Investments in healthcare: a quest for seeking improvements

Dr. Gianfranco Scaperrotta, the head of SS Senology Radiology at Fondazione IRCCS Istituto Nazionale dei Tumori (INT) in Milan, offers his perspective on what advisable investments healthcare executives should consider, pointing to inefficiencies in workflow and patient satisfaction in the stereotactic breast biopsy procedure to help illustrate his position.

by Dr. Gianfranco Scaperrotta

Healthcare executives – who are responsible for investment decisions – are constantly working to justify how a particular asset or purchase is beneficial to their facility. With multiple priorities to consider, from doctors’ and patients’ needs, to a facility’s financial goals and beyond – combined with budget limitations – the need to find and rationalize the right investment options can be particularly complex. This is largely caused by the demands being placed on facilities and doctors to work more quickly and efficiently. In an era marked by the concept of constantly doing more, faster and better, the search for the right investment essentially comes back to the same basic, and yet truly powerful idea: in the healthcare field, we are always on a quest for improvement.
One of the best ways to warrant an investment is to become immersed in the field’s overall functionality from a clinical, financial and patient perspective to unearth any weaknesses. There are certainly processes and procedures in each part of the healthcare industry that can and should be improved, and that, if effectively handled, could have a positive, widespread ripple effect across facilities. 
Breast biopsy procedure
The radiology sector, for example, is one of many in healthcare that has room for improvement. As the head of SS Senology Radiology at Fondazione IRCCS Istituto Nazionale dei Tumori (INT) in Milan, I feel this is particularly apparent when it comes to the current state of the stereotactic breast biopsy procedure. Throughout my 25-year career, I have performed many breast biopsy procedures, and although none of my experiences are exactly the same as one another, there are a few consistent aspects that are worth noting that help showcase a need for change. This is made evident when considering the overall procedural experience, from start to finish. 
More often than not, when patients come in for a breast biopsy, they’re already feeling anxious and uncertain about the procedure before they even enter the room. In addition to fearing a needle in the breast, they are likely contemplating the unsettling idea that they may be diagnosed with breast cancer. Their level of discomfort may grow while waiting for the clinicians to enter the room and begin to prepare for the procedure. To begin, the technologist will help the patient get into the appropriate position to ensure the biopsy needle is targeting the proper area of the breast, where the suspicious tissue was noted on the mammography exam. Depending on where the calcification is in the breast, in some cases, the patient must be placed in a particularly awkward position in order for the needle to reach the correct target area, and she must hold her body in that same position until the procedure is complete.  
At this point, the radiologist collects the tissue samples, which then require verification. This process varies depending on the facility. Whereas I have the resources to verify my patients’ samples in the same room where the biopsy is taking place, there are many cases in which the clinician must prepare the samples for transport, and then leave the procedure room to image and verify the samples on another piece of imaging equipment, which may already be in use for another patient and therefore cause scheduling delays. During this time the patient must remain in compression, which may increase her anxiety. In some cases, the clinician will determine the need to take more samples from the patient, making the procedure time lengthier than anticipated. After the tissues are verified, the breast biopsy procedure can conclude, yet the patient must first await her results, which will come later, after the samples have been sent to and evaluated by pathology. 
This one scenario in the radiology field demonstrates a few issues that must be tackled. First and foremost, patients are extremely anxious, and radiologists need to help ease their concerns. Perhaps they could be helped by enhancing the ambiance of the procedure room with more calming visuals or music to reduce tension. Additionally, positioning patients when their calcifications are in unusual areas can add to their discomfort. Similarly, lengthier procedure times  only add to patient apprehension, while also slowing radiologists down, which can affect their subsequent appointments. Lastly, patients must still wait for the samples to go through the pathology process before receiving a diagnosis.  

Patients satisfaction
It’s clear that today’s stereotactic breast biopsy could benefit from better workflow efficiency, yet this deep dive into the procedure also reveals a need for improved patient comfort. Together, time-savings and comfort contribute to overall patient satisfaction, and the fact that the stereotactic breast biopsy falls short in this area presents an opportunity for improvements to be made. For any doctor and facility, providing a positive patient experience and increasing satisfaction is crucial for success. Not only is it important to deliver high quality, swift care for patients for their health and happiness, but it’s also worth recognizing the business logistics associated with patient satisfaction – positive experiences can result in future referrals. Additionally, fast and efficient procedures mean that radiologists can get more work done in a day, furthering the overall productivity and financial success of a facility. 
In my opinion, when healthcare executives are thinking about their next investments, they should not only remember to consider a sector’s inefficiencies, but they should also take special note of those shortcomings that have the widest impact across the facility, like workflow and patient experience. Even beyond investments, it is human nature to constantly seek improvements. For example, I envision one day that radiologists will take an entirely new approach to the biopsy procedure, perhaps removing calcifications as a whole at once to start potential cancer treatment early, instead of taking smaller samples to first test the tissue. I encourage clinicians to similarly identify inefficiencies in their respective industries and search their minds for new, better ways. Let us challenge what we know and never tire from our quest to keep improving.