Radiotherapy business improvement process
The Cancer Institute NSW predicts there will be over 30 per cent more cases of cancer in the next ten years than there were in the last.
Background
To accommodate future demand, a need to identify opportunities
for improvements in the operational practice of radiation oncology
services has been identified. The principle objective of the
radiotherapy business improvement strategy (RT BIS) was to improve
access to radiation oncology treatment through better-coordinated
and more cost-effective service delivery.
Method
The methodology was based on the Six Sigma approach 1. Obstacles to service improvement
were identified through an all staff process mapping exercise and
then addressed using a quality improvement process.
Project teams and steering groups were established at each of
the ten participating radiation oncology treatment centres.
Each project followed a common methodology covering six broad
phases as outlined in Figure 1.
Figure 1
 |
Results
The study resulted in the following key outcomes and
findings:
Key outcomes
- By the end of the project the participating centres were
treating at a rate which equates to an additional 1,467 patients
per year in excess of baseline;
- The average increase in attendance per day, compared to
baseline, was 16 per cent.
- Waiting lists were reduced in most centres. By the end of the
period, in all centres waiting lists for ready for care (RFC)
patients tended towards the centres' current planning timeframe -
typically, 2 weeks;
- All centres have estimated theoretical treatment targets based
on a review of their historical capacity which will meet or exceed
the state benchmark;
- The elapsed time from consultation to treatment was reduced in
most centres, to an average of 10 days;
- Centre management teams have the tools needed to focus on
improving access to treatment;
- The treatment planning process at each centre has been
streamlined and simplified;
- The booking process in each centre has been formalised to
maximise throughput and where necessary eliminate 'single person
risk.'
- Patient communication has been improved.
Figure 2
 |
Figure 3
 |
Conclusion
Additional Findings:
- An across-the-board willingness to improve business processes
in all participating centres. This willingness allowed all centres
to treat significantly more patients, compared to baseline, during
the project period;
- Prior to the project, only two centres were exceeding the
planning benchmark of 414 courses per linear accelerator per year.
By project end, five centres were exceeding the planning benchmark.
Four others are constrained by shortage of referrals.
- Referrals are not well matched to treatment capacity, with the
result that some centres have waiting lists while others have spare
capacity;
- Improving a radiation oncology treatment centre's business
processes requires the participation of all departments; and
- Establishing a process in the centres for managing continuous
improvement is vital.
Summary:
By the end of the project, all participating centres
demonstrated a measurable and theoretically sustainable increase in
capacity of 16 per cent across all units. Where they existed,
waiting lists were reduced in most centres. A set of packaged
electronic business tools to assist units to address the management
of key performance indicators, treatment capacity and rostering
were also developed as a result of this project.
These outcomes of the RT BIS supported the literature on
clinical redesign 2. The RT BIS found that managing
the process for booking patients for treatment is a major key to
managing access to radiotherapy treatment in NSW.
The RT BIS demonstrated that extra capacity was theoretically
available to provide radiation therapy to cancer patients in NSW,
given the ongoing utilisation of the process improvement approach
applied during the project.
- C Adams, P Gupta and C Wilson. Six Sigma Deployment,
Practical Guide to Six Sigma Implementation. pp 288, December
2002
- O'Connell T, Ben-Tovim D, McCaughan B, et al. Health
services under siege: the case for clinical process redesign.
MJA. Volume 188 Number 6, 17 March 2008
Top of page
