The standard for Head and Neck Oncology requires 80% of patients who report to this department to begin treatment within 30 days. Previously, this was a major challenge as the various steps in the care process had to be carried out consecutively. However, a drastic reduction in the duration of the diagnostic phase was key to achieving this goal.
Patients would be registered on a Monday or Friday and then see three different doctors. In the weeks that followed, tests and scans would be carried out, some of which determined when the next one would be scheduled. As a result, it would take the treatment team several weeks to make a diagnosis and plan treatment. There was a great deal of waiting time between tests and scans, meaning patients were kept waiting for far too long.
Optimization of the intake clinic
Previously, improvements had been carried out in a quite fragmented manner, focusing on single elements. These improvements made a difference, but frequently caused other problems. In May 2016, with the support of the Operational Excellence unit, we initiated a project to optimize the intake clinic. As a result, the duration of the diagnosis phase was significantly reduced.
Now, patient intake is always on Mondays, and the patient will then see the three different specialists at the same time. Because we speak to and examine the patient as a team, we can often make a quick and accurate estimate of what will be the right course of treatment for the patient. The necessary examinations, scans, and ultrasounds then take place on the same day or on the Tuesday. By Wednesday, all of the results are available to the team and in principle, the patient can be informed of both their diagnosis and the treatment required. As a result, the patient is never waiting more than one week for their intake and in the majority of cases, the diagnostic phase is completed within three days.
"Sometimes you have to really shake things up to get them working optimally. And once you do, you can't help but wonder why you never did it this way before.”
We save so much time because we can hold our multidisciplinary meeting on the first day of the intake and schedule tests at lightning speed using reserved timeslots. After all, by Friday, we know how many patients will be coming next week.
A decisive factor in this project was the involvement of the Radiology department. It really is impossible to underestimate how useful that was, especially as we needed to organize everything on the Monday and complete the tests within two days. You can't do this on your own – the other departments must also examine ways to optimally satisfy demand. We still perform the same number of scans for every patient, it's just that the scheduling is much better. The challenge is getting everyone to work together on logistical solutions and make optimal agreements, and a shared sense of value for patients lays excellent foundations for these solutions.
The project required a great deal of thinking outside the box. The initial resistance that accompanies any change was handled smoothly. And resistance is understandable, as on the surface reducing the number of weekly intake opportunities from two to one appears to be a loss rather than a gain. People didn't believe in the system straight away, so how do you convince your colleagues of its value? You have to clearly show how time is saved based on well-founded assumptions, and you have to expand your horizons. A working visit to Nijmegen – where the system works very effectively in practice – helped boost the project group's enthusiasm.
After substantially shortening the diagnostic phase, we turned our attention to the second phase: treatment. Radiation therapy can be started very quickly, but if a patient needs an operation, then the Surgery department's waiting list can cause problems, especially during busy periods. As a follow-up to the successful intake project, Head & Neck Oncology was selected as one of the care paths in which hospital-wide innovation will be conducted.
Head and Neck Oncology projects
Registration at sourcePassengers 3 employees from Head & Neck, 3 employees from MIT/MUMC+DirectionsJourney
The objective of this project is uniform registration of patient-related data that can be entered once and used for multiple purposes. Within SAP, a 'head & neck document' has been created in which all important items can be recorded in a uniform and discrete manner (e.g. via drop-down lists or date fields). In this way, these parameters can be reused and automatically exported to the quality-control administration for the purposes of the DHNA (Dutch Head and Neck Audit) without having to enter them into the system multiple times. This saves a great deal of time.