Faster Cancer Treatment: Using a health target as the platform for delivering sustainable system changes Organisation Name: Ko Awatea, Counties Manukau Health Presenter: Bob Diepeveen HRT 1520 Innovations Workshops and Awards 19-20 November 2015, Sydney
Presenters Summary Slide New Ministry of Health target: Faster Cancer Treatment introduced First publication of the results showed in Counties Manukau Health 52% of the patients received their first cancer treatment within 62-days of being referred with a need to be seen within two weeks and a high suspicion of cancer, where 85% is the target. The Improvement Advisors worked together with Doctors, Cancer Nurse Coordinators and Service Managers via a structured, Lean, data-backed approach to sustainably improve the timeliness of cancer diagnosis & treatment. A few of the implemented improvements are: - Re-design cancer pathways through collaboration between services - Introduce electronic grading to reduce the time from referral to grading - Introduce CanTrack, a web-based database, which helps Cancer Nurse Coordinators have oversight of where their patients are on the pathway Counties Manukau health has improved their performance to 63% in July (Q4) 2015 in the Ministry reporting and tracking at 84% for September 2015 (Q1) and continues to improve the care for all cancer patients. Bob Diepeveen Bob.diepeveen@middlemore.co.nz +64 (0)21 023 98264 Ko Awatea (Counties Manukau DHB) 2
Key Problem Introduction of a new health target Faster Cancer Treatment: 85% of patients receive their first treatment within 62 days of being referred with a high suspicion of cancer and need to be seen within two weeks. In December 2014 Counties Manukau Health scored 52% on this measure. 3
Aim of this innovation Provide diagnosis and treatment for cancer patients in a timely manner. Identify opportunities for improvement in a short time frame. Implement the improvement ideas to enable a sustainable cancer pathway for all cancer patients. 4
5 Baseline Data / Current Situation Receive referral Grade referral First Specialist Appointment Multi Disciplinary Meeting Decision To Treat 1 st Treatment performed None of the tumour streams met the target Target = 62 days Data analysis of the performance per tumour stream for the above process step showed where improvement efforts should be focused
Key Changes Implemented Improved identification of FCT patients from the start of the process by better IT use Radiology: FCT referral stamp to increase visibility of patients within radiology Improved coordination of appointment/procedure scheduling, earlier involvement of Cancer Nurse Coordinator Cancer Nurse Coordinators given access to Agfa-Ris to track completion of radiology scans CanTrack, a web-based database to support tracking of patients, is being implemented Screenshot from CanTrack 6
Key Changes Implemented (2) Urology & Breast: Implemented e-grading, more specialties to follow Upper/Lower GI: Cancer Nurse Coordinator are immediately contacted after a suspected scope and follow-up CT is immediately booked Lower GI: order CT scan immediately after colonoscopy Gynaecology working with primary care to increase number of GPs requesting diagnostics prior to referral Lung extended pilot for an upfront PET-scan for cancer patients and use designated cancer clinics All tumour streams have put actions in place to prevent another Christmas glitch. 7
07 (Jul) 08 (Aug) 09 (Sep) 10 (Oct) 11 (Nov) 12 (Dec) 01 (Jan) 02 (Feb) 03 (Mar) 04 (Apr) 05 (May) 06 (Jun) 07 (Jul) 08 (Aug) 09 (Sep) 10 (Oct) Outcomes so far 62 day pass rate has gone up from 52% in December 2014 to 59% in March 2015 to 63% in the latest ministries report (July 2015, Q4) September s performance was 84% Continuous effort is put into improving the timely diagnosis and treatment of cancer patients % of 62 day target patients passed per month 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 2014 2015 8
Lessons Learnt Focusing on better outcomes for all cancer patients helped acceptance of improvement efforts with clinicians The problem/actions need to be owned by the right people in the organisation Let it happen vs Help it happen vs Make it happen It is hard to show a direct link between improvements and results, because of: Size of the project and number of tumour streams Multitude of interactions between services Multitude of improvements starting at once Small number of patients 9
Contact for this Innovation For more information Contact: Bob Diepeveen Improvement Advisor at Ko Awatea Tel: +64 (0)21 023 98364 Email: bob.diepeveen@middlemore.co.nz @diepbob 10