Towards High Reliability and Value Creation in Radiation Oncology Departments

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Funding Agency: University of North Carolina Health Care System; Elekta Limited, and Accuray CyberKnife

Title: Towards High Reliability and Value Creation in Radiation Oncology Departments

PIs: Lukasz Mazur (PhD) and Lawrence Marks (MD)

Co-PIs: Prithima Mosaly (PhD), Bhishamijt Chera (MD)

The grand challenge for radiation oncology centers is to develop highly reliable systems that deliver value to every patient. Value from the patient’s viewpoint is the provision of service that provides maximum therapeutic benefit with the least amount of cost, harm and effort. It has been simply described as the ratio of ‘Benefit’ to ‘Bother’. Value is tightly linked to reliability and quality. Highly reliable systems are designed to deliver the service efficiently, effectively, predictably and at the lowest cost. The opposite of value is waste. In a world of limited time and resources, any waste within the system serves (at least) as a distraction and (more often) as a hindrance to reliability and quality. We define waste broadly, and on all levels, such as:

  • Organizational (e.g. unclear or conflicting goals, unnecessary meetings, redundant/ambiguous policies, insufficient training of personnel, etc.).
  • Workplace (e.g. poor lighting, slow/cumbersome computer systems, cluttered clinic rooms, missing/broken equipment, interruptions, etc.).
  • People (e.g. decisions leading to unnecessary tests or evaluations, rushing, unnecessary workarounds, etc.).

Besides leading to lost time, rework, and excessive rechecking, waste also creates anxiety, frustration, poor communication and low employee satisfaction. The relentless elimination of waste in any form and shape will enable the ready delivery of value and quality-care to the patient.  This, this research is about how do we get there? We study concepts borrowed from high reliability and value creation organizations that can help guide radiation oncology centers towards culture of patient safety.

Journal Publications:

Mazur, L.M., Mosaly, P., Jackson, M., Chang, S.X., Burkhardt, D.K., Adams, R., Jones, E.L., X., J., Rockwell, J., and Marks, L.B. "Quantitative Assessment of Workload and Stressors in Clinical Radiation Oncology”, International Journal of Radiation Oncology, Biology and Physics, 2012; Accepted Jan 20th, vol. 83, no. 5; pp. e571-e576p.

Mazur, L.M., Prithima, Hoyle, L., Jones, E., and Chera, B., and Marks, L.B. “Relating Physician’s Workload with Errors during Radiotherapy Planning”, Practical Radiation Oncology, published online 19 July 2013

Chera, B.S., Mazur, L.M., Jackson, M., Taylor, K., Mosaly, P., Rockwell, J., Adams, R., Chang, S., Deschesne, K., Marks, L.B., “Quantification of the Impact of Multifaceted Initiatives Intended to Improve Operational Efficiency and the Safety Culture: A Case Study from an Academic Medical Center Radiation Oncology Department Practical Radiation Oncology”, Practical Radiation Oncology, published online 01 July 2013.

Mazur, L.M., Prithima, Hoyle, L., Jones, E., and Marks, L.B. “Subjective and Objective Quantification of Physician’s Workload and Performance During Radiotherapy Planning Tasks”, Practical Radiation Oncology, published online 25 February 2013.

Mosaly, P., Mazur, L.M., Jones, E., Hoyle, L., Chera, B., Zagar, T., MD, Marks, L.B. “Quantification of Physician’s Workload and Performance during Cross-coverage in Radiation Therapy Treatment Planning”, accepted to Practical Radiation Oncology, Practical Radiation Oncology, published online 24 April 2013.

Marks, L.B., Jackson, M., Xie, L., Chang, S. X., Burkhardt, K.D., Mazur, L. M., Jones, L. M., Saponaro, P., LaChapelle, D., Baynes, D. C., Adams, R. D., “The Challenge of Maximizing Safety in Radiation Oncology”, Practical Radiation Oncology Journal, vol. 1. no. 1; pp. 1-14, 2011.

Chera, B.S., Jackson, M., Mazur, L.M., Adams, R., Chang, S., Deschesne, K., Cullip, T., Marks, L.B., “Improving Quality of Patient Care by Improving Daily Practice in Radiation Oncology”, Seminars of Radiation Oncology Journal, vol. 22, no. 1; pp. 77-85.

Evaluation of Lean Implementation Efforts in Rural Hospitals

Funding Agency: The North Carolina Office of Rural Health and Community Care (ORHCC) - Department of Health & Human Services (DHHS).

Title: Evaluation of Social Connectedness, Change Management, Individual Readiness for Change, and Execution of Lean Practices for Quality Improvement in Rural Hospitals.

PI: Dr. Lukasz Mazur Co-PIs: Dr. John McCreery and Dr. Lori Rothenberg

Description: This research was focused on examining the informal social networks, change implementation processes, leadership styles and behaviors, individual readiness/learning, and execution of Lean practices exhibited during organization-wide Lean transformation initiatives.

Pragmatic Evaluating of Toyota Production System (TPS) Analysis Procedure for Problem Solving with Entry-Level Nurses and Industrial Engineers

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Funding Agency: Bozeman Deaconess Hospital (BDH, Bozeman, MT).  

Co-PIs: Dr. Lukasz Mazur and Dr. Gary Chen 

Description: Many medical and industrial engineering students gain an undergraduate/graduate degree without being properly exposed to quality improvement knowledge/methods/tools. In addition, relatively few healthcare professionals in industry are equipped to analytically view their work processes as a system or appreciate the relevance and benefits of systems engineering approach to process improvement and product development. This research project in education included three parallel pathways:The first was to increase the understanding of systems analysis performed either individually or in interdisciplinary teams. The second was to evaluate various systems engineering methods and learn how such methods affect the student’s individual and cooperative abilities to analyze and solve system problems. The third was to identify the individual and collaborative skills needed for future students to solve system related problems and determine how these skills can be developed.

Test of Toyota's 'DNA' in Medication Delivery Systems

Funding Agency: Bozeman Deaconess Hospital (BDH, Bozeman, MT).

Co-PIs: Dr. Lukasz Mazur and Dr. Gary Chen

Description: In general, simplifying and standardizing healthcare delivery processes can greatly reduce the likelihood of errors and unnecessary rework, while promoting creativity and innovation. This research project focused on discovering the fundamental principles that can be attributed to successful implementation efforts targeting process simplification and standardization in order to achieve higher quality in medication delivery systems. In addition, due to enormous gaps in knowledge related to implementation strategies of improvement programs, this research project also focused on understanding the phenomena needed to stimulate and sustain the desired/effective organizational behaviors and learning by professionals with regard to medication delivery routines.