Download Ministry of Health Faster Cancer Treatment Targets

Targets Improve Efficiency!
Ministry of Health Faster Cancer Treatment Targets Drive Process Improvement in the Gynaecology Service
Background & Aim:
In October 2014 the NZ Ministry of Health introduced a new health target:
Faster Cancer Treatment (FCT). This target states that by July 2016, 85% of
patients receive their first cancer treatment (or other management) within 62
days of being referred with a high suspicion of cancer and needing to be seen
within two weeks, increasing to 90% by June 2017.
The first publicised reporting period July – Dec 2014 showed none of the
DHB’s met the faster cancer treatment target, see the table on the right. Our
DHB, Counties Manukau Health (CMH), was one of the worst performing
DHBs in the country with only 52% of the FCT patients meeting the target.
In response CMH formed a working team of the Service Manager for
Medicine, the Lead Cancer Nurse Co-ordinator and Improvement Advisors
from Ko Awatea. This team was deployed to working with tumour streams,
support services and diagnostic services to support these areas to make
improvements that would deliver more timely diagnosis and treatment, as
well as reduce the variability.
What is the Problem?
What: Currently only 14% of the Gynaecology high suspicion of cancer patients meet the Ministry of Health
target of 62 days. This was only 0% for April 2015.
When: Since July 2014
Where: Cancer Pathways for Gynaecology Service at CMH
Scope: From date of receipt of referral to 1st cancer treatment
Benefits:
• Reduced time from referral received to 1st treatment
commenced for FCT patients
• Meet MOH 62 day target
• Improved/enhanced process and standardization
• Timely diagnosis and treatment for FCT patients
• Reduced wait and delay time for high suspicion
• of cancer patients
• Efficient utilization of resources
Objectives:
Observe and create a high level map for the gynae cancer tumor stream to identify opportunities for
improvement that will lead to:
• ensuring that at least 85% of the high suspicion of cancer and urgent patients commence treatment within
62 days of secondary care referral by 1 July 2016
• meeting the requirements of the 31 day FCT indicator
QR
code
Current State Analysis:
Receive
Referral
Fail/Pass
Fail
Fail Total
Pass
Pass Total
Grand Total
Grade
Referral
Tumour Stream
Gynaecological
Gynaecological
First
Specialist
Appointment
(FSA)
Diagnostics
Results:
MultiDisciplinary
Meeting
(MDM)
Decision to
Treat
First
Treatment
Values
Average of Time to Average of Time to Average of Time to Average of Time to Average of Time to
grading
FSA
MDM
decision to treat
treatment started
8.24
15.35
52.44
12.31
27.35
8.24
15.35
52.44
12.31
27.35
5.25
8.00
6.00
5.67
9.00
5.25
8.00
6.00
5.67
9.00
7.67
13.95
45.11
11.26
23.18
July 2014 to Sept 2015
Oct 2015 to June 2016
Ideas for Improvement!
Introduce
dedicated FCT
outpatient clinic
slots at weekly
Thursday clinics
Appoint
dedicated
Cancer Nurse
Co-ordinators
Introduce
standardised MDM
templates for
effective
communication
The various
improvement
interventions
tested and
implemented
by the
Gynaecology
FCT team have
resulted in
creation of an
improved
stable system
that is evident
by the overall
shift in the
overall
throughput
(referral to
first
treatment)
data for the
FCT patients.
Lessons Learnt:
• Partnership between Management and Clinical Leadership is the key to drive
improvement and sustained change
• Involve all the key stakeholders within the service i.e. management, clinical
lead, frontline staff, etc. right from the start
• Change takes time!
• Each pathway is different with different timeframes. The improvements need
to be tailored to make them work.
• Patient choice is a huge factor! We need to ensure we take that into
consideration and not get stuck on just achieving the target.
• A lot of churn for only 10% patients that fit into the target criteria. The
service has to process a lot of patients at the start of the pathway who
dropout once a negative cancer diagnosis is confirmed.
Next Steps:
• Enhancing communication with Primary Care to improve quality of referrals
• Improve patient engagement with service through education especially Maaori
and Pacific Island patients
• Maximise ambulatory services to expidite time to diagnosis
Project Team (Authors): Adrienne Laing (Service Manager – Gynaecology), Katherine Sowden (Clinical Lead - Gynaecology), Leani Curtis (Cancer Nurse Coordinator), Jennifer van der Westhuizen
(Cancer Nurse Coordinator), Sneha Shetty (Improvement Advisor)