Cancer Care Collaborative Approach to Optimize Clinical Care
A collaboration between clinicians and industrial engineers resulted in significant improvements in cancer screening, the development of toolkits, and more efficient care for hepatocellular carcinoma and breast, colorectal, lung, head and neck, and prostate cancers.
Once the face-to-face CCC process was established, tested, refined, and replicated successfully, the virtual team proved to be a cost-effective model. The virtual team did not travel to LSs, a major source of expense, so a process was set in place for their participation in all other facets of the collaborative. This led to the pilot testing of national virtual collaboratives (eg, specialty and surgical care collaboratives).
The toolkits for lung and CRC (phases 1 and 2) were organized, standardized, and disseminated throughout the VA to provide specific knowledge and tools to improve cancer care. The content of toolkits was primarily developed and/or identified by CCC participants. Funding for the toolkits was secured by OQP and SR, which led to the creation of the integration and crosswalk documents (eAppendix 7, available at fedprac.com/AVAHO).
In phase 3, lung cancer care teams showed the most improvement among all 3 phases of the collaborative. Aims statements in lung cancer process showed an increased percentage of improvement in all phases. Weekly multidisciplinary meetings provided a mechanism to rapidly review patients and triage appropriate pathways in the treatment algorithm. Open communication among sites and disciplines was vital and increased participation by physicians to identify ways to expedite diagnosis and treatment of lung cancer. In addition to access and timeliness of care (accommodating patients’ preference for scheduling), the teams identified areas they deemed important for successful programs and developed advisory panels that focused on quality, such as tumor boards, clinical trials, patient education, cancer care coordinator/navigator, survivorship, standard order sets and progress notes, reliable handoff, chemotherapy and radiation make/buy tools, head and neck toolkit, clinical documentation, chemotherapy efficiency, and Veterans Equitable Resource Allocation recovery for metastatic cancer.
Based on the evaluation results, participants gave their highest average ratings to items that asked about the general potential of SR to improve patient care and patient satisfaction, team dynamics, site leadership support; confidence in self, team, and coach; and the general potential of SR to improve staff satisfaction. Participants gave their lowest ratings to questions that asked about having the necessary time and resources to implement SR initiatives at their site as well as the level of active engagement by site leadership in SR work.
