National Quality Improvement in Radiation Therapy: A Look at the Past, Present, and Future

Abstract

The concept of continuous quality improvement (QI) in health care was borrowed from the business sector and coined under the umbrella of total quality management by quality gurus such as Philip Crosby, W. Edward Deming, Armand V. Feigenbaum, Kaoru Ishikawa, and Joseph Juran [1]. The focus back then was on the tools, techniques, and systems used for businesses to achieve QI. Over time, this concept broadened to incorporate values and behavioural practices such as empowerment, teamwork, participative management, continuous improvement, and culture change. In 1996, Huq and Stolen [2] suggested that the concept of total quality management was generic enough to be extended into all industry sectors, including health care. Deming’s process improvement cycle helps conceptualize the components of successful QI implementation. These include a planning phase, an implementation phase, a studying/measurement phase, and then acting on identified gaps to make change [3]. However, before we can clearly appreciate what successful QI implementation looks like, we need to be clear on how we are defining QI in health care, and this definition has evolved over time. Accordingly, the landscape of ‘‘successful QI’’ in health care has also evolved over time. Here are a few examples of this evolution in the context of radiation therapy services in Canada. In 2001, the Institute of Medicine suggested that QI initiatives should focus on safe, effective, patient-centred, timely, efficient, and equitable care [4]. This definition is a very tactical description of elements that should be embedded within QI strategies. Based on this definition, we observed how the national and provincial governments of Canada interpreted corresponding outcomes of success as seeing more patients, seeing them faster, and incentivizing provider behaviour in that direction. For example, in 2004, there was $5.5 billion provided nationally to reduce wait times for five areas in the health care system, including radiation therapy [5]. As a result of this, public reporting for patient wait times in Canada was born and was