Improving efficiency and safety in external beam radiotherapy treatment delivery using a kaizen approach

Publication date: Available online 29 June 2017
Source:Practical Radiation Oncology
Author(s): Kapur Ajay, Adair Nilda, O' brien Mildred, Naparstek Nikoleta, Cangelosi Thomas, Zuvic Petrina, Joseph Sherin, Meier Jason, Bloom Beatrice, Potters Louis
IntroductionModern external-beam radiotherapy treatment-delivery processes potentially increase the number of tasks to be performed by therapists and thus opportunities for errors. Yet the need to treat a large number of patients daily requires a balanced allocation of time per treatment slot. The goal of this work was to streamline the underlying workflow in such time-interval constrained processes to enhance both execution efficiency and active safety surveillance using a Kaizen approach.Methods and MaterialsA Kaizen project was initiated by mapping the workflow within each treatment slot for three Varian TrueBeam (TB) linear accelerators. Over 90 steps were identified and average execution times for each measured. The time-consuming steps were stratified into a 2x2 matrix arranged by potential workflow improvement versus the level of corrective effort required. A work plan was created to launch initiatives with high potential for workflow improvement but modest effort to implement. Time spent on safety surveillance, and average durations of treatment slots were used to assess corresponding workflow improvements.ResultsThree initiatives were implemented to mitigate unnecessary therapist motion, over-processing of data and wait-time for data transfer defects respectively. A 4th was implemented to make the division of labor by treating therapists as well as peer-review more explicit. The average duration of treatment slots reduced by 6.7% in the nine months following implementation of the initiatives (p-value 0.001). A reduction of 21 % in duration of treatment slots was observed on one of the machines (p-value <0.001). Time spent on safety reviews remained the same (20% of the allocated interval), but the peer review component increased.ConclusionsThe kaizen approach has the potential to improve operational efficiency and safety with quick turnaround in radiotherapy practice by addressing non-value adding steps characteristic of individual department workflows. Higher-effort opportunities are identified to guide continual downstream quality improvements.



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