How to Build a High-Reliability Program
Each year, over 370 million radiology studies are performed in the U.S. Alone, 10% of those studies—more than 37 million—include recommendations for additional imaging. Yet, nearly half of those recommendations go unfulfilled. That means 18.5 million patients each year may miss a crucial follow-up, many due to system failures, not clinical decisions. The consequences can be devastating.
This isn’t a theoretical problem. It’s personal. Take Jill’s story—shared by Angela Adams, RN, CEO of Inflo Health. Jill went to the ER with appendicitis. Her CT also revealed a breast lesion, which was never communicated to her. A year later, that oversight turned into a fatal, inoperable cancer diagnosis.
Why Follow-Ups Are Missed
Missed follow-ups are usually not caused by negligence—they’re a failure of systems. Here are the primary breakdown points:
- Unstructured documentation in radiology reports
- Lack of closed-loop communication between departments and providers
- No clear ownership of follow-up processes
- Manual tracking that leads to human error and delays
Analysis from Inflo Health revealed:
- 15% of studies across six million records had follow-up recommendations
- Breast and lung programs had the highest prevalence of follow-ups (70% and 98%, respectively)
- Closure rates varied: breast (64%), lung (60%), “other” programs (51%)
The Problem with “Other”
Most imaging happens outside of formal lung or breast programs. These studies make up 88% of imaging volume, and their follow-ups are often referred to primary care providers—without a structured handoff. Without clear workflows, half of these fall through the cracks.
Introducing High Reliability to Radiology
Borrowed from aviation and nuclear energy, the concept of a High Reliability Organization (HRO) refers to systems that function safely and effectively in complex, high-risk environments.
In healthcare—and radiology specifically—HROs:
- Anticipate and monitor failure points
- Use data to understand root causes
- Stay closely connected to frontline operations
- Defer to subject matter expertise
- Design for adaptability and resilience
The Swiss Cheese Model
Imagine your follow-up process as slices of Swiss cheese. Each layer—reporting, communication, tracking—has holes. High-reliability systems prevent those holes from aligning, so errors don’t slip through every layer.
From Concept to Action
Through programs like the ACR’s ImPower Learning Network and partnerships with technology vendors like Inflo Health, leading health systems are putting these HRO principles into practice.
Success depends on three pillars:
- People: Engaged staff, defined roles, and frontline expertise
- Process: Standardized protocols and communication pathways
- Technology: AI and automation that elevate—not replace—clinical judgment
Case Study: East Alabama Medical Center
Before transformation, EAMC faced common challenges: manual report parsing, inconsistent documentation, and limited primary care engagement. By integrating Inflo Health’s AI solution and participating in ACR’s ImPower Program, EAMC achieved:
- 74% increase in follow-up completion
- 20% improvement in guideline adherence
- 95% reduction in manual tracking time
High-reliability follow-up care isn’t just about meeting a benchmark—it’s about catching cancers early, reducing liability, and restoring trust in healthcare. And it’s within reach. With the right tools, teams, and commitment, health systems can prevent the next missed follow-up from becoming a tragedy.
Ready to benchmark your program? Take Inflo Health’s 6-question Follow-Up Maturity Assessment.
