Brief (0:30)

How have I delivered change in my service and what tools and techniques have I used to engage colleagues and overcome barriers to achieve the goal

So I’ll be talking you through a clinical audit I carried out as a treatment therapeutic radiographer when I was working in Lincoln

Idea (2.00)

So this was during my first year of clinical practice in radiotherapy - it became apparent that we might have been imaging our prostate patients unnecessarily.

For radiotherapy delivery you take an x-ray image to make sure the patient is in the correct position, then you move the couch from the control area outside the treatment room, then you treat

The protocol at the time was that if we imaged and we had to move the couch over 1cm (which is quite a lot in radiotherapy terms) we had to reimage to confirm the patient's position after we'd applied the couch move. We could then apply further moves of the couch if necessary.

I considered at the time that the 1cm threshold was arbitrary and the reimaging unnecessary. The idea was to carry out a small audit, to collect data to see if we ever applied further moves after reimaging, to see if it was necessary.

Project (2:00)

What did we do:

Firstly - put a small team together, back then my imaging skills were still developing as I was fairly new in post so I collaborated with a more advanced practitioner radiographer, who was an imaging specialist. We purposely kept the team small to keep things straightforward.

We devised a method of collecting data from 50 patients to prove what we had observed anecdotally. This was retrospective using imaging data collected as standard practice.

We found two things:

1. Additional moves had only been applied in a very small number of patients

2. Of these, all of them were within our accepted 3mm tolerances, proving that reimaging was unnecessary

Engaging with colleagues (2:00)

So how did we go about engaging with colleagues?

Initially I asked around, to get people's take on the situation, see how people felt about the status quo. We were a small department so that was a good place to start

We engaged colleagues by presenting our intention at a staff meeting and opening up the floor to discussion - we wanted to;
- ensure people understood the need for the change
- engage the key stakeholders from the start
- enable everyone to have their voice heard
- highlight issues with the current procedure
- discuss what not making the change looks like - this is
key isn't it, what is the cost of stasis?

Overcoming barriers (2:30)

One barrier that were keen to avoid was a perceived lack of expertise. For this to work the project needed an authority that at that time I simply didn't have. The solution to this was getting a respected experienced specialist on the team, to add weight to the idea.

Another concern was that we didn't want to the change to be too complex, either in the method of the project or what it meant for staff once the change was implemented. So we purposely kept it simple - small team, easy project, simple change.

We also wanted to avoid a lack of involvement of staff from the start becoming a barrier further down the line. As I've already mentioned, our solution was getting buy-in early, through informal discussions/staff meeting.

One last thing was timeliness. We didn't want the project dragging on or running the risk of not getting finished due to clinical pressures. As I've mentioned, the project wasn't complex...it's was key to timely delivery.

Summary (1:00)

And this led to a change:

It led to a change to our departmental protocols
It led to a time saving for our staff
It led to a cost saving in terms of x-ray production

But most importantly it led to benefits for our patients, not only from spending less time on the treatment couch but also from fewer radiation exposures, a real tangible clinical safety issue.

I remember working out at the time that some of our patients who regularly had moves greater than 1cm could be spared some 40 x-ray exposures over the course of their treatment.

And that was my presentation, I hope I've hit the brief with it...happy to take any questions.