Working to improve clinical practices and cancer services locally

Cancer programs in Ontario have a common goal to provide patients with timely diagnosis, treatment and care. Lengthy wait times and fragmented care cause cancer patients significant anxiety, increasing their emotional burden.

While the role of delivering cancer services to patients in their geographical areas is managed by individual organizations and agencies, Cancer Care Ontario (CCO) has created Regional Cancer Programs (RCPs) in each Local Health Integration Network (LHIN) to link patients, organizations and decision makers from across the full spectrum of care. It is the responsibility of the RCPs to work together to improve access to cancer services within the community.

“Individual cancer organizations have an opportunity to learn from others by working together and engaging in open conversations about current methods and policies,” says Dr. Linda Rabeneck, Regional Vice-President and Cancer Program Chief at Sunnybrook Health Sciences Centre. “It is our shared goal to build a system that will continue to decrease wait times, improve patient flow and provide the patient with multi-disciplinary care.”

In late 2004 the Ministry of Health and Long Term Care (MoHLTC) and CCO developed the Access to Cancer Services Innovation Fund proving RCPs with the opportunity to work together to develop and assess new cancer care delivery services. Working with regional cancer system partners, three Toronto CCO innovation projects were approved and developed over a ninemonth period.

At a recent event hosted by the Odette Cancer Centre (TSRCC), the comprehensive cancer program at Sunnybrook, representatives from the Toronto RCP came together to share, recognize and celebrate the three innovation projects. Each project aimed to improve patient wait times, increase overall capacity in the system, and achieve maximum efficiencies. Next steps include the development of project specific tool kits in order to perform knowledge transfer across the cancer system.

One initiative focused on improving access to lung cancer treatment in the Toronto region. This initiative partnered Toronto East General Hospital, four family practice groups and the TSRCC. The group’s goal was to reduce unnecessary delays and restrictions on access, improve patient and provider experience, and provide each patient with a tailored treatment that suits their needs.

By evaluating best practices and putting new policies in place to streamline referrals, manage processes, monitor performance and pool resources, the group was able to make significant improvements in wait times benefiting more than 100 patients within the first six months.

One of the most remarkable improvements was the reduction in time from a patient’s initial x-ray to lung cancer diagnosis. By setting targets and establishing new policies the overall time from the suspicious x-ray to the patient’s diagnosis was reduced from an average of 127.8 days to 30.8 days.

“Projects like this allow us to clearly evaluate our current practices and make the necessary changes,” says Dr. Rabeneck. “It is a powerful effect to discuss with colleagues from other hospitals and make program comparisons. In the future, we need to build into our organizations the tools to make these comparisons.”

The two remaining presentations focused on improvements in colorectal cancer diagnostic assessment and access to leukemia treatment in the Toronto Region.

“There is an unbelievable commitment to come together and build a regional system, to pull together and extend capacity. Also, recognizing there is a lesson to be learned from who is doing it best and to build on it and find the best practices,” said Terrence Sullivan, president and CEO of Cancer Care Ontario during his closing remarks. “We have to be willing to invest in innovations and realize some will fail.”

When asked to reflect on the evening’s presentations, Marnie Weber, Regional Director, Division of Acute Care Services, Ministry of Health and Long Term Care said, “I think that what is being done here is excellent. The four hospitals, working together in an integrated approach to improve patient care is all very positive.