Radiation Oncology: A LEAN Michigan Quality System Machine

When it comes to a cancer diagnosis, time is of the essence. That’s probably why Radiation Oncology’s first lean project meant so much to patients with bone and brain metastases—it reduced multiple trips over multiple days into same-day service and quicker access to treatment.

In the past, such patients would usually come in for a consultation, go home, come back for radiation planning, go home, and then come back to receive their first treatment. The process meant three trips to U-M for the patient, and a process that could take up to a week. Some patients—about 43 percent—did get all of this done in one day during one visit, but each case took a lot of effort. The system needed help.

So the Department faced a challenge: getting same-day treatments for more patients in a way that wouldn’t overburden faculty and staff.

Kathy Lash, R.T.T., director of clinical operations, Radiation Oncology, and Theodore S. Lawrence, Ph.D., M.D., chair of Radiation Oncology and the Isadore Lampe Professor of Radiology, formed a team of 16 to work together to think lean and improve their process.

“All of us thought we knew the processes, but it turned out we all had different perceptions,” says Lash. “You have to get cross-functional groups together. You have to get out into the workplace. And you have to become engaged in the processes.”

The team developed a standard method of scheduling and preparing all the inputs to the process (medical documents, imaging studies/reports, physician notes, insurance information). This reduced the number of process steps from 27 to 16.

“This same-day treatment has not meant more work for us,” Lawrence says. “On the contrary, by standardizing our processes, we are doing today’s work today, doing it once and doing it right. The staff were empowered by making these improvements, and the patients arem pleased to start treatment right away. Everyone—patients, staff and doctors—has benefited from this program.”

“We now do same-day treatment essentially 100 percent of the time for patients who want it,” adds Lash. “This is about 94 to 96 percent of our total patients.”

If you are thinking about going through the lean process, just do it. According to Lash, “A lot of times, people think we’re adding work by collecting data. But the lean tools—data collection and mapping out the current state of affairs—help make the work visible.” And that is key to making improvements.

To date, Radiation Oncology has taken on four more official lean teams and many more small workgroup teams to improve systems for patients, and increase faculty and staff satisfaction.

Learn more about lean and the Michigan Quality System.