Abstract
The differences in cancer survival across countries and over time are well recognised, with progress varying even among high-income countries with comparable health systems. Previous research has examined several possible explanations, but the role of leadership in systems providing cancer care has attracted little attention. As part of the International Cancer Benchmarking Partnership (ICBP), this study looked at diverse aspects of leadership to identify drivers of change and opportunities for improvement across seven high-income countries. Key informants in 13 jurisdictions were interviewed: Australia (2 states), Canada (3 provinces), Denmark, Ireland, New Zealand, Norway and United Kingdom (4 countries). Participants represented a range of stakeholders at different tiers of the system. They were recruited through a combination of purposive and 'snowball' strategies and participated in semi-structured telephone interviews. Interview transcripts were analysed thematically drawing on the World Health Organization (WHO) health systems framework and previous work analysing national cancer control programmes (NCCPs). Several facets of leadership were perceived as important for improving outcomes. These included political leadership to initiate and maintain progress, intellectual leadership to support those engaged in local implementation of national policies and drive change, and a coherent vision from leaders at different levels of the system. Clinical leadership was also viewed as vital for translating policy into action. Certain aspects of cancer care leadership emerged as underpinning and sustaining improvements, such as appointing a central agency, involving clinicians at every stage, ensuring strong leadership of cancer care with a consistent political mandate. Improving cancer outcomes is challenging and complex, but it is unlikely to be achieved without effective leadership, both political and clinical.
Highlights
Cancer survival has improved substantially in recent decades but continues to vary widely internationally,[1] even among countries with seemingly similar health systems.[2,3] Existing research has explored reasons for these differences, focusing on the continuum of care from awareness of symptoms[4,5,6,7,8,9] and timely diagnosis[10] to cancer treatment, aftercare and monitoring of patients.[11]
Within the overarching themes of leadership and governance, participants raised issues that fell into four sub-themes, each identified as important potential drivers for change that would shape cancer survival: (1) political leadership steering the development of cancer services; (2) intellectual leadership by those possessing a set of technical competences and skills that can bring about change, combined with a dedicated political mandate; (3) the inclusion of clinical leadership in decision-making and implementation, and (4) leadership across the different tiers of the system
This was especially true for leadership, where direct connections were seldom made with improvements in particular outcomes
Summary
Cancer survival has improved substantially in recent decades but continues to vary widely internationally,[1] even among countries with seemingly similar health systems.[2,3] Existing research has explored reasons for these differences, focusing on the continuum of care from awareness of symptoms[4,5,6,7,8,9] and timely diagnosis[10] to cancer treatment, aftercare and monitoring of patients.[11]. Overall leadership is a government’s responsibility[29] and necessitates a political mandate, some leadership functions in service organisation and delivery, including in cancer care, tend to be delegated to subordinate bodies such as health authorities, nongovernmental agencies, or professional associations. These might be national, regional and/or local, often reflecting the constitutional arrangements in a given country, whether
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