration of this key question. How do quality initiatives such as the pathology/radiology merger get launched and gain supporters? Physicians and nurses themselves care deeply about quality issues but will pick and choose their battles based on personal goals. More interest in this merger idea requires a group of older, established pathologists and radiologists in academic environments (probably not chairpersons) who would lobby for it on the basis of its potential to improve reporting and house officer training. They would need to pursue this goal both within their own health system and through their professional societies. This would be mainly an organizational change rather than one based on new science and technology so the gains would be theoretical until someone seriously runs the "experiment."

Comments

[Michael Blechner, MD]

Bruce,

My limited experience with executives has been the same and I have experienced the jist of your statement "The drift of their arguments was that it's the physicians and nurses who drive quality through their daily decisions and service to patients." One major problem with this attitude is that these physicians and nurses are overwhelmed and do not have the time to focus on driving improved quality and equally as important, they do not have access to data (relatively simple descriptive analytics) to help them target their efforts. Unfortunately, creating a functional analytics team is not always seen as necessary.