Showing papers by "Carol Sawka published in 2012"

Cancer Care Ontario's experience with implementation of routine physical and psychological symptom distress screening.

Abstract: Objective: In late 2006, Cancer Care Ontario launched a quality improvement initiative to implement routine screening with the Edmonton Symptom Assessment System (ESAS) for cancer patients seen in fourteen Regional Cancer Centres throughout the province. Methods: A central team: created a provincial project plan and management and evaluation framework; developed common tools and provided expert coaching and guidance, provincial data analysis, progress reporting and program evaluation. Regional Steering Committees and Improvement teams were accountable for planning and coordination within each region and supported by a funded Regional Improvement Coordinator. A hybrid model for quality improvement facilitated process improvements and uptake of screening. Results: Challenges to implementation included: lack of consensus on the chosen screening tool, lack of guidance for assessment or management of high scores, concern of inadequate time or resources to address issues identified by the screening, data entry was labour intensive, resistance to change and challenges to the traditional care model. Essential components for success were: centralized project management, a person dedicated to implementation of the project locally, clinical champions, clearly identified aims, monthly regional data reporting and implementation of quality improvement methodologies with expectations for performance. To achieve screening aims many centres engaged all members of the team, examined the roles of the different members and reorganized workflow and responsibilities and changed booking times. In March 2010, approximately 25,000 ESAS's were completed in the regional cancer centres across Ontario, with 60% of lung cancer patients and almost 40% of all other cancer patients who visited the Regional Cancer Centres screened. Conclusion: Routine physical and psychological distress screening is possible within regional cancer centres. Although considerable effort and investment is required, it is worthwhile as it helps create a culture that is more patient-centered. Copyright © 2011 John Wiley & Sons, Ltd.

The crucial role of clinician engagement in system-wide quality improvement: the Cancer Care Ontario experience.

Abstract: In 2004, Cancer Care Ontario's (CCO) role changed from providing direct cancer service to oversight, with a mission to improve the performance of the cancer system by driving quality, accountability and innovation in all cancer-related services. Since then, CCO has built a model for province-wide quality improvement and oversight--the Performance Improvement Cycle--that exemplifies the key elements of the Excellent Care for All Act, 2010. While ensuring that quality of the cancer system is by necessity a continuous process, the approach taken thus far has achieved measurable results and will continue to form the basis of CCO's future work. Clinician engagement has been critical to the success of CCO's approach to quality oversight and improvement. CCO uses a variety of formal and informal clinical engagement structures at each step of the Performance Improvement Cycle, and has developed operational processes to support quality improvement, and educational and mentorship programs to build clinician leadership capacity in that area. An example of sustained quality improvement in system performance is illustrated in a case study of the surgical treatment of prostate cancer. The improvement was achieved with strong collaboration across CCO's surgery and pathology clinical programs, with support from informatics staff.

A ten-year history: the Cancer Quality Council of Ontario.

Abstract: One of the longest-established quality oversight organizations in Canadian healthcare, the Cancer Quality Council of Ontario (CQCO) is an advisory group formed in 2002 by the Ministry of Health and Long-Term Care. Although quasi-independent from Cancer Care Ontario (CCO), the council was established to provide advice to CCO and the ministry in their efforts to improve the quality of cancer care in the province. The council is composed of a multidisciplinary group of healthcare providers, cancer survivors and experts in the areas of oncology, health system policy and administration, governance, performance measurement and health services research. Its mandate is to monitor and report publicly on the performance of the Ontario cancer system and to motivate improvement through national and international benchmarking. Since its formation, the council has played an evolving role in improving the quality of care received by Ontario cancer patients. This article will briefly describe the origins and founding principles of the CQCO, its changing role in monitoring quality and its relationship with CCO.

Determining resource intensity weights in ambulatory chemotherapy related to nursing workload.

Abstract: Ontario cancer programs aim to deliver high-quality nursing care and treatment that is safe for patients and staff. The reality of health care is that financial constraints, inherent in the delivery of care, require that funding mechanisms count not only the cost of drugs, but factors such as pharmacy and nursing human resource costs. While some organizations have developed patient classification systems to measure nursing intensity and workload, these systems apply primarily to inpatient populations, and are fraught with numerous challenges, such as the need for nurses to document to justify the workload required for care. The purpose of this paper is to outline the methodology and engagement of nurses to develop regimen-based resource intensity weights that can be applied to ambulatory chemotherapy suites. The methodology included determination of workload related to nursing time to prepare, teach, counsel and assess patients, as well as time to gather supplies, access lines, monitor, manage adverse reactions, manage symptoms and document care. Resource intensity weights provide better measures of the complexity of care required by cancer patients in ambulatory settings.

Patient navigation in cancer diagnostics: Providing information and support for more effective care.

Abstract: 5 Background: Patients frequently have a difficult time finding their way through the process of diagnostic testing for cancer; the uncertainty is stressful and anxiety can impede effective communication and decision-making. Patient navigation is an ideal approach to supporting patients during the diagnostic phase of cancer care. Methods: Between 2010 and 2011, 14 Patient Navigators were trained and introduced into Diagnostic Assessment Programs (DAPs) across Ontario. DAPs are designed to provide coordination and supportive care to patients undergoing diagnostic testing and assessment. A patient survey served to evaluate the impact of patient navigation on the patient experience. Standardized tools were introduced to measure symptom severity and symptom management. Interviews were done to gauge provider and team perspectives on the role. Results: During the pilot, patient symptoms improved in the areas of well-being, tiredness, anxiety and shortness of breath, each by 30% or more. The patient survey indic...

Déterminer la pondération de la consommation des ressources en chimiothérapie ambulatoire liée à la charge de travail des infirmières

Abstract: Les programmes de cancerologie ontariens se sont fixes comme objectif de dispenser des soins infirmiers de haute qualite et des traitements securitaires a la fois pour les patients et pour le personnel. Dans le domaine de la sante, les contraintes financieres inherentes a la prestation des soins exigent que les mecanismes de financement rendent compte non seulement du cout des medicaments mais encore de facteurs tels que les couts des ressources humaines en pharmacie et en soins infirmiers. Alors que certaines organisations ont elabore des systemes de classification des patients afin de mesurer l’intensite des soins infirmiers et la charge de travail des infirmieres, ces systemes s’appliquent principalement aux clienteles hospitalisees et presentent de nombreux defis tels que la necessite pour les infirmieres de documenter la charge de travail exigee par les soins a des fins de justification. Cet article a pour but de tracer les grandes lignes de la methodologie et de l’implication des infirmieres en vue d’elaborer une ponderation de la consommation des ressources basee sur les protocoles pouvant etre appliquee aux salles de chimiotherapie ambulatoire. La methodologie inclut la determination de la charge de travail reliee au temps dont les infirmieres ont besoin pour preparer, conseiller et evaluer les patients et leur fournir l’enseignement requis ainsi que le temps necessaire pour rassembler les fournitures, acceder aux lignes de perfusion, surveiller, gerer les effets indesirables, gerer les symptomes et documenter les soins. La ponderation de la consommation des ressources fournit une meilleure mesure de la complexite des soins exiges par les patients atteints de cancer traites en milieu ambulatoire.