The overall ambition of the Rossy Cancer Network (RCN) is to offer the best possible cancer care experience for patients and their families. Among its original projects, the network evaluated its current performance, set targets for improvement, and set up metrics to continuously assess its progress against these targets. The general framework to achieve this is as follows:
1) Development of quality indicators
2) Data collection
3) Data analysis
4) Reporting of results
5) Improvement initiatives
6) Continuous evaluation
Although the three RCN hospitals have historically maintained a commitment to high standards of care and quality improvement, they have done so on an individual basis. The result is an inability to effectively compare one institutions performance to another, and more importantly, the combined performance of all institutions to world class cancer centers. Furthermore, this stand-alone approach of measuring quality of care is disconnected from the reality of a cancer patient’s journey which often involves treatment or support from multiple institutions.
The objective of the Indicators and Outcomes workgroup is to complement the existing quality improvement programs in each RCN hospital by developing a common set of quality indicators that can be used to track quality and improvement targets at the network level; in a standardized fashion. This collective approach will support the ability to benchmark performance against world leading cancer centers, as well as maintain a highly integrated and consistent experience for the patient.
The first step was the development of RCN goals of cancer care improvement that could have a high impact on patients. The next step was collaboration among expert clinicians across the RCN to agree upon a set of quality indicators that addressed each goal. With patients and their families as the focus, the result was a ‘bank’ of 100+ quality indicators that covered meaningful aspects of care. A snapshot of this is illustrated below. Note that the treatment, access, and outcome categories have an initial focus of breast, colorectal, lung, and prostate cancers.
GOALS |
FOCUS |
PATIENT SIGNIFICANCE |
QUALITY INDICATOR EXAMPLE |
|
Improve the patient experience across the network |
Experience Palliative Care Psychosocial Care |
How will I know that you care about what I think and how I feel? |
Did your care providers treat you with dignity and respect? |
|
How will you ensure that my needs for support are being met? |
Were you aware that information and support services were available to support you throughout your cancer experience? |
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|
Improve access and patient flow for cancer care |
Wait Times |
How will you ensure that I get all of the services I need in a timely fashion? |
What is the wait time between diagnosis and initial treatment? |
|
Collaborative Treatment Planning |
How will you ensure that all my treatment options are considered? |
What is the percentage of patients treated on a clinical trial at any time? |
|
|
Improve patient safety in cancer care |
Safety & Risk Management |
What will you do to safeguard my well-being? |
What is the annual number of reported incidents and accidents related to medication errors? |
|
Quality of the Work Environment |
Is the hospital managed so that my care-providers can focus on my needs? |
What is the ratio of oncology nurses to patients? |
|
|
Improve the quality of cancer treatment across all cancer types |
Treatment |
How will you ensure that I’m getting the best possible treatment for my specific situation? |
What is the percentage of patients receiving chemotherapy who have severe toxicity? |
|
What is the percentage of patients who have a complete synoptic pathology report? |
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Improve cancer outcomes for RCN patients
|
Survival |
How will the RCN efforts prolong my life and help me remain disease-free? |
What is the percentage of patients who have systemic relapse post adjuvant therapy within 5 years of diagnosis? |
|
Mortality |
What is the one-year and five-year mortality rate of cancer patients, by type and stage? |
As data collection began on these quality indicators, the goal will be three-fold; to launch purposeful improvement initiatives and track changes in quality of care over time, to inform emerging research projects, and to inform effective resource acquisition and utilization.
To start, the focus will be on a few of these categories, namely patient experience, treatment, and access. As the RCN continues to build the necessary infrastructure associated with the collection and reporting of data, indicator sets will be added in a step-wise fashion.
This led to the development of an implementation plan for the public reporting of the RCN ‘scorecard’ to ensure that patients and their families remain as partners in our improvement efforts. Success will be measured not only by the volume of patients positively affected by this initiative, but also by the magnitude of improvement felt by each patient.