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.

by Penny Adams, Sue Sinclair, Rama Machiraju

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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.

References

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

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