Restructuring the Flow of Radiation Oncologist workflow in an Out-Patient Cancer Centre

This change project looks at Radiation Oncologist workflow in an Out-Patient Cancer Centre. Due to increasing patient volumes as well as increasing complexities in the pre-treatment stages of the Radiotherapy process, a new Consultant was recently recruited to the team. In order to optimise the use of other resources in the Department, such as IT equipment and ancillary personnel, a need was identified to better streamline internal scheduling processes. The project was guided throughout by the Senior and Swailes Organisational Development model, chosen due to its flexibility and cyclical nature. The key stakeholder groups were identified as being the Radiation Oncologists, Radiation Therapists, Nurses, Medical Physicists and Administrative team. Using qualitative and quantitative data from representatives of each, an action plan for implementing the change was devised. Using a high level process map of the patient journey through Radiotherapy as a guide, a new workflow schedule for the Consultant team was designed. Evaluation concentrated on two critical internal key performance indicators: access time for patients, defined as the time from receipt of referral to consult appointment, and the overall turnaround time for treatment planning, defined as the time from import of simulation dataset to plan approval. All relevant timeline information was extracted from the electronic medical record in October 2013 and repeated in March 2014. Using statistical process control to analyse the data, both processes stabilised in terms of the amount of variation seen, with the mean turnaround time for a Radiotherapy plan reducing by 10%. Repeated evaluation will be necessary once the new scheduling processes become embedded in practice. Further refinement of processes related to the most complex treatment plans is also recommended from this study.