Regional process redesign of lung cancer care: a learning health system pilot project

  • M. Fung-Kee-Fung The Ottawa Hospital; University of Ottawa
  • D.E. Maziak The Ottawa Hospital; University of Ottawa, Ottawa Hospital Research Institute
  • J.R. Pantarotto The Ottawa Hospital; University of Ottawa
  • J. Smylie The Ottawa Hospital
  • L. Taylor The Ottawa Hospital
  • T. Timlin The Ottawa Hospital
  • T. Cacciotti The Ottawa Hospital
  • P.J. Villeneuve The Ottawa Hospital; University of Ottawa, Ottawa Hospital Research Institute;
  • C. Dennie The Ottawa Hospital; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa
  • C. Bornais The Ottawa Hospital
  • S. Madore The Ottawa Hospital
  • J. Aquino The Ottawa Hospital; Ottawa Hospital Research Institute, University of Ottawa
  • P. Wheatley-Price The Ottawa Hospital; University of Ottawa
  • R.S. Ozer The Ottawa Hospital
  • D.J. Stewart The Ottawa Hospital; University of Ottawa
Keywords: Learning health system, lean improvement, lung cancer, regional, health information, community of practice, theory of constraints

Abstract

 

Background

The Ottawa Hospital (toh) defined delay to timely lung cancer care as a system design problem. Recognizing the patient need for an integrated journey and the need for dynamic alignment of providers, toh used a learning health system (lhs) vision to redesign regional diagnostic processes. A lhs is driven by feedback utilizing operational and clinical information to drive system optimization and innovation. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions.

Methods

To operationalize a lhs, we developed the Ottawa Health Transformation Model (ohtm) as a consensus approach that addresses process barriers, resistance to change, and conflicting priorities. A regional Community of Practice (cop) was established to engage stakeholders, and a dedicated transformation team supported process improvements and implementation.

Results

The project operationalized the lung cancer diagnostic pathway and optimized patient flow from referral to initiation of treatment. Twelve major processes in referral, review, diagnostics, assessment, triage, and consult were redesigned. The Ottawa Hospital now provides a diagnosis to 80% of referrals within the provincial target of 28 days. The median patient journey from referral to initial treatment decreased by 48% from 92 to 47 days.

Conclusions

The initiative optimized regional integration from referral to initial treatment. Use of a lhs lens enabled the creation of a system that is standardized to best practice and open to ongoing innovation. Continued transformation initiatives across the continuum of care are needed to incorporate best practice and optimize delivery systems for regional populations.

Author Biographies

M. Fung-Kee-Fung, The Ottawa Hospital; University of Ottawa

Department of Medicine

D.E. Maziak, The Ottawa Hospital; University of Ottawa, Ottawa Hospital Research Institute
Department of Surgery, Division of Thoracic Surgery
J.R. Pantarotto, The Ottawa Hospital; University of Ottawa

Division of Radiation Oncology

L. Taylor, The Ottawa Hospital

L. Taylor BA is a director of information systems

T. Timlin, The Ottawa Hospital


T. Cacciotti, The Ottawa Hospital

T. Cacciotti BCom is a manager in information systems

P.J. Villeneuve, The Ottawa Hospital; University of Ottawa, Ottawa Hospital Research Institute;

Department of Surgery, Division of Thoracic Surgery

C. Dennie, The Ottawa Hospital; The Ottawa Hospital, Ottawa Hospital Research Institute, University of Ottawa

 Department of Medical Imaging

C. Bornais, The Ottawa Hospital

C. Bornais, RN MN is a nurse navigator in the cancer program.

S. Madore, The Ottawa Hospital
S. Madore, RN, is clinical director of The Ottawa Hospital Cancer Program.
J. Aquino, The Ottawa Hospital; Ottawa Hospital Research Institute, University of Ottawa

Department of Medical Imaging

P. Wheatley-Price, The Ottawa Hospital; University of Ottawa

Department of Medicine

R.S. Ozer, The Ottawa Hospital

R. S. Ozer PhD MHA is a quality improvement coordinator

D.J. Stewart, The Ottawa Hospital; University of Ottawa

Department of Medicine

Published
2018-02-28
How to Cite
Fung-Kee-Fung, M., Maziak, D., Pantarotto, J., Smylie, J., Taylor, L., Timlin, T., Cacciotti, T., Villeneuve, P., Dennie, C., Bornais, C., Madore, S., Aquino, J., Wheatley-Price, P., Ozer, R., & Stewart, D. (2018). Regional process redesign of lung cancer care: a learning health system pilot project. Current Oncology, 25(1), 59-66. https://doi.org/10.3747/co.25.3719
Section
Surgical Oncology