Background: A multi-disciplinary team from the Peter MacCallum Cancer Centre in Melbourne, Australia developed a performance data suite to support a service improvement project based on lean manufacturing principles in their 19 chair Chemotherapy Day Unit (CDU), and Cytosuite chemotherapy production facility. The project aimed to reduce patient wait time and improve equity of access to the CDU.
Methods: A project team consisting of a pharmacist and a CDU nurse supported the management team for 10 months in engaging staff and customers to identify waste in processes analyse root causes and eliminate non-value adding steps, reduce variation and level workloads to improve quality and flow. Process mapping, staff and patient tracking and opinion surveys, chart audits, and interrogation of electronic treatment records were undertaken.
Results: This project delivered a 38% reduction in median wait time on the day (from 32 mins to 20 mins, p<0.01), a 7 day reduction in time to commencement of treatment for patients on combined chemo-radiotherapy regimens (from 25 days to 18 days, p<0.01) and a 22% reduction in wastage associated with expired drug and pharmacy rework (from 29% to 7%, p<0.01). Improvements in efficiency enabled the Cytosuite to increase the percentage of product manufactured within 10 minutes of the appointment time by 29% (from 47% to 76%, p<0.01).
Conclusion: A lean improvement methodology provided a robust framework for improved understanding and management of complex system constraints within a CDU resulting in improved access to treatment and reduced waiting times on the day. In acknowledgement of the potential for broader application of these learnings, the Victorian Department of Health's Cancer Strategy branch has recently commissioned a multi-site redesign collaborative project with eight participating chemotherapy day services accross metro and regional Victoria.