Abstract
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. 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. 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. 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.
Highlights
Improving access to timely cancer diagnosis requires more than just increasing the volume of patients processed through the system
We developed the Ottawa Health Transformation Model as a coherent regional approach for large-scale change integrating the patient journey with best practice
This paper demonstrates the application of the ohtm to create effective redesign of the regional system for lung cancer diagnostic services
Summary
Improving access to timely cancer diagnosis requires more than just increasing the volume of patients processed through the system. It requires balance of the timely access to care with the quality of the services delivered within the cost-constrained availability of resources[1,2]. In the Champlain region of Ontario, Canada, cancer diagnosis services are delivered in a variety of hospitals and care settings to a population of 1.2 million people dispersed across 18,000 square kilometres. 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. An essential component of a lhs is a collaborative platform that provides connectivity across silos, organizations, and professions
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