title: IMRT utilization in Ontario: qualitative deployment evaluation.
abstract: OBJECTIVE
  The purpose of this paper is to describe a jurisdiction-wide implementation and evaluation of intensity-modulated radiation therapy (IMRT) in Ontario, Canada, highlighting innovative strategies and lessons learned.
  
  
  METHODS
  To obtain an accurate provincial representation, six cancer centres were chosen (based on their IMRT utilization, geography, population, academic affiliation and size) for an in-depth evaluation. At each cancer centre semi-structured, key informant interviews were conducted with senior administrators. An electronic survey, consisting of 40 questions, was also developed and distributed to all cancer centres in Ontario.
  
  
  RESULTS
  In total, 21 respondents participated in the interviews and a total of 266 electronic surveys were returned. Funding allocation, guidelines and utilization targets, expert coaching and educational activities were identified as effective implementation strategies. The implementation allowed for hands-on training, an exchange of knowledge and expertise and the sharing of responsibility. Future implementation initiatives could be improved by creating stronger avenues for clear, continuing and comprehensive communication at all stages to increase awareness, garner support and encourage participation and encouraging expert-based coaching. IMRT utilization for has increased without affecting wait times or safety (from fiscal year 2008/2009 to 2012/2013 absolute increased change: prostate 46, thyroid 36, head and neck 29, sarcoma 30, and CNS 32 per cent).
  
  
  CONCLUSIONS
  This multifaceted, jurisdiction-wide approach has been successful in implementing guideline recommended IMRT into standard practice. The expert based coaching initiative, in particular presents a novel training approach for those who are implementing complex techniques. This paper will be of interest to those exploring ways to fund, implement and sustain complex and evolving technologies.
authors.forename: Kate
authors.initials: K
authors.lastname: Bak
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Murray
authors.forename: Eric
authors.initials: E
authors.lastname: Gutierrez
authors.forename: Jillian
authors.initials: J
authors.lastname: Ross
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
mesh_terms: D002173:Cancer Care Facilities / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D033181:Information Dissemination; D009369:Neoplasms / Q000532:radiotherapy*; D009864:Ontario; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards; D050397:Radiotherapy, Intensity-Modulated / Q000191:economics / Q000379:methods* / Q000592:standards