Proud of high scores in patient centeredness Marjolein van Os

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On International Nurses Day, May 12^th - the birthday of Florence Nightingale – a guest post is provided by Marjolein van Os. Marjolein is team leader of a team of technicians, preparing and treating patients on some of our linear accelerators and is a senior research technician. She is also a board member / member of the Scientific Committee of the RTT-section within the European union EORTC / ROG. She has worked in Erasmus MC - Daniel den Hoed Radiation Oncology since 1990.

With Marjolein van Os at one of our linear accelerators

In 2009, the course headed by the radiotherapy department at Erasmus MC changed radically. The number of patients needing our care kept rising, the department was about to expand in the form of an extra facility in the more southern town of Dordrecht, but the number of staff (in our case: Radiation Therapy Technologists) did not grow evenly. That was not to stop the expansion rate however: new managers were to set out the new course. In got Freek, amongst others. With his Toyota. Not just as a means of transportation but more so as the new yardstick. The principles of the Toyota Production System, meanwhile, proved applicable in health care elsewhere (our radiation colleagues in Maastricht were pioneers). Working ‘lean’ would require less staff, get more patients treated and would prove to be fun. Yeah, right....

The statement ‘lean’ could accomplish all that, met with quite fierce resistance. Measures about to be taken were seen as covert budget cuts and people resisted to budge. The radiation oncology department within Erasmus Medical Center is largely based in and known as the ‘Daniel den Hoed clinic’ and has a very high standard and name for its patient centeredness. Of which we are all very proud. And we’re not going to have that status thrown down our Meuse River for the sake of being more efficient.

After 2 years, lots of talks, experiments and headaches, I'd say we have now started to converge Lean and patient centeredness. Lean is a means by which you can achieve a lot within any organization. We have learned it is a method, not an end in itself. He ends have to be specified by ourselves. Lean helps to look at our own work as an outsider: is every step I take purposeful. Is this helping me to achieve my ends? And if not it’s wasted effort. And waste must be eliminated. So logical, so simple, so effective. And I did not believe any of it but: it is ever so easy to unite those principles with patient centeredness. It took us a lot of learning to reach that conclusion but we did. We’ve started to look at our work and our processes from the goal: are we creating patient value? We’re still trying to get used to asking this question. What’s in it for our patients? Nothing? Well, there’s a waste identified. Don’t know? Let’s ask our patient. You want something from the treatment menu? Or be processed ASAP?

This seems to be our key to success: reach out and involve one another. Applying lean principles can not be done individually. It needs teams. It needs time. But it can accomplish great ends.

Since last year the Dordrecht facility is up and running. On may of our linear accelerators we work with one RT Technician less than we did before. Work has been organized better and it’s less hectic. Yeah, right! And the best part is: patients still value our care as high standard in patient centeredness.

On this 12^th of May, International Nurses Day (and all other workers in healthcare), I can sincerely state that, after 20 years of working in Radiation Oncology, I’m still very pleased with and proud of what I do.