Managing logistics within a specialist cancer treatment centre. Karen Diment, Service Improvement Manager (Radiotherapy) Andy Warburton, Senior software developer, Velindre Cancer Centre, Cardiff, Wales, UK Assessment of the Problem: Lessons learnt: For further information ; Measurement of improvement following initial pilot: The radiotherapy pathway processes are complex as they cross numerous team and departmental boundaries at several different points in the patient pathway. A paper referral form was the start point for the process and its purpose was to enable the patient to be appropriately scheduled, planned and treated. There were several serious concerns with the paper form process. Strategy for change: Data omissions and errors on the referral forms resulted in inappropriate scheduling. 18% of patients scheduled to attend for radiotherapy required re-scheduling. It was impossible for relevant staff groups to view the progress of the patient through the process without viewing the paper form – which may be in a variety of locations. Delays in the form moving from person to person, department to department. No forms have been lost using the new system. Referrals captured instantly at one single entry point, eliminating batching. Visible referral and target dates allow prioritisation, ensuring patients are treated in turn. Improved efficiency by eliminating latent time transferring the form between departments and personnel. All relevant staff members can see the progress of the patient, ensuring complete transparency to previously unclear processes. Research and brainstorming demonstrated that an electronic referral and tracking system for radiotherapy referrals was a potential solution. Benchmarking indicated that this concept was not widely used elsewhere in the UK and the solution would need to be internally developed. In addition LEAN principles were applied to the scheduling processes, to reduce waste and develop a logical flow. Significantly increased consistency of data entry and completion due to auto populated fields and standardised pick lists. Redesign of the scheduling process was essential to facilitate automation & to support a “pull” process. This required a change of cultural practice and proved to be the most difficult aspect of this improvement. Development, pilot and roll out have taken longer then initially expected and maintaining buy-in from staff has also been challenging. It will however soon be possible to capture data in all sections of the process, enabling identification of constraints & bottlenecks – leading to future improvement projects. Appointments were generated by a variety of staff groups resulting in routine batching of paper forms in a variety of locations, and out of turn scheduling of appointments. The form going missing resulting in at least duplication of the form, at worst a patient being “lost” from the system and having their treatment delayed with the possible adverse consequences.