A quality management system (QMS) for a radiation oncology department in an academic hospital in the Western Cape, South Africa

Abstract

The focus of this study is to investigate the level at which quality management (QM) objectives, according to ISO standards, are met by the radiation oncology staff as well as doctors referring patients and patients receiving treatment at an oncology department. The study was undertaken at an academic hospital in the Western Cape, South Africa. The study addressed the following research question: “Do the QM system and practices at the division of Radiation Oncology at an academic hospital comply with ISO standards?” Radiation therapy is the treatment of cancer with ionizing radiation. The department has Quality Assurance (QA) practices that assure the safe, consistent delivery of radiation to the target volumes that are defined for treatment from a technical point of view. Errors or incidents are inevitable and an understanding of when, why and how they occur could assure that systems are put into place to help minimize the frequency with which they occur. In order to do this, a systematically planned programme should be documented and implemented to assure that the treatment delivered meets the required standards. Such a programme is called a Quality Management System (QMS) and it must involve the documentation of all the processes that could influence or is involved in the treatment of patients. This includes the managerial, the psycho-social as well as the technical treatment planning processes. An important process is the identification of the QM objectives. Furthermore, the current levels of satisfaction with the QM programme needs to be assessed in order to improve the QMS. The approach of the study is twofold. Firstly, the ISO standards regarding the first three QM objectives were identified and documented from literature and documents. The three QM objectives identified were: i) staff satisfaction and morale, ii) referring doctor satisfaction and iii) patient satisfaction. Secondly, the existing QM practices were investigated by means of an organisational satisfaction survey audit conducted with the staff in the department, the doctors referring patients to the department and the patients getting treatment at the department. The staff members were represented by a self-selecting sample group of 44 participants that completed a self-administered survey questionnaire. The referring doctors were also a self-selecting sample group of 64 participants that received a mailed or hand-delivered survey questionnaire. The patient group was a statistically calculated proportion sample of 230 patients that were interviewed with a structured administered survey questionnaire by the researcher. The analysis of the data was layered and triangulated by means of identification of perspectives from different groups of people involved in the same setting. The first layer of analysis involved deconstructing and discussing the ISO documents, guidelines and policies in order to establish the required ISO standards regarding the three QM objectives researched in this study. The second layer of analysis involved quantitative descriptive analysis methods used to analyse the data generated by the Likert-scale questions. The third layer of analysis involved the analysis of the narrative data from the open questions of the questionaires and structured interviews with the patients where content thematic analysis allowed categories to emerge by means of pattern matching. A benchmark of 50% was established from literature for satisfaction levels to be considered acceptable. The findings of this study are expressed in terms of meeting this benchmark. In the staff group, five quality indicators were investigated. Three out of the five indicators of staff satisfaction (60%) met the 50% benchmark, which indicates that the department is meeting the standards set for this QM objective. The three indicators that met the benchmark were: i) working environment, ii) physical environment and safety and iii) job description. The two indicators not meeting the benchmark were i) recognition and ii) re-imbursement. In the referring doctor group a total of three quality indicators were investigated and two (66%) met the benchmark. The two indicators that met the benchmark were i) telephone etiquette and ii) patient management. The indicator not meeting the benchmark was follow-up reports. Therefore, the quality indicators for this specific QM objective are also meeting the standard required. The results for the last QM objective, patient satisfaction, shows that the seven indicators investigated have all (100%) met the benchmark set for satisfaction. The seven quality indicators investigated were i) administration, ii) atmosphere and comfort, iii) cleanliness of the department, iv) professionalism, v) information sharing, vi) cleanliness and safety in the ward and vii) patients’ general comfort in the ward. The content analysis resulted in recommendations that were categorised as follows: i) specific recommendations according to the thematic content, ii) practical recommendations for future audits and iii) recommendations regarding the proposed QMS for the department. An important outcome of this study was the establishment of baseline data regarding these three QM objectives and the development of shortened survey questionnaires for use in future organisational survey audits. In conclusion, it is argued that quality improvement should be seen as a continuous, structured process using a system that can create participation throughout the department to plan and implement processes that would meet and exceed the expectations and demands of the clients and staff utilizing the services of the department. This process, together with the structure provided by the ISO 9000 set of standards, is a valuable guideline for the development of a comprehensive QMS. This thesis was an initial step towards a scientifically documented, implemented and regulated QMS that could guide the department in working towards achieving their set objectives and eventually towards attaining Radiation Therapy specific accreditation.