ESTRO 2024 - Abstract Book

S2809

Interdisciplinary - Health economics & health services research

ESTRO 2024

Change in organisational structure influences perceived leadership in radiotherapy

Rachelle Swart 1 , Frits van Merode 2,3 , Liesbeth Boersma 1 , Maria Jacobs 4

1 Maastricht University Medical Centre+, Department of Radiation Oncology (Maastro), GROW School for Oncology and Reproduction, Maastricht, Netherlands. 2 Maastricht University Medical Centre+, FHML, Maastricht, Netherlands. 3 Maastricht University, Care and Public Health Research Institute, Maastricht, Netherlands. 4 Tilburg University, Tilburg School of Economics and Management, Tilburg, Netherlands

Purpose/Objective:

Many Radiotherapy centres are tasked with effectively managing the integration of innovative treatments such as proton therapy (PT) and MR-linac, while at the same time ensuring smooth operations of conventional photon based treatments. In literature, this is often referred to as an “ambidextrous challenge”. Leadership at the top level is crucial in successfully leading this challenge (1 – 5). Three leadership styles can be distinguished (6). First, transformational leadership inspires followers to achieve extraordinary goals by proactively promoting collective interests. Second, transactional leadership emphasizes fulfilling contractual obligations through goal setting, monitoring, and control. Third, ‘Laissez - faire’ leadership, involves leaders avoiding decision -making, shirking responsibility, and refraining from exerting authority. In innovative radiotherapy centres transformational leadership is required (6). This study was performed in a large academic Dutch radiotherapy centre where PT was introduced in 2019, alongside conventional photon therapy for approximately 4500 patients yearly. This innovation strained the existing governance model, leading to the perception that managers used a laissez-fair leadership for the regular operations instead of a transformational, due to a shift in their focus towards PT. In addition, , a division between PT and photon therapy developed, hindering communication and information flow, resulting in coordination issues. Finally, management complained about span of control due to the new challenges. Therefore, several interventions were applied in the organisational structure aimed to diminish the prevalence of laissez-faire leadership while fostering transformational leadership, such that a harmonious equilibrium would develop between the successful implementation of innovative practices and simultaneously keeping the management of regular operations streamlined. The objective of the current study is to analyse the impact of these organisational structural changes.

Material/Methods:

At the start of PT implementation, employees in patient care (PC) were supervised by the Management Team Patient Care (MT-PC), which consisted of head of physics, a medical manager, and 2 managers PC. The MT-PC was mainly supervised by the Director- PC and the chair of the Directory Advisory Board (DAB) (Figure 1). Next to their management tasks, the Director-PC, head of physics and medical manager were working in PC as clinicians themselves. When noticing the tensions, several interventions were implemented in the first half of 2022. First, teamleaders were introduced for each clinical team, which consisted of radiation oncologists and radiation technicians (RTTs), centred around 2-3 specific tumour types. Adding teamleaders reduced the span of control for the MT-PC. Second, a PC-manager was included in the DAB alongside the Director-PC. Third, PT and photon therapy were integrated at the tactical level by adding the manager PT to the MT-PC (Figure 1).