In the Netherlands, first-rate care pathways have been developed for various types of cancer. The only drawback is that patients cannot receive the full benefit of this care if they have to wait – unnecessarily – before they receive treatment. However, this waiting time can be greatly reduced through the use of multidisciplinary appointment planning. This is according to Gréanne Leeftink, who works at the University of Twente’s CHOIR research institute. On Friday 15 December, she will be awarded a PhD by the Faculty of Behavioural, Management and Social Sciences for a PhD thesis entitled: Why Wait? – Organizing integrated processes in cancer care.
In oncological care, patients often have unnecessarily long waits before they receive their treatment, even if a diagnosis has already been made. That can be prevented by effective planning, says Ms Leeftink, whose PhD research focused closely on the steps that patients have to take in the context of cancer care. There is a way to optimize this entire care chain, however. Rather than viewing it in isolation, we should incorporate aspects of the care given to non-oncological patients. Cancer care makes frequent use of shared resources. However, when reserving capacity, it is vital to ensure that this does not impact other patients, wherever possible. So, as a technical business specialist, this PhD candidate is advocating an integrated approach. In addition to the quality of care, both the work process and productivity need to be improved. Aside from benefitting patient care, this will help to create a healthy working environment for the staff. This, in turn, will yield further benefits for patients.
Histopathology
One third of the population of the Netherlands will, at some stage, be diagnosed with cancer. Many of these patients are offered a process to speed up that diagnosis. However, that demands great flexibility from the various disciplines involved. Basing her approach on models derived from mathematics and stochastics, Gréanne Leeftink monitored the course of one such care pathway through a histopathology laboratory. In the lab, urgent orders for cancer patients interrupt the regular workflow. This can greatly increase both the staff’s workload and the time required to process tissues.
Time savings
Ms Leeftink developed a method to improve logistics in the histopathology laboratory. This method takes account of manual processes for single tissue samples and automated processes for batches of tissue samples. By minimizing the throughput time for all tissues in the laboratory (20% reduction), this method facilitates rapid diagnosis, while evening out the technicians’ workload (50% reduction). Potentially, the greatest time savings involve the bulk processing equipment. These machines handle large batches of samples and automate some laboratory processes. If this equipment is started up at certain times of the day, the histopathology laboratory can achieve a 25% reduction in processing time. The Utrecht University Medical Center (UMC Utrecht) has now implemented these recommendations in their daily work processes.
Appointment schedules
Another small-scale study involved the procedures used in a specialized oncology outpatient clinic. Here, a multi-disciplinary approach is used to generate a treatment plan for patients who have been diagnosed with cancer, in the course of a hospital visit. When the patients arrive at the clinic, neither they nor anyone else has any idea about a possible treatment plan. Gréanne Leeftink developed a stochastic model that determines a schedule blueprint for the specialists involved. This method helps the specialists involved to understand the factors to be considered when setting up multi-disciplinary consultations. On the one hand, this approach means time savings for patients and less overtime work for specialists. On the other hand, it does require specialists’ schedules to be flexible. The newly-developed method enables this assessment to be made consciously and in a structured way. It has been used to create robust appointment schedules for one of UMC Utrecht’s specialized cancer clinics.
Planning solutions
Ms Leeftink’s PhD programme included several months of research at the Mayo Clinic in the US. Her aim was to demonstrate that the methods and solutions used are widely applicable. There she showed that, despite the differences in care systems and types of hospital, the underlying structures are comparable. Thus patients in the US and in the Netherlands can benefit from the same multi-disciplinary planning solutions. One eventuality these planning solutions take into account is when patients fail to show up or cancel their appointment. To keep this to a minimum, appointments are planned for times that are convenient for the patient.
Gréanne Leeftink
Gréanne Leeftink works at the University of Twente’s Center for Healthcare Operations Improvement & Research (CHOIR). As part of her PhD research, she worked part-time at the UMC Utrecht. She also spent three months doing research at the Mayo Clinic, a prestigious hospital at Rochester, Minnesota. At the beginning of 2017, she was selected to attend the Global Young Scientists Summit 2017 in Singapore: https://www.utwente.nl/nieuws/!/2017/1/38204/drie-jonge-uters-bij-top-in-singapore. Ms Leeftink’s PhD defence coincides with the ‘Healthcare Logistics: Balancing Between Practice and Theory’ conference, which is to be held at the University of Twente from 13-15 December. For more information: https://www.utwente.nl/en/choir/events/SymposiumBalancingPracticeTheory/
