Session Item

LEAN project was undertaken to implement Lean Management (LM) principles to improve workflow, identify and eliminate wastes in radiotherapy. This is important in centers with a huge patient volume and/or LINAC change. The value of the study was defined as achieving patient satisfaction and quality through the timely delivery of treatment, and specifically “patient treated on time”.

LEAN project was conducted in the Center GenesisCare Radiation Oncology at Toledo, Spain (April-October) where 70 patients were treated per day and a new LINAC was installed in February 2019. The project has been developed in two phases:

1) Observation: (February-March): the workflow and sources of waste were recorded.

2) Continuous Improvement: (April-October) we worked in:

Identification: Radiation technicians were trained in daily collected patients treated “on time” (green) and those who had suffered delay (red) on a blackboard and the reasons.

Plan: The team analyzed the causes of delay to propose solutions. They realized that more than the 50% of patients were pelvic tumors and the major cause of the delays.

Execute and Review: then one of the actions carried out was for pelvic tumors during August-October 2019 (8 weeks). Patients were instructed by nurses in how to drink the water daily before their session, dietary measures (empty rectum) and clothes recommendations (garments with elastics at the waist and comfortable shoes without laces).

All patients comments and concerns were collected and they were related to feel ashamed to undress in front of the radiotherapy technicians (31.8%), difficulty with shoes (22.7%), no place in the LINAC to leave objects (13.6%), the necessity of using rectal catheter (40.9%), the use of crutches and obesity (9%). Usually problems appeared in patients over 70 years and they were solved with training during the treatment process.

The real effectiveness of LEAN project implementation is that at the beginning of April 52% of the all the patients were treated “on time” and in mid-October became 92%. Regarding the pelvis tumors patients, in which specific actions were taken, the number of patients treated “on time” increase from 69% to 87% in 8 weeks (August-October).

After the daily analyzed, the causes of treatment delays could be resolved with a better redistribution of the LINAC agenda to manage the ambulance transportation problems and, in pelvic tumors patients, a more intense training about bladder, rectum, and dress preparations.

Applying LM principles is a promising technique to identify sources of waste and streamline workflow in healthcare delivery.

Although not all wastes were completely suppressed, they were reduced with LEAN project and if incidents are limited the patients are treated “on time”.

The change of pelvic tumors protocol affects all the patients’ treatments.

Overall patients’ satisfaction and workflow has improved by 40% with the project implementation.