MR-guided brachytherapy for cervical cancer: Quantifying process waste and identifying opportunities for system performance improvement.

Abstract

The aim of this study was to evaluate the current cervical cancer magnetic resonance-guided brachytherapy (MRgBT) process in the study institution and seek opportunities to improve efficiency and optimize quality of care. Eight procedures were observed where the time, location, and activities performed by health care professionals were recorded using Lean method principles. Wastes, as defined within Lean methodology, were identified during the observation. Workflow was illustrated by process maps. Milestone activities were identified for final time analysis. Finally, the research team developed solutions by eliminating wastes in the workflow. The mean procedure time ± standard deviation was 8.2 ± 0.41 hours, including 1.9 ± 0.18 hours spent on Lean wastes (84% waiting, 16% transportation). The most inefficient high-level activity was MRI with 1.1 hours spent on waiting and transportation. The parallel processing solution yields a 2.3 hours' time saving in each case. The optimal solution recommends an integrated MRgBT suite and dedicated human resource, yields a 4.1 hours' time saving (50% increase in efficiency) in each case. This was the first study to quantify the performance of an MRgBT process. This study can serve as a template for other brachytherapy process improvements.