A synthesis of systems engineering tools to improve patient safety, quality and efficiency in health care

Cancer occurrence has given rise to high risks and deaths of patients all over the world. The consistent negative impact of cancer on humans have spurred healthcare providers and administrators to judiciously search for better options to treat and manage cancer patients. One of such treatment modalities that is safe, cheaper and effective is Radiotherapy. However, due to the technological advancement of treatment options which involved multi-systems and different professionals, have inadvertently created new pathways for multiple Radiotherapy incidents to occur during patient treatment. Consequently, patients have been affected in various ways: from minor to severe injuries, and in even deaths were recorded significantly in many cancer centres in the world. Even though numerous improvement measures have been developed over the years to mitigate and minimise the impact of errors and mistakes caused by Radiotherapy treatment systems and humans on patients; still, Radiotherapy incidents at various levels continued to occur prevalently in the globe. Following from the above, this study is aimed at integrating Systems Engineering tools, such as Lean Management (LM), Lean Six Sigma (LSS), Total Quality Management (TQM) / Plan-Do-Check-Act (PDCA), Benchmarking and Human Factors Engineering (HFE) with a view to developing a simplified framework that can improve the Quality, Safety and Efficiency of healthcare. The lack of standard quality improvement initiatives to address the issues of patient safety, quality of care and process efficiency mostly due to modern technological complexities, which often led to errors and mistakes, is a serious concern to healthcare providers and management. Thus, there is a need for the development of a comprehensive framework for clinical utilisation of difficult technology and process inefficiencies. The study utilised both quantitative and qualitative methodologies: namely, a Single Case Study, Questionnaire and Benchmarking Case Study, which were adopted to answer the central research question vis-à-vis the study’s objectives. The varied research methodologies employed in this study, supported by the outcomes of the literature review, provided the mechanisms for the development of a framework, called the Radiotherapy Lean (RADLean) Improvement Blitz. This framework is a holistic integration of Systems Engineering tools with the core purpose to streamline Processes, improve Patient Safety, Quality and Efficiency with lower costs. Also, it will act as a catalyst in encouraging and stimulating organisations cultural change from top management down to lower employees. The RADLean Blitz Improvement framework is proactively and reactively designed robustly to respond and address issues that likely to affect Patient Safety, Process Efficiency and Quality of Patient care that might manifest in the systems during the routine patient treatment process. The framework is developed holistically on the following initiatives; namely, IDEFØ Technique, Lean Management tools, Total Quality Management / Plan-Do-Check-Act tools, Lean Six Sigma methodology and Human Factors Engineering techniques. It composed of four primary high-level phases: (1) Identification of Drivers, Strategic Goals &amp; Operational Objectives, Need for Improvement and Management final Approval; (2) Engagement of Stakeholders, Gap Analysis, Team Formation, Metrics Identification; (3) Management Commitment &amp; Support, SWOT Analysis, Training of Improvement Tools; (4) and Correct Plans if required Improvement Readiness, Experts’ Reviews &amp; Change Control, Systems and Controls. These four phases are further sub-divided into six interactive implementation stages for effectiveness: Assess, Plan, Ratify, Improve, Control and Standardise (APRICS). The framework was verified and validated through three known stages: the first stage involved validation of the RADLean Toolbox using DELPHI Techniques of experts’ review cycle, underpinned by IDEFØ technique grounded on two Kelly’s quality measurement factors; the second stage entails Kelly and Ijomah combination of quality measurement factors, while the last stage consisted of the interactive session of experts’ panel. The verification and validation were carried out in order to identify the strength, weaknesses, opportunities and threats (SWOT) of the framework and to strengthen it for wide-scale usage. Hypothetically, with the developed framework, patients are expected to receive Radiotherapy services in a reasonable timeframe, which can be achieved through routine safety performance awareness; hence errors and hazards will be easily identified and resolved without difficulties. Thus, improving Quality, Safety, Efficiency and Reliability while minimising costs.