Radiotherapy: Review of increasing capacity of facilities
The NSW Audit Office review in 2009 also recommended that NSW Health assess options for increasing the capacity of radiotherapy facilities, which might include the feasibility and ‘value for money’ of extended hours operation. CHSD was commissioned to undertake a targeted literature review to assist NSW Health in responding to this issue.
The issues regarding the ‘extended hours’ were first considered by the Department in 1993 and a Business Process Improvement project was undertaken for radiotherapy services was completed in 2009. This demonstrated that improvements in efficiencies can be realised with existing infrastructure by improvements in operational processes and as part of planning a quality comprehensive cancer service.
There are many factors that influence the model of care and service delivery of radiotherapy, so the targeted literature review focused particularly on the feasibility and ‘value for money’ of extended hours operation. The options for increasing capacity of radiotherapy facilities fall broadly under three headings:
1. Increase the number of linear accelerator machines available
2. Work existing machines smarter
3. Work existing machines harder
Option three is the most relevant as NSW Health already has strategies underway for options one and two. Approximately 50% of the cost of running a radiotherapy service is attributable to staff and 30% to equipment and maintenance costs. The remaining 20% includes cost inputs relating to space, materials and departmental overheads.
Radiotherapy facilities, like most outpatient departments, have traditionally based appointment times around a 9.00 am to 5.00 pm, five day working week; however some facilities are introducing extended hours to more effectively manage patient workflow. To extend the working hours means that the existing pool of linear accelerators will need to be run for longer periods.
This option is reliant on an available and appropriately skilled workforce, so the availability of staff and appropriate skills mix will be the rate limiting factor for many localities seeking to increase productivity and or utilisation of equipment, through extended hours. If the demand for radiotherapy is increasing faster than the rate trained radiographers become available, then one of the main constraints to radiotherapy capacity is the number of radiographers available.
Determining the feasibility and ‘value for money’ of extended hours operations must balance many competing factors – finding a balance between optimum patient access and the available human and financial resources is the challenge.
Thompson C, Grootemaat P, Fildes D and Gordon R (2011) Increasing Capacity of Radiotherapy Facilities through Extending Working Hours: Findings of a Targeted Literature Review. Centre for Health Service Development, University of Wollongong.