The big bang vs. phased approach: ASCO standard implementation within a large academic medical center.

Abstract

419 Background: The implementation of quality improvement initiatives within a large academic medical center can present as challenging and complex. Research findings indicate that the most successful of the large service corporations maintain a strong focus on the small, functional units who carry out the core activities that involve interaction with customers. (Quinn J, Baruch J, Zien K. Innovative Explosion: Using Intellect and Software to Revolutionize Growth Strategies. New York: Free Press; 1997.) This phased approach allows a larger medical center the opportunity to target implementation around one or two sites at a time with a focus on the staff education, workflow processes, and technology integration. Our institution found that the big bang approach can pose as a threat to the success of implementation at a large academic medical center. Methods: The initial approach taken by our large academic medical center was the roll out of all required ASCO PC4 standards throughout the entire enterprise: the big bang approach. This approach would entail the implementation of 7 standards, 17 sub-standards within 15 sites and over 84 departments within the span of one year. Instead, we took the phased approach: a less burdensome, more efficient, and cost-effective strategy. Between 11/2023 1/2023, we implemented a total of 6 standards within two sites and 3 departments. In the span of three month, a multidisciplinary approach was applied, engaging all levels of employees at each site, including MDs, NPs, MAs and Front Desk Staff. The two sites identified were strategically selected based on current resources and initiative alignment with those of ASCO requirements. On 1/30/23 the two sites went live with 6 ASCO standards. Results: Some challenges in implementation included training of staff in a timely manner, influencing the change of behavior, and education retention of staff. Despite the challenges faced, between 2/6/23 and 3/24/23 data showed adequate engagement and compliance. 567 patients were identified by for patient tracking through developed reporting, 328 patients had a chart review or a follow-up from the oncology care coordinator. Between 1/30/23 and 3/24/23, 61% of patients were screened for SDOH needs with 32 referrals to a community health worker, 8 referrals to social service and 12 interventions with patients indicating self-harm. 100% of patients received education around OMH, with a total of 1,923 MyChart messages sent to patients regarding support with ACP. 68.8% of clinician completed adequate goals of care documentation to meet standard requirements and new workflow. Conclusions: A phased approach of first piloting ASCO's PC4 quality program at 2 sites within our large cancer center was successful. The experiential knowledge gained will allow more efficient role out of necessary staff education, workflow processes, and technology integration to support wider adoption across our center.