Category Archives: Radiology Innovation and Quality

Disruptive innovation! Six-sigma! DMAIC! Sustainable growth rate!  These are words people throw around, but it’s the idea that counts, not just the acronyms.

The Meaning of Version 2.0


Version 2.0 is a good thing. Except when it’s not.

Being 2.0 means embracing something brand new, something different, revolutionary, totally revamped from the old 1.0 that’s just not as good. It’s simple math, really. 2.0 is twice of 1.0.

The terminology we use for what software developers call a “major version release” is a popular way to address all things new and cool. For instance, in 2010, Justin Bieber released his My World 2.0 album, charming fans world-wide with the #1 hit Baby.

In health care, we also like new versions. Typically used to describe a move towards all-digital access, a post on The Health Care Blog describes the evolving wave of patient self-scheduling methods as “2.0.” An Academic Radiology paper describes radiology education using computing devices over paper as “Radiology Education 2.0.” Even an iTunes app providing a set of emergency radiology teaching cases calls itself Radiology 2.0 (incidentally, because the software is in its first release, the app is actually “Radiology 2.0 v1.0”).

In fact, versioning in health care is so popular that when The American College of Radiology decided to push a new approach to imaging, it decided to skip 2.0 and start with Imaging 3.0.

Continue reading

Dan Ariely on Conflicts of Interest

On a previously post I became interested in financial conflicts of interest (COI) and disclosure.

COI is not restricted to financial incentives. It also doesn’t have to be a boring topic. Dan Ariely in a TedTalk below discussed perils of COI in academia with compelling anecdotes.

On The NRMP Residency Match, And What People Meant by “It’ll All Work Out”

The optimal solution of the NRMP match algorithm is deceptively simple, but its implication for the lives of applicants is anything but simple.

Three years ago, my then-girlfriend and I sat down and parsed through what would become the most important determinant of our lives moving forward.

Because we attended different medical schools, we carried on a long distance relationship for five years. The NRMP match was more than just a residency choice. It was also a solution that could finally close our distance and take the relationship forward again.

The ranked list seemed like the most difficult decision we had to make. There were so many variables, each with differing levels of importance.


Icons made by Freepik from is licensed under CC BY 3.0

Continue reading

Disclosures – on Financial Conflicts of Interest

Conflicts of interest in medicine…

  1. Sometime leads to academic dishonesty
  2. Is pervasive
  3. Is probably unavoidable in the absence of infinite non-profit grants
  4. All of the above

Continue reading

Measure Differently to Think Differently

Credit: Innovation by Boegh, licensed by Creative Commons

There are many forms of innovations.  Sometimes medical innovation is nanotechnology, molecular imaging, high-precision targeted therapy, or 3D-printed prosthetic, which are advancements whose adaptation rate are limited by the rate of research.  This is a good thing.

And then, there exists technology that has become commonplace in every other industry but is still considered “innovation” in medicine due to their glacial adaptation rates in hospitals and clinics.  Case in point: When was the last time you saw a pager that doesn’t belong to a healthcare provider?

Continue reading

Do More or Better – But Usually Can’t Do Both

Today’s world provides us with tools that make humans more capable than ever. Writers who used to make elaborate trips to exotic locations to gleam material for the next espionage thriller while talking to their book agent on the landline with expensive long distance fees can now do the research at their computers while setting up an Amazon self-publishing account.  Radiologists who used to be at the mercy of transcriptionists to translate their verbal stutters into fluent medical poetry days later now generate reports within minutes using voice recognition technology.

These are empowering tools, putting the ability to affect outcome directly in the hand of those holding the highest stakes.  In general terms, it makes sense that with advancements in technology, professionals can now (1) do the same amount of work with better quality, or (2) do more work at the same quality.

Unfortunately,  inadvertently what happens is we tend to be expected to accomplish more and do better (occasionally one also expects to feel less tired at the end of it!) Business school professors would teach that technology advances push the entire pareto-efficient frontier forward.  That is, assuming that you are already working at your absolutely most efficient way such that any improvement in speed will automatically have a quality tradeoff, then adapting a new technology may change the nature of the curve such that you can now move both “up” and “to the right.”  The truth is, I am so rarely pareto-efficient in the first place that if a new technology can somehow land me onto my existing frontier, it was well worth the cost.  And while technology like this, this, and this don’t literally breaking any frontiers, they do have the added benefit of putting productivity in my conscious thought and – at least temporarily – make me healthier and more productive.

The Irony of Complexity

Anyone who has worked on a complex problem knows that simplicity is the result of many, many hours of hard work. 

  • Colin Dunno, Designer at Dropbox, in response to the question, “What is the need for all the world class designers at Dropbox, for a product that seemingly has zero complexity?”

Like a figure skater on ice, to score you have to do hard moves but make it look easy.  If the product of your complex work looks complex, then there’s room for improvement.

Healthcare has plenty of room to improve.

“Doing QI” is Not The Same as Improving Quality (2/2)

There is a fine line between “quality improvement” and innovation. Some may argue that quality improvement is a fix – making something better, more successful, or less error-prone.  Innovation, they might, involves creating something truly new, something that had never existed.

But if one insists on that definition, then some of the world’s most respected “innovators” were not innovators at all.  Steve Jobs did not create the first portable MP3 music player, only the arguably best.  Alexander Fleming did not invent the first antibiotic, only the most effective and famous.  Issac Newton was not the first to describe gravity, only its most mathematically characterized incarnation.

Innovators is a misnomer, coming from the Latin word novus (i.e. new), convincing us that one must strive to create something novel (i.e. novus) to innovate.  Innovators do not create something new; they are fixers of broken systems.  They are masters in the their traditional crafts who felt unsatisfied with the status quo’s offering, be it in technology, medicine, or physics.  They are quality improvement experts.  They did not need Level-5, 5S’s, 5Y’s, 6-Sigma, 12-Step QAPI, DMAIC, FADE, DOWNTIME, Kaizen, balanced scorecard, Deming cycle, ad infinitum.

“Doing QI” Is Not the Same as Improving Quality (1/2)

I was once told that when someone boasts to love James Joyce’s Ulysses, to ask that person how the book ends.

Like to the lover of Ulysses, the next time you hear someone in love with “Toyota” please ask him/her to describe the Toyota Production System. The short version would do.

When we see others succeed, we ask, “How do you do it?”  They may reply, “Here’s how,” followed by a set of well-intended advice in shortcuts and tips.  We then create a spiffy mnemonic and hold it as the bible for replicating the others’ success.

When quality improvement becomes an increasingly rigid set of criteria, alphabet bundle, and kanzi, it becomes easier to think of it as an end in itself.  Let us “do quality improvement.”  Let us find a project to applying these incredible principles (and they are incredible, but they are not hammers).  Let us refer to it as “QI” because that’s a thing now.

But sometimes quality is just about mending the gap when you see one.  Sometimes being methodical helps, but being passionate – not just mending a gap, but your gap – is probably all the requisite there is.  “Doing the QI,” then, may sometimes become an unintended obstacle.

The Irony of Consolidating Innovation

Innovation competition is a common mechanism for developing novel products or or otherwise encouraging creative people to do what they do best – create.  Entire organizations are formed around innovation (IDEO being a high-profile example).

The logic that high rewards attract high performers is reasonable.  And consolidating resources to fund two critically acclaimed novel inventions arguably makes more sense than dividing up the limited funds among 20+ ideas with variable viability.

But these assumptions only work if one makes the assumption that the inception of an idea is a planned process with an “innovative index” directly proportional to effort.  Only then can one make the conclusion that bigger rewards draws better ideas – it does so because people try harder.

But what if creativity is not an effort-dependent activity?  What if innovation, like chemical reactions in equilibrium, only appears predictable on the macroscopic level but is in fact sporadic and dependent on some lucky combination of kinetic creative energy colliding against one another?

It then comes as no surprise that many NIH-funded projects are sustaining innovations, those creating incremental improvements to existing technology.  2% improvement in blood pressure control.  Statistically significant but clinically undetectable improvements in cholesterol control.   Seven Tesla MRIs.  Sustaining innovations, by definition, build on a solid precedence and have higher probability of showing positive results, albeit by a smaller magnitudes.

Disruptive innovations are the smartphones, the PCR machine, the first AML chemotherapy.  They wield the ability to change entire industries; they are also rare.  They are one-in-a-million chemical reactions that require collision at a precise angle with the right kinetic energy.  One might even say that at the start, the inception of a disruptive innovations is sporadic, a lucky accident.

If earth-shaking novel ideas occur by chemical reaction, then it may be clear what we as a society must do to foster them.  The chemist does not give her molecules incentives and rewards for making a carbon-carbon bond.  Instead, the chemist selects the ideal solvent to make the reaction possible, offers a catalyst to lower the activation energy, and gently heats the primordial soup of innovation.

Then she waits, for above all, innovation takes time.  Innovation can’t be made to happen; it can only be allowed to happen.