Ambulatory chemotherapy business improvement strategy

Program evaluation
31 May 2011
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The Ambulatory Chemotherapy Business Improvement Strategy (ACBIS) was developed as part of the NSW Cancer Plan 2007–10 to examine and redesign key clinical service provision models in cancer care.

To better understand ambulatory chemotherapy services across NSW, the Cancer Institute NSW undertook a Review of Ambulatory / Outpatient Chemotherapy and Haematology Services in New South Wales in 2005.  A follow-up statewide survey, focusing on identifying issues that could improve the delivery of ambulatory chemotherapy, was then conducted in 2008.

Based on the findings of these surveys, we developed and trialled four high level solutions for NSW chemotherapy units across a set of eight representative sites between October 2009 and November 2010.  Managers from each of the units were invited to be members of the steering group that provided oversight for the pilot.

For the ACBIS pilot, we had the following objectives:

  • Development and trialling of a process analysis / improvement approach to validate identified process bottlenecks identified in the 2008 survey.
  • Development of process improvement solutions with a view to wider rollout.
  • Provision of advice to support future business improvement initiatives in ambulatory chemotherapy.

The outcomes of this review will be considered both in terms of short-term business process improvement for NSW ambulatory chemotherapy units and in the longer term as part of statewide planning to provide quality ambulatory chemotherapy services for future cancer patients.

Key findings

Across the representative sites, the ACBIS pilot found that:

  • A variety of booking systems were used to record and manage patient scheduling.
  • Fifty per cent of the pilot units used manual/paper based systems.
  • Systems to book appointments did not generally match resource and staff availability.
  • Units differed in available data sets for extracting reports for operational decision making.
  • There was limited scope for most units to form improvement teams due to staffing and resource issues.
  • Patient education was delivered to varying standards, leading to delays in treatment commencement. A need to consolidate the varying sources of patient education to support best evidence based practice was recommended.
  • The use of the PCV measurement metric could be developed to support operational planning.
  • Recording toxicity of chemotherapy drugs is poorly documented and would benefit from electronic recording and reporting.

Key outcomes

  • A system survey that provided a landscape of the current business and information systems in chemotherapy units across in NSW.
  • A set of KPIs for potential application in managing throughput, utilisation, workload, waiting times and finance.
  • A collection of patient education resources.
  • Recommendations for roll out and other business improvement suggestions for NSW chemotherapy services.
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