title: Organizational development trajectory of a large academic radiotherapy department set up similarly to a prospective clinical trial: the MAASTRO experience.
abstract: OBJECTIVE
  To simultaneously improve patient care processes and clinical research activities by starting a hypothesis-driven reorganization trajectory mimicking the rigorous methodology of a prospective clinical trial.
  
  
  METHODS
  The design of this reorganization trajectory was based on the model of a prospective trial. It consisted of (1) listing problems and analysing their potential causes, (2) defining interventions, (3) defining end points and (4) measuring the effect of the interventions (i.e. at baseline and after 1 and 2 years). The primary end point for patient care was the number of organizational root causes of incidents/near incidents; for clinical research, it was the number of patients in trials. There were several secondary end points. We analysed the data using two sample z-tests, χ(2) test, a Mann-Whitney U test and the one-way analysis of variance with Bonferroni correction.
  
  
  RESULTS
  The number of organizational root causes was reduced by 27% (p < 0.001). There was no effect on the percentage of patients included in trials.
  
  
  CONCLUSIONS
  The reorganizational trajectory was successful for the primary end point of patient care and had no effect on clinical research. Some confounding events hampered our ability to draw strong conclusions. Nevertheless, the transparency of this approach can give medical professionals more confidence in moving forward with other organizational changes in the same way.
  
  
  CONCLUSIONS
  This article is novel because managerial interventions were set up similarly to a prospective clinical trial. This study is the first of its kind in radiotherapy, and this approach can contribute to discussions about the effectiveness of managerial interventions.
authors: 1 Department of Radiation Oncology (MAASTRO), School for Public Health and Primary Care-Health Services Research, Maastricht University Medical Centre (MUMC+), Maastricht, Netherlands.
authors: M
authors: M
authors: Jacobs
authors: L
authors: L
authors: Boersma
authors: A
authors: A
authors: Dekker
authors: E
authors: E
authors: Hermanns
authors: R
authors: R
authors: Houben
authors: M
authors: M
authors: Govers
authors: F
authors: F
authors: van Merode
authors: P
authors: P
authors: Lambin
mesh_terms: D000046:Academic Medical Centers / Q000458:organization & administration*; D002986:Clinical Trials as Topic; D006801:Humans; D009426:Netherlands; D009937:Organizational Objectives; D017064:Process Assessment, Health Care; D011446:Prospective Studies; D018787:Radiation Oncology / Q000458:organization & administration*; D012107:Research Design