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Innovative UBC-BC Cancer Agency system reduces waitlisting for chemotherapy patients

The stress of scheduling chemotherapy treatments has been substantially reduced by a new technology created and implemented by a team of researchers from the Sauder School of Business at the University of British Columbia and the BC Cancer Agency.

Called Chemo SmartBook, the innovative new scheduling system was recently awarded an Excellence in BC Health Care Award from the Health Employers Association of British Columbia in the category of "Top Innovation Health Authority."

Since its June 2010 launch by the BC Cancer Agency at its Vancouver Centre, Chemo SmartBook has reduced the number of patients who receive fewer than seven days notice of an appointment by 58 per cent and decreased the number of waitlisted patients by 84 per cent.

Chemo SmartBook employs mathematical optimization techniques similar to those driving the complex schedules of airlines and manufacturing companies. Its computer-based system automatically assigns patients to nurses, balances workloads, alerts pharmacists of daily schedules and meets patient appointment preferences. An easy to use web-based interface was created to allow schedulers to arrange and communicate appointments, often immediately after chemotherapy is prescribed.

These innovations replaced a daunting paper-based scheduling system that required clerks to arrange more than 60 appointments a day, while keeping in mind the mixing of drugs, the balancing of workloads and the availability of equipment. The system was stretched and patients were frequently unable to learn when they were to receive treatment at the time it was prescribed.

"In a large percentage of cases, patients were being notified as little as one day in advance of their appointments," says Sauder Prof. Martin Puterman, who first identified the need for the project while navigating the treatment process with his wife who had been diagnosed with breast cancer.

"I wanted to help reduce patient stress by letting them know well in advance when to expect their chemotherapy and I knew we had the skill in operations research at Sauder to work with the BC Cancer Agency to make it happen," says Puterman, who is a professor in operations and logistics at Sauder, and research director at the UBC Centre for Health Care Management.

The BC Cancer Agency Vancouver Centre delivers 15,000 chemotherapy treatments to more than 2,000 patients each year. With this large and growing client base, clinicians were aware of the need to streamline their scheduling processes.

They welcomed Puterman's 2009 proposal to have Masters of Management in Operations Research students tackle the challenge as an industry project arranged by Sauder's Centre for Operations Excellence. The students, along with faculty, graduates and post-doctoral fellows, worked closely with BC Cancer Agency staff to create a system that decreases administrative duties and increases time for patient care.

"SmartBook has been a very successful and effective collaboration," says John French, Senior Director, Operations, Business and Strategic Planning for the Radiation Therapy Program at the BC Cancer Agency. "It has allowed our staff to better focus on patient care, which makes their job much more rewarding and enhances our patients' experience, ultimately improving patient satisfaction."

An evaluation of the SmartBook's impact reveals that most patients were not only being scheduled with appointments faster, but that efficiencies it created were producing greater capacity in the system. There was a 55 per cent decrease in the number of working days patients were likely to wait to for their first treatment, and a 37 per cent decrease in the number of days with appointment requests that exceeded availability.

"It's very rare for a business school to affect medical practice in such a significant way," says Puterman. "But through this collaboration, we demonstrated that what we do at Sauder can have a major impact on challenges facing Canada's healthcare system."

The project has been presented internationally to academic and healthcare audiences, including Stanford University, the University of Michigan, Mayo Clinic, and the University of Chicago Medical Center. The Sauder-BC Cancer Agency team is hoping to extend the system to all five of the BC Cancer Agency regional cancer centres across B.C. and explore how it can be implemented in other jurisdictions in Canada and the United States.


University of British Columbia

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