Overall Goal

To develop, evaluate, and implement innovative ways to manage the delivery of cancer care so that wait time targets are achieved and quality care is assured.

Primary Objectives

  • To develop a simulation model of RT processes that will identify RT system bottlenecks and provide a platform for assessing the precise impact of changes prior to putting them into practice.
  • To develop a high-level simulation model of patient flow that will identify system bottlenecks and investigate the impact of changes in RT and other processes on overall patient flow and wait times.
  • To develop forecasting models that will provide inputs to operations management and systems planning.
  • To develop new methods for patient-level decision-making that take into account the impact of optimal future clinical decision-making and system availability on current decisions.
  • To develop new methods for optimizing service delivery including enhanced patient scheduling algorithms, enhanced staff scheduling approaches that use overtime judiciously, and new RT machine maintenance strategies that reduce breakdowns and the need to reschedule patients and staff.


Cancer affects a large number of Canadians. Excessive waits for radiation therapy (RT) can lead to worse outcomes in terms of disease control for many patients. As a result, the Canadian Association of Radiation Oncology (CARO) has adopted targets for timelines of RT. At the very least, wait times should be within the commonly accepted standards identified by CARO – 10 days from referral to consultation with a radiation oncologist and 10 working days from radiotherapy requisition date to firs day of therapy.

RT is an appropriate therapy on which to focus our initial modeling efforts because it is widely used to treat many types of cancer. Wait times result from delays from the point of diagnosis to initial referral (external to the RT process) and from referral to treatment (internal to the RT process). Improving the efficiency of the health care system by understanding and managing the causes and effects of these variations is pivotal to improving access to care.

The benefit of using Operations Research (OR) models is that they can be used to evaluate a large number of possible policies within a short amount of time, at relatively low cost, and with no risk to patients.

Our team is extremely well positioned to carry out this research and implement its findings. What makes our team unique is the collaboration between the Sauder School of Business, the UBC Centre for Health Care Management (CHCM) and key system decision-makers from the BCCA. This group has extensive experience in developing and applying OR methodology, radiation oncology, health care management, health policy, and biostatistics.

The Sauder researchers bring expertise in applying OR techniques to complex systems. Dr. Martin L. Puterman brings his expertise in using OR to model, plan and manage health care systems. As Co-PI, he will provide strong leadership to the team and insight into OR methods. Dr. Steven Shechter has extensive experience with OR models in health care and medical decision-making. As a PhD student, Mariel Lavieri has begun research on clinical decision making in cancer care and will provide extensive background research on OR models in health care.

The BCCA, where the research will be based, is a province-wide, population-based cancer control program for residents of British Columbia. The involvement of clinicians and health care managers will ensure that the output of the research will be usable by decision makers. PI Dr. Scott Tyldesley's experience in radiation oncology, health policy and health services research will enable him to effectively lead this research group and provide guidance on study design and implementation. Dr. Tom Pickles is the President of CARO and will provide information on cancer management and national resource impacts. As Director of Clinical Operations in RT, John French will provide insight into the clinical workings of RT delivery and will facilitate the implementation of the team's research into the clinical and operation environment. Dr. Thomas Keane is the provincial program head of the RT program and provincial radiation oncology professional practice leader. As such, he will facilitate the implementations of the team's findings throughout the province.