title: Improving the Quality of Radiation Treatment for Patients in Ontario: Increasing Peer Review Activities on a Jurisdictional Level Using a Change Management Approach.
abstract: OBJECTIVE
  Peer review of radiation treatment (RT) plans is a key component of quality assurance programs in radiation medicine. A 2011 current state assessment identified considerable variation in the percentage of RT plans peer reviewed across Ontario's 14 cancer centers.In response, Cancer Care Ontario launched an initiative to increase peer review of plans for patients receiving radical intent RT.
  
  
  METHODS
  The initiative was designed consistent with the Kotter eight-step process for organizational transformation. A multidisciplinary team conducted site visits to promote and guide peer review and to develop education and implementation processes in collaboration with the centers. A centralized reporting infrastructure enabled the monitoring of the percentage of RT courses peer reviewed and the timing of peer review (before completion of 25%of treatment visits, after completion of >25%treatment visits).
  
  
  RESULTS
  The initiative is ongoing, but early results indicate that the proportion of radical intent RT courses peer reviewed province wide increased from 43.5% (April 2013) to 68.0%(March 2015). This proportion is now a quality metric in Ontario and is publicly reported through the Cancer System Quality Index. The performance target for this metric was initially set at 50%(cases treated with radical intent) and revised to 60% in 2014. Provincial performance exceeded targets in both years (58.2% and 68.2%, respectively). Considerable variation was observed, however, in rates and timing of peer review among Cancer Care Ontario centers.
  
  
  CONCLUSIONS
  This initiative demonstrates that a change management framework can be useful for planning and achieving substantial increases in jurisdictional peer review activities.
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Reddeman
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Foxcroft
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Gutierrez
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hart
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lockhart
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Marissa
authors.initials: M
authors.lastname: Mendelsohn
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ang
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada.
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
authors.affiliation: Cancer Care Ontario; Princess Margaret Cancer Centre, University Health Network; The University of Toronto, Toronto; R.S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; Cancer Research Institute, Queen's University, Kingston, Ontario, Canada michael.brundage@krcc.on.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Brundage
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Lindsay
authors.initials: L
authors.lastname: Reddeman
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Sophie
authors.initials: S
authors.lastname: Foxcroft
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Eric
authors.initials: E
authors.lastname: Gutierrez
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Margaret
authors.initials: M
authors.lastname: Hart
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lockhart
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Marissa
authors.initials: M
authors.lastname: Mendelsohn
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Michelle
authors.initials: M
authors.lastname: Ang
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Michael
authors.initials: M
authors.lastname: Sharpe
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada.
authors.forename: Padraig
authors.initials: P
authors.lastname: Warde
authors.affiliation: Cancer Care Ontario; University Health Network; The University of Toronto, Toronto; R. S. McLaughlin Durham Regional Cancer Centre, Oshawa; Kingston General Hospital; and Queen's University, Kingston, Ontario, Canada michael.brundage@krcc.on.ca.
authors.forename: Michael
authors.initials: M
authors.lastname: Brundage
mesh_terms: D002173:Cancer Care Facilities; D019468:Disease Management; D006801:Humans; D033183:Interdisciplinary Communication; D009369:Neoplasms / Q000453:epidemiology* / Q000532:radiotherapy; D009864:Ontario / Q000453:epidemiology; D010347:Patient Care Planning; D010380:Peer Review; D011785:Quality Assurance, Health Care; D058996:Quality Improvement; D011787:Quality of Health Care; D011878:Radiotherapy / Q000592:standards*