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5. Implementation and Education

5.1. Approach to Implementation and Education

5.1.1 VERT contacts in each radiotherapy and oncology department and educational institution in England were identified at the start of the Project. These institutional Leads provided information which, with the monthly installation and training information provided by Vertual Ltd., enabled the Co-ordinator for Implementation and Education to monitor installation and training progress in the 41 institutions which completed installation during the 18 months of the Project. The Steering Group was also kept appraised of the situation in relation to those Trusts unable to install VERT during this period.

5.1.2 Visits by the Implementation and Education Co-ordinator commenced in mid-April 2008 and continued regularly until mid July 2009.  All educational institutions and 30 of the 31 departments were visited at least once - the remaining department did not have VERT installed until August 2009. However, departments and educational institutions visited early in the Project were offered a further visit in the latter stages both to:

  • share the ideas and suggestions for VERT use gained by the Co-ordinator through discussion with a wider group of users during the Project; and to
  • capture insights and evolving ideas for using VERT in these institutions which, by then, had had the most experience.

5.1.3 During visits the Co-ordinator provided support, help and advice on the use of the VERT software and hardware, recording details of any associated problems or issues. These were fed back to Vertual Ltd. after each visit.

5.1.4 The Project outcomes were discussed during visits to clinical departments and educational institutions. VERT Leads were asked about the ways in which they were using, or planning to use VERT to meet the objectives and, where necessary, were given advice on planning relevant tutorials and teaching sessions. In addition they were asked to compile a report at the end of the Project indicating how they had addressed, or would address, the Project outcomes.

5.2. Procurement and Installation Issues

5.2.1 The procurement process was identified as challenging by the majority of institutions, primarily due to the extremely tight deadlines imposed by the funding process. Perhaps unsurprisingly, the major problem encountered by both educational institutions and Trusts was identification of suitable physical space for the VERT installations. However, the timescale for the Project also pushed the boundaries for educational institutions in terms of the time required to meet institutional tendering requirements and for internal administrative processes. Similarly internal procurement processes led to delay with building work for some radiotherapy and oncology departments housed in Private Finance Initiative (PFI)-funded buildings.

5.2.2 The majority of installations were straightforward with few issues arising. However, several problems were identified in some centres including:

  • room refurbishment error (for example, incorrect calculation of aperture size for screen);
  • hand pendants not working (generally identified as a training issue rather than malfunction);
  • unreliable PCs (for example, a graphics card problem in one or two educational institutions);  and
  • projector alignment and image blending issues (primarily a training/familiarisation issue rather than technical problem).

Where problems were identified they were usually resolved quickly through contact with Vertual Ltd.
 

5.3. Training

5.3.1 Vertual Ltd. provided a 2-hour training session for staff as soon as possible after installation although it was noted that some centres experienced a little delay during the period when installations were at their peak. Some departments were unable to release all relevant staff to attend these sessions because of service commitments but key personnel attended and subsequently cascaded training to others.

5.3.2 A number of centres developed their own training packages for delivery to different groups of students and staff. This was considered to be good practice by the User Group and thus it is strongly recommended that:

  • centres develop suitable training packages to supplement training offered by Vertual Ltd. and cascade training to various user groups at a frequency appropriate to local needs.

 

5.4. Outcomes from Implementation of User Groups

5.4.1 National User Group and Grouping of Departments

5.4.1.1 Attendance at the National VERT User Group evolved during the course of the Project.  The majority of departmental representatives at the first meeting were Heads of Department, Department Managers or Superintendent Radiographers. However, representation at subsequent meetings included a higher proportion of VERT Leads, departmental educators and other staff, reflecting the way implementation of VERT moved into the hands of those more directly involved in training students and colleagues within the departments.

5.4.1.2 One consequence of limiting departmental membership on the National User Group and establishing the Group Representative system instead was that staff in some departments felt remote from the Project. For example, several departmental managers contacted the Co-ordinator asking to send their own individual representative for this reason.

5.4.1.3 The VERT Lead for each of the clinical departments was expected to communicate with other members of the Representative Group.  This worked well generally, particularly where the groups were smaller but proved more problematic in some, but not all, of the larger ones.

5.4.1.4 A major benefit of establishing the Group Representative system was the way in which communication between radiotherapy and oncology departments was encouraged. Good communication between department, departmental groups and educational institutions was essential in ensuring that the Project aims and objectives were achieved and to ensure that VERT became embedded in curricula. The VERT Project Co-ordinator facilitated this process where necessary.

5.4.2 Regional User Groups

5.4.2.1 Although in most cases the educational institutions led formation of the Groups, a number of departments set up their own Regional User Group and involved the associated educational institution. The Groups functioned in a similar way in either case with most Groups, once established, meeting on a regular (typically 2-3 monthly) basis.


5.4.2.2
The primary purpose of meetings of these Groups was to discuss the ways in which VERT could be used with students and qualified staff.  However, they also facilitated significant collaboration in the acquisition of patient data to be used with VERT systems both in clinical departments and educational institutions. Acquisition and transfer of suitable treatment planning data was identified as an issue throughout user group discussions (see 6.4.5 ‘Access to Treatment Planning Data' on p.32).

5.4.2.3 Staff involved in discussions about the use of VERT in radiotherapy programmes during the early stages of the Project tended to be those traditionally involved in course discussions between clinical departments and educational institutions - i.e. Managers from clinical departments and Course/Programme Directors from the educational institution. However, many VERT Leads were not Managers or Course Directors and thus the Regional User Groups provided a forum for discussion between groups of staff who might not otherwise usually meet. The consequent discussion of new ideas on a range of other relevant subjects was considered to be of benefit in improving the student experience more generally.

5.4.3 Local User Groups

5.4.3.1 Small, local User Groups evolved within the radiotherapy and oncology departments. These commonly included the institutional VERT Lead, other interested radiographers, dosimetrists, physicists and medical staff.

5.4.3.2 The potential advantages of a multidisciplinary user group were identified as:

• facilitating the acquisition of suitable treatment plans;

• inclusion of different professional perspectives in planning the use of VERT;

• fostering inclusive ownership of VERT across the whole radiotherapy team;

• encouraging different groups of staff to use VERT with students;

• promotion of wider dissemination of VERT initiatives, research and resources; and

• enhancement of communication between professional groups.

The multidisciplinary nature of local User Groups was considered, therefore, to be beneficial as a foundation for further development of high quality, more diverse VERT resources, enriched by different professional perspectives.

5.4.3.3 A strategy that incorporates local VERT leads, local user groups, regional user groups and a national user group was considered essential for the continued development of the most effective use of VERT. Such a strategy: promotes sharing of ideas and approaches to problems or issues; provides mutual support: and facilitates the sharing of data. It also has wider benefits for students, staff and departments involved as it promotes collaboration between the educational institutions and departments more generally. Accordingly, it is strongly recommended that:

• Local, regional and national user groups are established with a multidisciplinary membership wherever possible.

5.4.4 Department and Educational Institution VERT Leads
Identification of an institutional VERT Lead was crucial to the development of VERT use within clinical departments and educational institutions. Adequate support and, in particular, allocation of sufficient time to undertake the role was found to be essential.  Where the VERT lead was allocated time within their workload VERT use was well-developed and maintained. However, from feedback during Co-ordinator visits, it was clear that erosion of this time by departmental or other pressures had a detrimental effect on the implementation, development and evaluation of VERT and a possible consequential decrease in enthusiasm for VERT use.  Inadequate allocation of time resulted in some VERT installations being used well below their full potential. (See 6.4.2 'Staffing and Time’ on p. 30)
 

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