Session Item

Previous research among Dutch radiotherapy (RT) centers showed that 69% of the planned innovations were simultaneously implemented at 7 or more centers without a structure to share lessons learned about the implementation process. Therefore, a multidisciplinary Taskforce Innovation Implementation was raised aimed at supporting RT centers to continuously improve their implementation efficiency. The aim of this study is to investigate the status of the innovation implementation process in Dutch RT centers and to develop tools to reinforce mutual learning with regard to innovation implementation.

First, we asked the 18 Dutch RT centers to provide us their 10 most valuable innovations that were or will be implemented in the period 2019-2022. Subsequently, we selected the four most mentioned topics on which we performed semi-structured interviews with physicists, radiation oncologists and radiation therapists (RTT) from several centers. The interviews were structured using the Consolidated Framework for Implementation Research making sure all relevant implementation issues were addressed. The interviews were transcribed and coded by using template analysis.

Based upon the inventory (72% of the RT centers responded to the inventory), we conducted interviews with 23 persons from 12 out of 18 RT centers on projects concerning 1) automation 2) adaptive RT 3) tracking and image guided RT and 4) patient participation. Most innovations were implemented with a delay, mainly due to: shortage of time from personnel (n=9 centers), prioritization of projects (n=8 centers), collaboration with external parties (n=6 centers) and resistance to or acceptance of the innovation (n=5 centers). These barriers were quite similar between the centers, especially on similar topics. E.g., centers implementing surface tracking often mentioned that they encountered some form of resistance in the RTT group. Although consultation of other centers before starting the implementation process was often done, this mainly focused on the content of the innovation and only to a small extent on the implementation process or the challenges that were encountered during implementation. The presence of complete implementation plans was scarce; shorter versions were available in 9 centers and 3 centers did not have an implementation plan. Formal evaluation of the implementation process and changes in workflow, e.g., to discover challenges and delaying factors, was rarely performed.

This study showed that most centers experience comparable challenges when implementing innovations. By sharing data on the implementation process, and developing an evidence-based implementation plan to face challenges, centers can learn from each other. We are currently developing a web-based platform to share knowledge and experience about implementation processes in RT centers, to improve implementation efficiency.