Practical implementation of quality improvement for high-dose-rate brachytherapy

Schubert, Laura; Liu, Arthur; Gan, Gregory N.; Amini, Arya; Hutchison, Rebecca; Ernest, Janyce; Thornton, Dale; Stoehr, Scott; Hinman, Bonnie; Stuhr, Kelly; Westerly, D; Schefter, Tracey E.; Fisher, Christine M.

doi:10.1016/j.prro.2015.09.003

Cited by 9 publications

(4 citation statements)

References 24 publications

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“…Previous literature describes only isolated empirical implementations of PM in healthcare and the analysis of articles reviewed in our systematic literature review 21 shows that in most of these studies, the way in which PM exercises are conducted is poorly documented. 42,43 A few papers in the healthcare literature provide suggestions on how to conduct a PM exercise. 18–20 Detailed practical guidelines for PM both in the healthcare 7 and non-healthcare 16,17 field have also been developed by experts and practitioners.…”

Section: Introductionmentioning

confidence: 99%

The use of process mapping in healthcare quality improvement projects

Antonacci

Reed

Lennox

et al. 2018

Health Serv Manage Res

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Introduction Process mapping provides insight into systems and processes in which improvement interventions are introduced and is seen as useful in healthcare quality improvement projects. There is little empirical evidence on the use of process mapping in healthcare practice. This study advances understanding of the benefits and success factors of process mapping within quality improvement projects. Methods Eight quality improvement projects were purposively selected from different healthcare settings within the UK's National Health Service. Data were gathered from multiple data-sources, including interviews exploring participants' experience of using process mapping in their projects and perceptions of benefits and challenges related to its use. These were analysed using inductive analysis. Results Eight key benefits related to process mapping use were reported by participants (gathering a shared understanding of the reality; identifying improvement opportunities; engaging stakeholders in the project; defining project's objectives; monitoring project progress; learning; increased empathy; simplicity of the method) and five factors related to successful process mapping exercises (simple and appropriate visual representation, information gathered from multiple stakeholders, facilitator's experience and soft skills, basic training, iterative use of process mapping throughout the project). Conclusions Findings highlight benefits and versatility of process mapping and provide practical suggestions to improve its use in practice.

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Section: Introductionmentioning

confidence: 99%

The use of process mapping in healthcare quality improvement projects

Antonacci

Reed

Lennox

et al. 2018

Health Serv Manage Res

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“…Reviewed studies also show how if used throughout the entire project, PM can play a role in the success of improvement initiatives by supporting continuous improvement. In this respect, PM has been found to be particularly useful for clarifying the scope of projects, targeting the intervention and planning improvement actions [ 9 , 79 , 116 , 161 ]. Co-production and knowledge exchange.…”

Section: Resultsmentioning

confidence: 99%

Process mapping in healthcare: a systematic review

Antonacci

Lennox

Barlow

et al. 2021

BMC Health Serv Res

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Introduction Process mapping (PM) supports better understanding of complex systems and adaptation of improvement interventions to their local context. However, there is little research on its use in healthcare. This study (i) proposes a conceptual framework outlining quality criteria to guide the effective implementation, evaluation and reporting of PM in healthcare; (ii) reviews published PM cases to identify context and quality of PM application, and the reported benefits of using PM in healthcare. Methods We developed the conceptual framework by reviewing methodological guidance on PM and empirical literature on its use in healthcare improvement interventions. We conducted a systematic review of empirical literature using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) methodology. Inclusion criteria were: full text empirical study; describing the process through which PM has been applied in a healthcare setting; published in English. Databases searched are: Medline, Embase, HMIC–Health Management Information Consortium, CINAHL-Cumulative Index to Nursing and Allied Health Literature, Scopus. Two independent reviewers extracted and analysed data. Each manuscript underwent line by line coding. The conceptual framework was used to evaluate adherence of empirical studies to the identified PM quality criteria. Context in which PM is used and benefits of using PM were coded using an inductive thematic analysis approach. Results The framework outlines quality criteria for each PM phase: (i) preparation, planning and process identification, (ii) data and information gathering, (iii) process map generation, (iv) analysis, (v) taking it forward. PM is used in a variety of settings and approaches to improvement. None of the reviewed studies (N = 105) met all ten quality criteria; 7% were compliant with 8/10 or 9/10 criteria. 45% of studies reported that PM was generated through multi-professional meetings and 15% reported patient involvement. Studies highlighted the value of PM in navigating the complexity characterising healthcare improvement interventions. Conclusion The full potential of PM is inhibited by variance in reporting and poor adherence to underpinning principles. Greater rigour in the application of the method is required. We encourage the use and further development of the proposed framework to support training, application and reporting of PM. Trial Registration Prospero ID: CRD42017082140

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“…Seven large‐scale projects were enacted, resulting in 46 QI interventions. Large‐scale projects consisted of improvements to the (a) high dose rate (HDR) brachytherapy program, (b) total body irradiation (TBI) program, (c) use of bolus, (d) clinical electron setups, (e) risks of physical collisions throughout the department, (f) hands‐on department‐wide emergency training, and (g) use of optional software options to enhance safety.…”

Section: Resultsmentioning

confidence: 99%

Implementation and operation of incident learning across a newly‐created health system

Schubert

Petit

Vinogradskiy

et al. 2018

J Applied Clin Med Phys

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PurposeThe purpose of this work is to describe our experience launching an expanded incident learning system for patient safety and quality that takes into account aspects beyond therapeutic dose delivery, specifically imaging/simulation incidents, medical care incidents, and operational issues.MethodsOur ILS was designed for a newly created health system comprised of a midsized academic hospital and two smaller community hospitals. The main design goal was to create a highly sensitive system to capture as much information throughout the department as possible. Reports were classified according to incidents and near misses involving therapeutic radiation, imaging/simulation, and patient care (not involving radiation), unsafe conditions, operational issues, and accolades/suggestions. Reports were analyzed according to impact on various steps in the process of care. Actions made in response to reports were assessed and characterized by intervention reliability.ResultsA total of 1125 reports were submitted in the first 23 months. For all three departments, therapeutic radiation incidents and near misses consisted of less than one‐third of all reports submitted. For the midsized academic department, operational issues and unsafe conditions comprised the largest percentage of reports (70%). Although the majority of reports impacted steps related to the technical aspects of treatment (simulation, planning, and treatment delivery), 20% impacted other steps such as scheduling or clinic visits. More than 160 actions were performed in response to reports. Of these actions, 63 were quality improvement interventions to improve practices, while 97 were learning actions for raising awareness.ConclusionsWe have developed an ILS that identifies issues related to the entire process of care delivery in radiation oncology, as evidenced by frequent and varied reported events. By identifying a broad spectrum of issues in a department, opportunities for improvement can be identified.

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Practical implementation of quality improvement for high-dose-rate brachytherapy

Cited by 9 publications

References 24 publications

The use of process mapping in healthcare quality improvement projects

The use of process mapping in healthcare quality improvement projects

Process mapping in healthcare: a systematic review

Implementation and operation of incident learning across a newly‐created health system

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