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.
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.