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Improving Wellness Through Reading Room Design and Flexible Scheduling Options
Abstract
Breast radiologists have high rates of burnout. Some contributing factors include the sedentary nature of the occupation, reading room design and isolation associated with higher volumes, and increased remote interpretation. Reading rooms can also be filled with numerous distractions and produce conditions that do not support optimal workflow. Identifying and addressing these issues may help prolong physician careers and increase overall productivity. This article presents approaches to improve wellness for breast imaging radiologists and reduce the overall rate of burnout.
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Quality of work life is understood to be directly linked to the level of satisfaction of an individual with the execution of his or her tasks. Workplace physical activity is an important activity that aims to relax the muscle groups most used in occupational tasks, to increase workers' enthusiasm, and to reduce sickness absenteeism, thus contributing to improvements in quality of life. This study aimed to analyze the effects of the implantation of workplace physical activity protocols at companies. We performed a literature review in the LILACS, SciELO, and Google Scholar databases using the following keywords: "quality of life," "exercise therapy," and "occupational health." With this search, we obtained 73 studies, of which 24 were selected afer reading the titles and abstracts. Afer full reading of the studies and applying eligibility criteria, 16 articles were excluded and the remaining eight were used in this review. By analyzing these eight studies, we were able to verify the benefits of workplace physical activity in improving quality of life, reducing pain intensity and frequency, and preventing occupational diseases. Workplace physical activity programs, when performed at least three times a week, provide various benefits to workers' health and wellbeing, especially in the reduction of aches and pains and musculoskeletal discomfort, which directly influences improvements in quality of life.
The impact of COVID-19 on the world of breast cancer care has been unprecedented, with worrisome short- and long-term consequences, and there remains a long road ahead to recover and unbury the breast imaging departments from their current backlog. Radiologists have to consider what the new normal will be going forward. At present time, because of widescale COVID-19 vaccination, benign vaccine-related reactive lymphadenopathy is likely to be encountered in oncologic patients and we need data-driven guidelines to manage unilateral lymphadenopathy and avoid unnecessary biopsies. In the next years, some procedures like wearing masks and maintaining social distancing will probably remain in use, as radiologists show patients that they are concerned about patient safety. Accordingly, odds are it will incorporate novel protocols for patient safety, innovative technologies (such as telemedicine and Artificial Intelligence algorithms), and changes in radiology workflow to create an environment that feels safe to both patients and radiologists, preventing backlogs (preventive service must not to be declined anymore) and burnouts (we need to take medical staff’s mental health seriously). However, there is hope on the horizon with new lessons learned from this pandemic that can help clear the backlog and improve the working in breast imaging departments to achieve what is most important: saving lives in the fight against breast cancer
Objectives
To determine the early impact of the COVID-19 pandemic on breast imaging centers in California and Texas and compare regional differences.
Methods
An 11-item survey was emailed to American College of Radiology accredited breast imaging facilities in California and Texas in August 2020. A question subset addressed March-April government restrictions on elective services (“during the shutdown” and “after reopening”). Comparisons were made between states with chi-square and Fisher’s tests, and time frames with McNemar’s and paired t-tests.
Results
There were 54 respondents (54/240, 23%, 26 California, 28 Texas). Imaging volumes fell during the shutdown and remained below pre-pandemic levels after reopening, with reduction in screening greatest (ultrasound 12% of baseline, mammography 13%, MRI 23%), followed by diagnostic MRI (43%), procedures (44%), and diagnostics (45%). California reported higher volumes during the shutdown (procedures, MRI) and after reopening (diagnostics, procedures, MRI) versus Texas (P = 0.001 - 0.02). Most screened patients (52/54, 96% symptoms and 42/54, 78% temperatures), and 100% (53/53) modified check-in and check-out. Reading rooms or physician work were altered for social distancing (31/54, 57%). Physician mask (45/48, 94%), gown (15/48, 31%), eye wear (22/48, 46%), and face shield (22/48, 46%) use during procedures increased after reopening versus pre-pandemic (P < 0.001 - 0.03). Physician (47/54, 87%) and staff (45/53, 85%) financial impacts were common, but none reported terminations.
Conclusion
Breast imaging volumes during the early pandemic fell more severely in Texas than in California. Safety measures and financial impacts on physicians and staff were similar in both states.
Background
There are unique challenges to parenting in residency and there is limited data to guide policy regarding lactation facilities and support for female physicians-in-training. We aimed to assess issues surrounding breast-feeding during graduate medical training for current residents or recent graduates from United States (US) residency programs.
Methods
A national cross-sectional survey was sent to current and recently graduated (2017 and later) female residents in June 2020. This questionnaire was administered using the Qualtrics Survey tool and was open to each participating woman’s organization for 4 weeks. Summary statistics were used to describe characteristics of all respondents and free-text responses were reviewed to identify common themes regarding avenues for improvement.
Results
Three hundred twelve women responded to the survey, representing a 15.6% response rate. The median duration of providing breastmilk was 9 months (IQR 6–12). 21% of residents reported access to usable lactation rooms within their training hospital, in which 12% reported a computer was present. 60% of lactating residents reported not having a place to store breast milk. 73% reported residency limited their ability to lactate, and 37% stopped prior to their desired goal. 40% reported their faculty and/or co-residents made them feel guilty for their decision to breastfeed, and 56% reported their difficulties with breastfeeding during residency impacted their mental health.
Conclusion
Residents who become mothers during training face significant obstacles to meeting their breastfeeding/pumping needs and goals. With these barriers defined, informed policy change can be instituted to improve the lactation experience for physicians-in-training.
Physical and mental stressors on radiologists can result in burnout. Although current efforts seek to target the issues of burnout and stress for radiologists, the impact of their physical workspace is often overlooked. By combining evidence-based design, human factors, and the architectural concept of the Eudaimonia Machine, we have developed a redesign of the radiology reading room that aims to create an optimal workspace for the radiologist. Informed by classical principles of well-being and contemporary work theory, Eudaimonia integrates concerns for individual wellness and efficiency to create an environment that fosters productivity. This layout arranges a work environment into purposeful spaces, each hosting tasks of varying degrees of intensity. The improved design addresses the radiologist’s work requirements while also alleviating cognitive and physical stress, fatigue, and burnout. This new layout organizes the reading room into separate areas, each with a distinct purpose intended to support the range of radiologists’ work, from consultation with other health care providers to reading images without interruption. The scientific principles that undergird evidence-based design and human factors considerations ensure that the Eudaimonia Radiology Machine is best suited to support the work of the radiologists and the entire radiology department.
Screening mammography’s efficacy in reducing breast cancer deaths depends on patient compliance with screening recommendations and the radiologist’s interpretative skills. Reasons for suboptimal screening compliance may be multifactorial, including possible limitations in access. Additionally, while studies show experienced breast radiologists are more accurate in their mammographic interpretation, only a minority of the nation’s mammograms are interpreted by breast imaging specialists. To simultaneously optimize the benefit of early breast cancer detection while minimizing the harms associated with a false positive interpretation, delivery models that help improve access to breast expertise should be considered. Telemammography is one such delivery model that may be underutilized in current practice. While radiologists and other stakeholders of healthcare have accepted teleradiology interpretation of non-mammography studies as routine, telemammography use and acceptance is less well known. In this article, we review the operational components of a telemammography practice in today’s information- and technology-dependent society. Current use of telemammography and remaining potential challenges are discussed. Telemammography can improve healthcare delivery and access by bringing together patients and breast expertise. If accepted, use of telemammography can help meet Centers for Disease Control’s Healthy People 2020 goals related to breast cancer.
Objective:
We detail the association of sedentary behavior with a variety of health problems and provide the radiologist with a number of simple activities and techniques that can improve overall health while still meeting the productivity demands of a high-volume practice. Although these techniques are well known and recognized in the fitness and nutrition literature, they are not widely used in the radiology reading room. The computer- and workstation-based work routinely performed by diagnostic radiologists typically occurs in the seated position, leading to more than 8 hours per day of sitting. Studies have found that even for those who exercise regularly, spending increased time sitting can negate the healthful effects of exercise. Time spent in a seated or sedentary position leads to slowing of one's metabolism, with negative resultant effects.
Conclusion:
The concept of nonexercise activity thermogenesis (NEAT) will be described, with examples given of how to burn more calories while at work and, therefore, improve the health of the diagnostic radiologist. NEAT refers to the energy expended during activities of daily living, excluding sportlike or intentional exercise. The concept of NEAT must be understood by radiologists, because it allows the development of multiple strategies to combat the ill effects of sitting while working. Adding intermittent movement and stretching exercises throughout the day can stimulate metabolism. An understanding of the association of sedentary work behavior with a number of health risks is crucial for radiologists so that they can implement basic changes into their work routine, allowing them to increase activity to address and avoid these potential health hazards.
Background:
The purpose of this study was to examine the effects of walking at self-selected speed on an active workstation on cognitive performance.
Methods:
Sixty-six participants (n = 27 males, 39 females; mean age = 21.06 ± 1.6 years) completed a treadmill-desk walking and a seated control condition, separated by 48 hours. During each condition, participants completed computerized versions of the Stroop test, a modified flanker task, and a test of reading comprehension.
Results:
No significant differences in response speed or accuracy were found between walking and sitting conditions for any the cognitive tests.
Conclusions:
These findings reveal that performance on cognitive tasks, including executive control processes, are not impaired by walking on an active workstation. Implementing active workstations into offices and classrooms may help to decrease sedentariness without impairing task performance.
Volatile organic compounds (VOCs) are major contaminants of indoor air, with concentrations often several times higher than outdoors. They are recognized as causative agents of “building-related illness” or “sick-building syndrome”. Our previous laboratory test-chamber studies have shown that the potted-plant/root-zone microorganism microcosm can eliminate high concentrations of air-borne VOCs within 24 hours, once the removal response has been induced by an initial dose. However, the effectiveness of the potted-plant microcosm in ‘real-world’ indoor spaces has never previously been tested experimentally. This paper reports the results of a field-study on the effects of potted-plant presence on total VOC (TVOC) levels, measured in 60 offices (12 per treatment), over two 5–9 week periods, using three planting regimes, with two ‘international indoor-plant’ species. Fourteen VOCs were identified in the office air. When TVOC loads in reference offices rose above 100 ppb, large reductions, of from 50 to 75% (to <100 ppb), were found in planted offices, under all planting regimes The results indicate that air-borne TVOC levels above a threshold of about 100 ppb stimulate the graded induction of an efficient metabolic VOC-removal mechanism in the microcosm. Follow-up laboratory dose-response experiments, reported in the following paper, confirm the graded induction response, over a wide range of VOC concentrations. The findings together demonstrate that potted-plants can provide an efficient, self-regulating, low-cost, sustainable, bioremediation system for indoor air pollution, which can effectively complement engineering measures to reduce indoor air pollution, and hence improve human wellbeing and productivity.
Specifications and standards for lighting installations in occupational settings are based on the spectral sensitivity of the classical visual system and do not take into account the recently discovered melanopsin-based, blue-light-sensitive photoreceptive system. The authors investigated the effects of exposure to blue-enriched white light during daytime workhours in an office setting.
The experiment was conducted on 104 white-collar workers on two office floors. After baseline assessments under existing lighting conditions, every participant was exposed to two new lighting conditions, each lasting 4 weeks. One consisted of blue-enriched white light (17 000 K) and the other of white light (4000 K). The order was balanced between the floors. Questionnaire and rating scales were used to assess alertness, mood, sleep quality, performance, mental effort, headache and eye strain, and mood throughout the 8-week intervention.
Altogether 94 participants [mean age 36.4 (SD 10.2) years] were included in the analysis. Compared with white light (4000 K), blue-enriched white light (17 000 K) improved the subjective measures of alertness (P<0.0001), positive mood (P=0.0001), performance (P<0.0001), evening fatigue (P=0.0001), irritability (P=0.004), concentration (P<0.0001), and eye discomfort (P=0.002). Daytime sleepiness was reduced (P=0.0001), and the quality of subjective nocturnal sleep (P=0.016) was improved under blue-enriched white light. When the participants' expectation about the effect of the light treatments was entered into the analysis as a covariate, significant effects persisted for performance, alertness, evening fatigue, irritability, difficulty focusing, concentrating, and blurred vision.
Exposure to blue-enriched white light during daytime workhours improves subjective alertness, performance, and evening fatigue.
The transition from a film-based to a filmless soft-copy picture archiving and communication system (PACS)-based environment has resulted in improved work flow as well as increased productivity, diagnostic accuracy, and job satisfaction. Adapting to this filmless environment in an efficient manner requires seamless integration of various components such as PACS workstations, the Internet and hospital intranet, speech recognition software, paperless electronic hospital medical records, e-mail, office software, and telecommunications. However, the importance of optimizing workplace ergonomics has received little attention. Factors such as the position of the work chair, workstation table, keyboard, mouse, and monitors, along with monitor refresh rates and ambient room lighting, have become secondary considerations. Paying close attention to the basics of workplace ergonomics can go a long way in increasing productivity and reducing fatigue, thus allowing full realization of the potential benefits of a PACS. Optimization of workplace ergonomics should be considered in the basic design of any modern radiology suite.
The effects of lighting on the human circadian system are well-established. The recent discovery of 'non-visual' retinal receptors has confirmed an anatomical basis for the non-image forming, biological effects of light and has stimulated interest in the use of light to enhance wellbeing in the corporate setting.
A prospective controlled intervention study was conducted within a shift-working call centre to investigate the effect of newly developed fluorescent light sources with a high correlated colour temperature (17000 K) upon the wellbeing, functioning and work performance of employees. Five items of the SF-36 questionnaire and a modification of the Columbia Jet Lag scale, were used to evaluate employees on two different floors of the call centre between February and May 2005. Questionnaire completion occurred at baseline and after a three month intervention period, during which time one floor was exposed to new high correlated colour temperature lighting and the other remained exposed to usual office lighting. Two sided t-tests with Bonferroni correction for type I errors were used to compare the characteristics of the two groups at baseline and to evaluate changes in the intervention and control groups over the period of the study.
Individuals in the intervention arm of the study showed a significant improvement in self-reported ability to concentrate at study end as compared to those within the control arm (p < 0.05). The mean individual score on a 5 point Likert scale improved by 36.8% in the intervention group, compared with only 1.7% in the control group. The majority of this improvement occurred within the first 7 weeks of the 14 week study. Substantial within group improvements were observed in the intervention group in the areas of fatigue (26.9%), alertness (28.2%), daytime sleepiness (31%) and work performance (19.4%), as assessed by the modified Columbia Scale, and in the areas of vitality (28.4%) and mental health (13.9%), as assessed by the SF-36 over the study period.
High correlated colour temperature fluorescent lights could provide a useful intervention to improve wellbeing and productivity in the corporate setting, although further work is necessary in quantifying the magnitude of likely benefits.
Physician burnout continues to increase in prevalence and disproportionately affects women physicians. Breast imaging is a woman-dominated subspeciality, and therefore, worsening burnout among women physicians may have significant repercussions on the future of the breast imaging profession. Systemic and organizational factors have been shown to be the greatest contributors to burnout beyond individual factors. Based on the Mayo Model, we review the evidence regarding the 7 major organizational contributors to physician burnout and their potential disproportionate impacts on women breast radiologists. The major organizational factors discussed are work–life integration, control and flexibility, workload and job demands, efficiency and resources, finding meaning in work, social support and community at work, and organizational culture and values. We also propose potential strategies for institutions and practices to mitigate burnout in women breast imaging radiologists. Many of these strategies could also benefit men breast imaging radiologists, who are at risk for burnout as well.
Objective
The coronavirus disease 2019 pandemic accelerated trends in remote radiology work. We evaluated the opinions of SBI members regarding remote and in-person breast imaging work.
Methods
An institutional review board–exempt anonymous survey was distributed to SBI members. Survey questions included demographics and opinions on remote and in-person work.
Results
The response rate was 12% (307/2 561). Overall, 79% of respondents preferred hybrid work, 16% preferred in-person work, and 5% preferred fully remote work. Only 34% of respondents had remote work in current practice. Screening mammograms (97%) and breast MRI (92%) were deemed most suitable for remote work. Most respondents believed barriers for remote work were inability to perform US (80%) and high monitor price (78%). Seventy-six percent of respondents believed remote work improves work-life balance and reduces burnout. Work model preferences were significantly associated with gender (P =.048) and perceived work-related impacts (P <.001). Women were more likely to prefer hybrid work than men (82% versus 73%). Compared to those who prefer in-person work, respondents who prefer hybrid work were more likely to believe remote work improves efficiency (89% versus 3%) and reduces burnout (88% versus 6%) while not negatively affecting career growth (88% versus 3%) or communication (87% versus 4%).
Conclusion
Hybrid work is the preferred model among SBI survey respondents. However, a minority have the option for remote work in current practice. Perceived benefits of remote work are efficiency and reduced burnout among breast imaging radiologists while not negatively affecting career growth or communication.
The importance of developing a robust remote workforce in academic radiology has come to the forefront due to several converging factors. COVID-19, and the abrupt transformation it precipitated in terms of how radiologists worked, has been the biggest impetus for change; concurrent factors such as increasing examination volumes and radiologist burnout have also contributed. How to best advance the most desirable and favorable aspects of remote work while preserving an academic environment that fulfills the tripartite mission is a critical challenge that nearly all academic institutions face today. In this article, we discuss current challenges in academic radiology, including effects of the COVID-19 pandemic, from three perspectives-the radiologist, the learner, and the health system-addressing the following topics: productivity, recruitment, wellness, clinical supervision, mentorship and research, educational engagement, radiologist access, investments in technology, and radiologist value. Throughout, we focus on the opportunities and drawbacks of remote work, to help guide its effective and reliable integration into academic radiology practices.
There is an ongoing trend in the direction of flexible work arrangements in which employees can decide where and when to work. Multiple studies have demonstrated a significant decrease in associated job-related stress, improved job satisfaction, job autonomy, and collaboration when flexible work arrangements exist. However, some have reported increased workload and home spillover to work (Grice et al., 2008; MacHe et al., 2020).1., 2. The American Association for Women in Radiology (AAWR) convened a panel of radiologist presenters with diverse backgrounds who shared their own experiences with flexible work arrangements at the Radiological Society of North America (RSNA) 2021 Scientific Assembly and Annual Meeting. This manuscript summarizes the discussion and reviews various aspects of workplace flexibility.
The RSNA 2021 AAWR-sponsored panel on workplace flexibility reviewed the current state of different work arrangements available for radiologists and addressed future strategies for implementing workplace flexibility. The panelists addressed the imperatives and key factors for the availability of diverse opportunities and ways to foster future opportunities. Matters discussed included differences in the availability of flexible work arrangements in the healthcare system compared to other industries, normalizing flexible work arrangements at the organization level, underutilization of currently available flexible work arrangements, part-time positions and stigma associated with them, thriving in a part-time capacity, workplace flexibility options for radiology residents and fellows and successfully implementing workplace flexibility at institutions. The panel ended with a call to action to develop toolkits with effective resources to support implementing flexible workplace opportunities.
The continually increasing demands placed on physicians have led to high levels of burnout, and breast radiologists are no exception. Professional coaching is a means to guide and support the radiologist through a process of positive thinking, stress reduction, goal setting, mental growth, work-life balance, and behavioral change. Professional coaching may be effective in preparation for leadership roles or in response to workplace issues or conflict. The radiologist, with the help of a coach, establishes goals, expands perception and mindset, and collaboratively may find ways to resolve issues by taking new and different approaches. This article discusses why radiologists should seek out a certified coach and what a coach can offer radiologists during these trying times, as well as outlining the coaching process. Coaching has proven useful in addressing professional growth, workplace issues, and physician burnout. At the conclusion of the article, the readers will be able to discern whether coaching can support a better quality of life for them.
Rationale and Objectives
Few studies have examined what constitutes effective interventions to reduce burnout among radiologists. We compared self-reported burnout among academic medical center radiologists before and after a series of departmental initiatives intended to increase wellbeing and professional satisfaction.
Materials and Methods
This Institutional Review Board-approved, prospective study took place 2017-2019 in a tertiary academic medical center. In pre- (2017) and post-intervention (2019) periods, we administered the previously-validated Stanford Physician Wellness Survey to faculty in our 11-division radiology department. Faculty rated their burnout level across 8 domains (professional fulfillment, emotional exhaustion, interpersonal disengagement, sleep difficulties, self-compassion, negative work impact on personal relations, organizational/personal values alignment, perceived quality of supervisory leadership). Between the two surveys, departmental initiatives focusing on culture, team building, work-life balance, and personal well-being were implemented (e.g., electronic medical record training, shorter work hours). Pre- and post-survey results were compared, using Whitney-Mann U test to calculate Z scores.
Results
Faculty members rated lower professional fulfillment (Z-3.04, p=0.002), higher emotional exhaustion (Z=2.52, p=0.012), increased sleep-related impairment (Z=2.38, p=0.012), and reduced organizational/personal values alignment (Z=-4.10, p<0.0001) between the two surveys. No significant differences were identified associated with interpersonal disengagement (Z=1.82, p=0.069), self-compassion (Z=1.39, p=0.164), negative impact of work on personal relationship (Z=0.89, p=0.372) and perceived supervisory leadership quality (Z=0.07, p=0.942).
Conclusion
Despite numerous departmental initiatives intended to improve culture, workplace efficiency, work-life balance, and personal wellness, self-reported burnout was unchanged or worsened over time.Physician and employee wellness embedded into institutional culture maybe more effective than departmental improvement initiatives.
Implementation of optimal ergonomic setups of workstations and reading rooms can help to improve the overall quality of life for most radiologists by preventing repetitive stress injuries and potentially improving efficiency. It is important for radiologists to know what optimal ergonomic setups are and what works for the individual person in order to implement the best possible ergonomic setups as they may differ from person to person. These issues have become more important recently as many radiologists have been working from home and will continue to do so, at least partially, during the COVID-19 pandemic. In this paper, we aim to increase awareness of sound ergonomic principles and discuss possible options for individual optimization along with practical tips for implementation of optimal ergonomic setups.
Background and purpose:
As a result of the coronavirus disease 2019 (COVID-19) pandemic, many radiology departments shifted to working a portion of clinical assignments from home. To determine the effect of working from home on performance, productivity, quality, and safety, we evaluated turnaround time, volume of studies, and error rates on rotations worked from home compared with in the hospital.
Materials and methods:
The number of studies interpreted per day for each neuroradiologist, turnaround times, and error rates reported to peer learning was identified from April 1, 2020, through September 30, 2020. For each neuroradiologist, mean turnaround times and volumes per day at home versus in the hospital were compared. Similar comparison was performed for STAT studies.
Results:
During the time period, 2597 CTs (1897 at home, 700 in the hospital) and 3685 MRIs (2601 at home, 1084 in the hospital) were read. By individual neuroradiologists, 57% (4/7) had shorter turnaround time at home and 57% (4/7) demonstrated an increase in the mean number of studies per day read at home. No statistically significant difference was noted in the neuroradiologists' performance while reading STAT studies. Reported error rates were not found to be higher at home, with statistically significantly lower rates when working at home (P = .018).
Conclusions:
Variable productivity and performance of neuroradiologists when working from home versus in the hospital were found, being 57% faster and/or more productive while working at home without an increase in error rates. The decision to work at home versus in the hospital may best be based on local factors, balancing the variability among individual neuroradiologist's and the institution's needs, recognizing that working from home is not a one-size-fits-all phenomenon but requires adaptability for successful implementation.
Remote workstations were rapidly deployed in our academic radiology practice in late March 2020 in response to the COVID-19 pandemic. Although well received by faculty, there were concerns for the impact on resident education. Surveys of the radiology trainees and faculty were conducted seven- and thirteen-months following workstation deployment as a part of a quality improvement project to assess the impact on radiology education and faculty wellness, as well as assess the desired trajectory of remote work in an academic setting.
The majority of trainees (52%) reported the implementation had negatively impacted resident education, greatest among lower level residents (p<.001). This perception did not change despite interventions and perceived improvement in teleconferencing.
Greater than 75% of radiologists with remote workstations reported improved wellness and lower stress levels compared to the onsite radiologists. The majority of all respondents voted to continue or expand remote work following the COVID-19 pandemic in both surveys.
Onsite teaching is important for the education of residents, particularly for lower level residents. However, the adoption of a hybrid model in an academic setting may prove beneficial for faculty wellness and recruitment of the next generation.
Objective
The objective of this study is to determine the major stressors affecting practicing breast radiologists.
Methods
All members of the Society of Breast Imaging within the United States received an email invitation to complete an anonymous survey evaluating stressors that may contribute to physician burnout. Stressors evaluated included pace at work, work–life balance, care of dependents, job security, financial strain, decreasing reimbursement, new regulations, delivering bad news, fear of getting sued, and dealing with difficult patients, radiologists, and administrators.
Results
The overall response rate was 13.5% (312/2308). For those who opened the email, response rate was 24.6% (312/1269). The most prevalent stressors reported were working too fast (222/312, 71.2%), balancing demands of work with personal life (209/312, 70.0%), fear of getting sued (164/312, 52.6%), and dealing with difficult administrators (156/312, 50%). Prevalence of stress related to new regulation requirements, job security, financial strain, decreased reimbursement, dependent care, call, delivering bad news, and dealing with difficult patients, difficult referrers, and difficult radiologists were present in fewer than 50% of respondents.
Conclusion
The most prevalent sources of stress in breast imaging radiologists relate to working too fast and balancing demands of work with time needed for personal life.
Purpose:
The purpose of this study was to evaluate the emotional and financial impact of COVID-19 on breast radiologists to understand potential consequences on physician wellness and gender disparities in radiology.
Methods:
A 41-question survey was distributed from June to September 2020 to members of the Society of Breast Imaging and the National Consortium of Breast Centers. Psychological distress and financial loss scores were calculated on the basis of survey responses and compared across gender and age subgroups. A multivariate logistic model was used to identify factors associated with psychological distress scores.
Results:
A total of 628 surveys were completed (18% response rate); the mean respondent age was 52 ± 10 years, and 79% were women. Anxiety was reported by 68% of respondents, followed by sadness (41%), sleep problems (36%), anger (25%), and depression (23%). A higher psychological distress score correlated with female gender (odds ratio [OR], 1.9; P = .001), younger age (OR, 0.8 per SD; P = .005), and a higher financial loss score (OR, 1.4; P < .0001). Participants whose practices had not initiated wellness efforts specific to COVID-19 (54%) had higher psychological distress scores (OR, 1.4; P = .03). Of those with children at home, 38% reported increased childcare needs, higher in women than men (40% vs 29%, P < .001). Thirty-seven percent reported that childcare needs had adversely affected their jobs, which correlated with higher psychological distress scores (OR, 2.2-3.3; P < .05).
Conclusions:
Psychological distress was highest among younger and female respondents and those with greater pandemic-specific childcare needs and financial loss. Practice-initiated COVID-19-specific wellness efforts were associated with decreased psychological distress. Policies are needed to mitigate pandemic-specific burnout and worsening gender disparities.
Medical errors have a significant impact on patient care, worker safety, and health care finances. Breast imaging has the most common cause of organ-related misdiagnosis subject to malpractice suits. In order to effectively develop strategies to prevent errors, breast imaging radiologists must first understand the underlying causes of the errors that occur in the breast imaging setting. Errors in breast imaging can be related to errors in interpretation, improper workup of imaging findings, procedural errors, or errors in communication to the patient or other medical staff. The Yorkshire contributory factors framework was developed to identify factors that contribute to the errors in a hospital setting and can be adapted for use in the breast imaging setting. Within this framework, active failures refer to errors that directly affect the patient. Active errors include slips (including biases), lapses, and mistakes. The framework describes how active errors often result from factors that occur uphill from these active errors at different levels within the system. Once error causes are understood, there are concrete strategies and tools that breast imaging radiologists can implement to decrease adverse events, reduce medical errors, and promote a safety environment in the breast imaging clinic. Error mitigation tools can be summarized using the acronym SAFE, which includes support the team, ask questions, focus on a task, and effectively communicate/ensure equipment optimization/safe environment. Knowledge of errors commonly seen in a breast imaging clinic represent an opportunity for constructive changes and, ultimately, improved health care delivery.
Rationale and Objectives
Although the evidence for the benefits of breastfeeding is strong, parents are often unable to continue breastfeeding upon returning from maternity leave for a variety of reasons. Breastfeeding parents in medicine face unique challenges upon returning to the workforce after maternity leave. Current research on breastfeeding radiologists is limited. The objective of this research is to evaluate breastfeeding barriers and identify potential solutions to help radiologists reach their breastfeeding goals.
Materials and Methods
A 17-question survey was developed from validated surveys and pilot tested using focus groups. The survey was emailed to members of the American Association for Women in Radiology and promoted through social media. Bivariate analyses were performed using chi-square tests. p values <0.05 were considered statistically significant. Institutional review board deemed that this anonymous voluntary survey met criteria for exemption.
Results
50 respondents met criteria for study inclusion (estimated response rate 42%). Of the respondents, 60% were trainees, 80% practiced in academic institutions and 92% were full-time. 100% intended to breastfeed, of whom 56% met personal breastfeeding goals (12-month median duration). Available lactation facilities included: Dedicated lactation room (38%), private space (58%), hospital grade pump (30%), refrigerator (46%), dedicated PACS (8%). Cited workplace challenges included lack of time (82%), lack of space (34%), and unsupportive work culture (42%). Having adequate time was associated with meeting breastfeeding goals (p = 0.028). No other factors were statistically significant (p > 0.05).
Conclusion
Almost half of breastfeeding radiologists (44%) did not meet breastfeeding goals, citing a variety of facility-based and institutional barriers. Among these, having sufficient time to pump/breastfeed was associated with achieving breastfeeding goals. Given the barriers faced by breastfeeding radiologists, there is an opportunity to make structural and cultural changes to provide lactation support at work.
The philosophy of building ‘lean’ workplaces, to maximise occupant performance, has seen a stripping away of nature within built environments. However, the biophilia hypothesis indicates that a severance in human connection with nature can lead to significant reductions in health, well-being and performance. The aim of this study was to determine whether introducing and removing living plants within an office environment can affect occupants’ perceived health, well-being and performance metrics. 40 occupants took part within a modern office building with 2 potted plants per person introduced into individual offices, and 8 in break-out spaces. Changes in occupants’ perception were tested using questionnaires. Whether the location of planting impacted measured parameters and occupants’ workplace satisfaction was also investigated. Introducing plants into offices had significantly positive effects on occupants’ perceived attention, creativity and productivity; plants’ removal elicited significantly negative effects in perceived attention, productivity, stress and efficiency. Planting had no significant effect on perceived health, tiredness, motivation or well-being. Furthermore, interactions with plants during break times had no significant effect on perceived performance metrics. This study showed occupants to have improved satisfaction with their overall workplace environment when they have physical and visual access to plants within their offices and break-out spaces.
Objective
Burnout is defined as a psychological syndrome arising as a response to chronic prolonged interpersonal job-related stress. Physician burnout has been increasingly recognized over the past decade as an epidemic within the United States. The goal of this study was to ascertain the prevalence of burnout amongst practicing breast imaging radiologists.
Methods
A survey contained demographic questions based on workforce surveys carried out by the American College of Radiology and a validated condensed version of the Maslach Burnout Inventory (MBI) evaluating the three aspects of burnout. The radiologist members of the Society of Breast Imaging (SBI) received the survey internally from the SBI as a weekly e-mail with a web link to the survey from February 19, 2019, to March 13, 2019. The link allowed respondents to complete the survey anonymously. The authors were blinded to the SBI mailing list and the SBI was blinded to the responses.
Results
A total of 370 breast imaging radiologists from the SBI responded to the survey. Overall, 290 out of 370 (78.4%) were highly burned out in at least 1 measured dimension of burnout; 197 out of 362 (54.4%) were highly burned out in at least 2 dimensions of burnout; and 27 out of 362 (7.5%) were highly burned out in all 3 dimensions of burnout. However, rates of personal accomplishment were high, with only 8.8% experiencing high burnout in the dimension of personal accomplishment.
Conclusion
Our study demonstrates a high prevalence of burnout amongst breast imaging radiologists. Burnout rates were highest in the youngest breast imaging radiologists.
The introduction of daylight into buildings has great potential to reduce energy use and positively impact building occupants. However, if daylighting designs are poorly conceived, the luminous environment may lead to issues such as glare, headaches, or eye strain. This research presents results from a large-scale study, which included field measurements and surveys of three large commercial office buildings in the U.S. Each building utilized a differing type of shading strategy: automated blinds, electrochromic glazing, and roller shades, respectively. This paper reports findings from the measured physical data and the surveys, which were sent to each building to assess occupants’ subjective visual comfort perceptions. In total, 5,031 surveys were sent to the three buildings, and 1,068 total occupants responded (a response rate of 21.2%). Key outcomes included the following: (1) occupants who were more pleased with their access to daylight were also more likely to have a higher perceived level of productivity and higher level of satisfaction, (2) occupants’ self-reported satisfaction with their workspace significantly differed based on their distance to the window in Buildings 1 and 2, and those closer to the perimeter of the building were more satisfied than those who sat further away from the windows, and (3) the trend of negative responses from occupants in Building 2 (i.e. a perceived gloominess, perpetual sense of an overcast sky, etc.) raise interesting design questions, as related to the use of electrochromic glazing. It is crucial that designers understand daylighting strategies, shading, and corresponding human perceptions of comfort.
Burnout is a psychological syndrome created by chronic job stress, and it is typified by emotional exhaustion, depersonalization, and feelings of decreased personal accomplishment. In physicians, burnout occurs at alarming rates, and it is on the rise. High burnout rates are ubiquitous in radiology across multiple subspecialties. We know of no study specifically examining burnout among breast imaging radiologists, but given the rates across multiple specialties in radiology, we must assume that a significant portion of breast imaging radiologists also experience burnout. As breast imaging increases in volume and complexity, we must find new ways of practicing that help achieve a healthy work environment.
Purpose:
To assess the impact of California's Breast Density Law (BDL) on MRI utilization and clinician ordering practices.
Materials and methods:
Our institutional review board approved this study that retrospectively compared the ordering pattern for screening breast MRI examinations in the 30-month period before and after the BDL was enacted. Examinations were subcategorized into those with breast density mentioned as an examination indication. Patients were classified into (1) high risk; (2) above average risk, defined but not quantified; and (3) undefined or average risk. χ2test or Fisher's exact test was used to compare MRI utilization, use of breast density as an indication, patient demographics, and provider characteristics.
Results:
Screening MRI examinations with breast density as the indication increased from 8.5% (32 of 376) to 21.1% (136 of 646, P < .0001) after BDL. When high-risk patients were excluded, the increase was from 8% to 17.2% (P < .0001). Patient demographics before and after BDL were, by race: white 71.8% versus 71.2%; Asian 6.4% versus 10.5%; black 3.7% versus 3.1%; American Indian 0.3% versus 1.4%; Native Hawaiian or Pacific Islander 1.6% versus 1.7%; by ethnicity: Hispanic or Latino 10.6% versus 7.9%. Before and after BDL, predominantly female providers (81.4% and 77.4%, P = not significant [NS]) and specialists (62.5% and 63.5%, P = NS) ordered the majority of breast MRI examinations compared with males (18.6% and 22.6%, P = NS).
Conclusion:
Screening breast MRI utilization for non-high-risk women more than doubled after the California BDL went into effect. BDL has had an impact on MRI utilization, and its clinical value for changing outcomes deserves further study.
Purpose:
The purpose of this study was to determine the extent and severity of musculoskeletal discomfort in radiologists using a standardized tool, the Cornell Musculoskeletal Discomfort Questionnaire (CMDQ). In addition, we evaluated the influence of demographic factors on the frequency of symptoms, degree of discomfort, interference of symptoms with ability to work, and overall pain.
Methods:
The CMDQ was distributed via an anonymous link to all radiology trainees and faculty at our institution. The questionnaire assessed frequency and location of pain, severity of symptoms, and degree to which discomfort interfered with work. In addition, demographic data were collected.
Results:
The survey was completed by 99 radiologists (39% response rate). The majority (80%) of respondents spent greater than 7 hours per workday at a diagnostic workstation. The neck (66%), lower back (61%), upper back (43%), right shoulder (36%), and right wrist (33%) were the areas where radiologists most frequently reported ache, pain, or discomfort at least once per week. More than 7 hours per day at a computer workstation was significantly associated with higher total pain.
Conclusions:
Musculoskeletal discomfort in the week before the survey was reported by the majority of radiologists and was significantly influenced by demographic factors. Further investigation is needed to understand the causes of radiologists' discomfort at work and to evaluate interventions to ameliorate these symptoms.
Research has shown that colours influence motivation and cognitive performance. In achievement contexts, red evokes avoidance motivation that hinders creativity, while blue elicits an approach motivation that facilitates creativity. However, due to their position and mode of presentation, colours may convey a different message. Red accent lighting creates a cosy, friendly room atmosphere that may, even in an achievement context, elicit an approach rather than an avoidance motivation. Results (N = 146) showed that both blue and red accent light increased strategic approach motivation compared to white accent light. Moreover, through the heightened approach motivation, colourful accent light indirectly improved creative performance. Implications for future research on colour and practical implications for colour usage are discussed.
Practitioner Summary
Designing work environments for creativity is a new topic in ergonomics research and practice. The present study demonstrates indirect effects of coloured accent light on creativity providing interesting possibilities for the design of work places for knowledge workers, classrooms, and all other rooms in which people work on new ideas.
Objective:
To investigate patient, staff, and carer responses to an environmental intervention in an oncology clinic waiting room and evaluate the acceptability of artificial plant materials.
Design postintervention:
Cross-sectional survey study.
Setting:
Oncology outpatient clinic waiting room located in a metropolitan comprehensive cancer center in Australia.
Main outcome measure:
Observer ratings of perceived qualities and effects of lifelike (fake) plants while spending time in the waiting room.
Participants:
Convenience sample (N = 143) consisted of 73 cancer patients, 13 staff, 52 carers, and 5 "others" aged between 24 and 89 years (M = 56, SD = 14.5).
Intervention:
Artificial plant arrangements, hanging installations, two movable green walls, and one rock garden on wheels placed throughout the outpatients' clinic waiting room.
Results:
Eighty-one percent (115/142) of respondents noticed the green features when first entering the waiting room and 67% (90/134) noticed they were artificial. Eighty-one percent (115/142) indicated "like/like a lot" when reporting their first reaction to the green features. Forty-eight percent (68/143) were positively affected and 23% (33/143) were very positively affected. Eighty-one percent (110/135) agreed/strongly agreed that "The greenery brightens the waiting room," 62% (80/130) agreed/strongly agreed that they "prefer living plants," and 76% (101/133) agreed/strongly agreed that "'lifelike' plants are better than no plants." Comments included mostly positive appraisals and occasional adverse reactions to artificial plants. No significant differences were found between patients', staff, and carers' reactions.
Conclusions:
The environmental intervention positively impacted patients', staff, and carers' perceptions of the oncology waiting room environment. Patients, staff, and carers mostly accepted artificial plants as an alternative design solution to real plants.
Burnout is a concern for radiologists. The burnout rate is greater among diagnostic radiologists than the mean for all physicians, while radiation oncologists have a slightly lower burnout rate. Burnout can result in unprofessional behavior, thoughts of suicide, premature retirement, and errors in patient care. Strategies to reduce burnout include addressing the sources of job dissatisfaction, instilling lifestyle balance, finding reasons to work other than money, improving money management, developing a support group, and seeking help when needed.
Purpose:
To investigate the prevalence of repetitive strain injury (RSI) among breast-imaging radiologists, the factors associated with such symptoms, and strategies to reduce injury.
Methods:
In 2012, an anonymous survey regarding RSI and work habits was administered to 2,618 physician members of the Society of Breast Imaging via e-mail. Analysis of 727 (27.8%) de-identified responses was completed using STATA 12.1. Pain levels before and after implementation of digital imaging were compared with the Wilcoxon signed-rank test. The associations between RSI symptoms and work habits were assessed with logistic regression and test for trend.
Results:
In the survey 438 of 727 (60.2%) respondents reported RSI symptoms, and 242 of 727 (33.3%) reported prior diagnosis/treatment. Results showed a statistically significant trend for the odds of RSI symptoms to increase with decreasing age (P = .0004) or increasing number of daily hours spent working (P = .0006), especially in an awkward position (P < .0001). Respondents recalled a significant increase in pain level after implementation of PACS, and a decrease in pain after ergonomic training or initiating use of an ergonomic mouse, adjustable chair, or adjustable table (P < .001, all comparisons). Only 17.7% (129 of 727) used an ergonomic mouse and 13.3% (97 of 727) had attended ergonomic training. Those with RSI symptoms or prior diagnosis of a Repetitive Strain Syndrome (RSS) were more likely to desire future ergonomic training compared with those without symptoms or injury (odds ratio 5.36, P < .001; odds ratio 2.63, P = .001, respectively).
Conclusions:
RSI is highly prevalent among breast-imaging radiologists nationwide and may worsen after implementation of PACS or with longer work hours. Ergonomic training and ergonomic devices may diminish or prevent painful RSI among radiologists.
This review examines the effectiveness of sit-stand workstations at reducing worker discomfort without causing a decrease in productivity. Four databases were searched for studies on sit-stand workstations, and five selection criteria were used to identify appropriate articles. Fourteen articles were identified that met at least three of the five selection criteria. Seven of the identified studies reported either local, whole body or both local and whole body subjective discomfort scores. Six of these studies indicated implementing sit-stand workstations in an office environment led to lower levels of reported subjective discomfort (three of which were statistically significant). Therefore, this review concluded that sit-stand workstations are likely effective in reducing perceived discomfort. Eight of the identified studies reported a productivity outcome. Three of these studies reported an increase in productivity during sit-stand work, four reported no affect on productivity, and one reported mixed productivity results. Therefore, this review concluded that sit-stand workstations do not cause a decrease in productivity.
Purpose
The paper aims to identify and demonstrate the benefits of plants in offices in contributing to employee health and well‐being by applying the study to a working office.
Design/methodology/approach
Via comprehensive literature reviews, the paper identifies the importance of indoor plants in office environments, firstly through physically improving the air quality and removing pollutants and secondly in improving employee well‐being through psychological benefits.
Findings
It is argued that plants are important in removing indoor air pollutants and in increasing employee perceptions of well‐being. The paper identifies, through literature review, plants with the ability to remove common office pollutants. It shows that there is a general preference for plants in offices through a perception survey and that occupants of planted offices feel more comfortable, more productive, healthier and more creative and feel less pressure than occupants of non‐planted offices.
Research limitations/implications
The empirical research presented was limited to one office building. Research is now continuing, with the survey currently being completed by occupants of various offices throughout the UK.
Practical implications
The paper argues that indoor plants should become an integral part of corporate real estate strategies and that they have potential to alleviate sick building syndrome symptoms.
Originality/value
This paper provides an insight into how plants can be incorporated within corporate real estate strategies to improve employee health and well‐being and improve perceived productivity. It brings together two separate strands of research into the benefits in physically improving air quality and the psychological benefits of plants to humans.
Two-thirds of the US population is overweight or obese. Sedentary lifestyles and occupations are one factor in the development of obesity. Methods to help reduce sedentary work environments may help reduce obesity. The purpose of this study was to determine the feasibility of using a walking workstation during computed tomographic image interpretation.
Two radiologists reinterpreted 100 clinical computed tomographic examinations they had previously interpreted, each while walking at 1 mph on a treadmill using an electronic workstation. Ten cases were reviewed per session. The time period between the initial conventional interpretations and the reinterpretations was greater than one year, to reduce recall bias. Discrepant findings were ranked according to a classification system based on clinical importance on a scale ranging from 1 to 6. Discrepant findings classified as greater than or equal to 3 were considered significant. Detection rates for the initial interpretations and reinterpretations were determined for each reviewer and compared using a paired t-test.
A total of 1,582 findings were reported (825 by reviewer 1 and 757 by reviewer 2). There were 459 findings with clinical importance of 3 or higher. For reviewer 1 (91 cases of at least one important finding), the mean detection rates were 99.0% for the walking technique and 88.9% for the conventional interpretations (P = .0003). For reviewer 2 (89 cases with at least one important finding) the mean detection rates were 99.1% for the walking technique and 81.3% for the conventional interpretations (P < .0001).
The use of a walking workstation for the interpretation of cross-sectional images is feasible. Further studies are needed to assess the potential impact on diagnostic accuracy.
We review current data on types of stressors acting on women physicians, the consequences of these stressors and methods of coping with them. We undertook a systematic review of original articles published in the last 15 years and registered mainly on Medline and on the internet websites focusing on these issues. In addition to the pressures acting on all physicians, women physicians face specific stressors related to discrimination, lack of role models and support, role strain, and overload. The depression rate in women physicians does not vary from that of the general public but the rates of successful suicide and divorce are much higher. Women in academic settings are promoted more slowly, have lower salaries, receive fewer resources, and suffer from a range of micro-inequities. They often lack mentors to provide advice and guidance. They must cope with the pressures of choosing when to have a child and conflicts between being a wife and mother and having a career. Despite these pressures, they report a high degree of career satisfaction. Although women physicians suffer from a variety of stressors that can lead to career impediments, stress reactions, and psychiatric problems, generally they are satisfied with their careers. Personal coping techniques can help women deal with these stressors. Pressures will continue until attitudes and practices change in institutional settings. Some institutions are initiating changes to end discrimination against women faculty.
Natural elements in the built healthcare environment have shown to hold potential stress-reducing properties. In order to shed light on the underlying mechanism of stress-reducing effects of nature, the present study investigates whether the stress-reducing effects of indoor plants occur because such an environment is perceived as being more attractive.
A single-factor between-subjects experimental design (nature: indoor plants vs. no plants) was used in which participants (n=77) were presented with a scenario describing hospitalization with a possible legionella diagnosis. The study was conducted from March to May 2007 in the Netherlands. Subsequently, they were exposed to a photo of a hospital room. In this room were either indoor plants, or there was a painting of an urban environment on the wall. Afterwards, perceived stress and the perceived attractiveness of the hospital room were measured.
Participants exposed to the hospital room with indoor plants reported less stress than those in the control condition. Mediation analysis confirmed that indoor plants in a hospital room reduce feelings of stress through the perceived attractiveness of the room.
This study confirms the stress-reducing properties of natural elements in the built healthcare environment. It also sheds light on the underlying mechanism causing this stress-reduction.
Effect of lighting color on human performance
- Benedictus