Aims
Icon Cancer Care completed a study in December 2012 identifying issues around patient experience in a private day oncology hospital setting. A project was established in 2013 with the aim of improving the patient and family experience by re-designing workflow for all stakeholders.
Improving the patient experience was key and the goal to improve and streamline patient flow with reduced wait times. Improving the team climate by implementing a cultural change would increase productivity with improved processes and documentation.

Methods
Detailed mapping of the existing patient flow was carried out with input from patients, providers and employees. New potential processes and improvement initiatives were produced, mapped and then prioritised. The project was split into stages, each stage using the PDCA (Plan, Do, Check, Act) Cycle.
Project roles and work streams were outlined, with assessment and reallocation of expertise in the team, keeping a strong focus on the new design.

Results
The patient waiting time has reduced by 40%, with the percentage of patients waiting 30 minutes or less increasing. Activities around patient engagement were re-distributed with direct data entry and accessibility of all information remotely. The new medication supply process increased efficiency for the team and impacted the time a patient spends awaiting treatment.
Documentation underwent significant change with reallocation of resource and has seen a reduction in outstanding orders on day of treatment from 60-70% to 10%.
Efficiency gains include chemotherapy ordering, reduced patient waiting times and an improved patient experience.

Conclusions
The project encompassed operational processes which led to re-defining work flow, capability development and re-allocating responsibilities and expertise.
The project has led to a cultural change at one day hospital, with the initiatives now transferrable across other clinics. The new team culture is providing continuous and ongoing improvement.