“You have cancer.” With sledge-hammer-like force, these three words forever alter the life of a patient and their support system. The stopwatch starts ticking. Time becomes precious as never before.
While cancer care providers want to meet these patients’ pressing needs, the systems that drive patient interactions often misalign with what the patient wants or needs. Patients typically carry the burden of managing their complex treatment pathways and feel distanced from their care providers. This erodes trust and leaves patients looking for a different experience.
How can cancer programs do better? The answer lies in developing a mindset of continuous improvement and building the patient experience to prioritize urgency, comfort, and trust. Cancer program leaders can use this as an opportunity to rethink their operating models and design workflows to optimize patients’ time spent in the care system—and create more time for their lives beyond.
For the patient, a streamlined experience promotes adherence to care, resulting in better outcomes. For health systems, an optimal experience can create operational efficiencies, provider and staff satisfaction, and improved patient retention for current and future care needs.
Cancer programs need a highly collaborative, advanced care model to achieve these benefits. They must center their processes around patients to better align with patient preferences. We discuss four strategies to improve operational performance while creating an optimal patient experience and honoring the patient’s desire to live their life, not sitting in a facility…waiting.
How health systems can deliver a patient-centered experience
Programs are adopting four key strategies to put the patient at the heart of the care model:
1. Optimize the patient journey by streamlining the process—reducing handoffs, breaking down siloes, and empowering the care team for real-time decision-making.
Health systems that establish a highly collaborative cancer care model deliver an experience that truly puts patients at the center. The collaborative care model, centered around a care-to-chair workflow, is structured so that the multidisciplinary care team comes to the patient room during a single clinical encounter, decreasing the need for patients to move between care sites. It also simplifies patient interactions as their visits with all essential providers (e.g., research, nutrition, education, and pharmacy) take place in a single exam room.
This model is less about the sequence of providers entering the exam room and more about co-location of the appropriate clinical teams in a space optimized for interaction with each other and the patient. Co-locating providers and their staff in a common work room is a powerful mechanism to enable conversations that develop into care plans, including consideration for enrollment in clinical trials.
At the end of this series of visits, the patient leaves with their comprehensive care plan and books their next appointment. If necessary, the team can also confidentially address any potentially sensitive financial issues before the patient leaves the building.
Coupling the collaborative care model with judicious use of technology can also be a powerful tool for streamlining processes. When health systems assess these products thoroughly to understand their impact on current workflows, they can identify how the technology will enhance the clinical team experience or replace specific work. This can ensure that the digital solution truly adds value.
Strategy in action: A large academic cancer center recently developed a highly coordinated, patient-centered care journey as it sought to rapidly grow amid increasing competition. The goal was to streamline care, reduce delays, increase throughput, and help patients more quickly return to their lives outside the hospital.
Teams evaluated the patient journey, uncovered efficiencies, and implemented improvements to increase patient throughput. They also implemented a care-to-chair outpatient model.
In tandem, they deployed key digital strategies, including a real-time location system to track patient and care team movements, using artificial intelligence (AI) to reduce unnecessary movement and decrease bottlenecks in patient flow. They also deployed ambient listening that reduced provider burden, improved their ability to focus on patients, and expanded clinical capacity. As a result, patients and providers are more satisfied, and retention has improved.
2. Optimize access to care to increase care plan compliance and reduce wait times between treatment modalities.
Improving access has long been a critical healthcare priority. This has only escalated since the pandemic exacerbated inefficiencies as delayed screenings and services pinched access points and caused patient backlogs. Health systems have renewed the focus on access by identifying ways to increase the number of patients seen, with strategies such as doubling down on provider templates and decreasing the time providers spend with each patient.
However, these strategies are insufficient because a root cause of the access problem is care team optimization.
Optimizing the team means ensuring that each provider works at the top of their license. For example, advanced practice providers (APPs) see return patients who are not in active treatment, medical assistants (MAs) support coordinated clinical flow and administrative documentation, and registered nurses (RNs) take a larger role in care coordination and education. This enables greater care team capacity to accommodate new patients, more access for patients who need to see physicians, and increased provider satisfaction.
Strategy in action: An academic cancer center designed a framework for an ambulatory care team model, incorporating a provider compact to define commitments from providers and the health system. Providers committed to renew focus on the outpatient clinical experience and to support independent APP practice models with toolkits for implementation.
The organization created a staffing model across care teams with projected full-time equivalents required to support volume demands. The organization expects an increase of more than 20,000 ambulatory visits for new and returning patients across the cancer service line in 1 year.
3. Create end-to-end navigation to enhance multidisciplinary interaction between providers and patients and the continuum between inpatient and outpatient episodes of care.
Navigation is essential for an efficient, positive experience. By weaving it into the fabric of the clinical workflow, health systems can create a high degree of interaction between the patient and the care team.
End-to-end navigation starts with providing each patient with a point of contact within the cancer program to answer questions, guide the process, and ensure compliance with the care plan. Well-planned and implemented navigation ensures that the patient and care team communicate well, and it guides the patient through their care pathways and care modalities both inside and outside the clinical setting. Navigation also helps patients manage symptoms and arms them and their caregivers with the tools they need to recognize trouble early.
End-to-end navigation combined with a collaborative care model provides numerous benefits, including:
- Eliminating excruciating wait times associated with legacy tumor board cycles
- Minimizing patient questions that proliferate with waiting between provider appointments
- Reducing missed appointments
- Increasing care compliance
- Empowering patients to play an active role in their care
- Enabling administrative efficiencies
Strategy in action: A large academic medical center began its journey to coordinated navigation services with the goal of matching every patient with a dedicated person to support their cancer journey. But gaps in care permeated the system because of the wide variety of navigator roles and approaches to navigation that were all decentralized across the enterprise.
The organization undertook a rigorous design and demonstration strategy, intentionally designing navigation services and delineating a distinct role for navigation that coordinates with the care team. After the first year of implementation, patient retention has improved, conversion rates are up, and patient satisfaction scores have materially increased.
4. Integrate research into the outpatient workflow, combining clinical and research teams to enhance enrollment in clinical trials and improve care quality for patients in trials.
Patients seek programs that offer hope, which many see in clinical trials. More than ever before, oncology care is rooted in clinical research, and patients are demanding access. Embedding research in the clinical workflow provides access to innovative treatment options and fosters individualized care as clinical research leads to more personalized interventions based on the patient’s genomic profile.
Cross-training outpatient and research nurses and embedding research teams into the clinical environment can increase enrollment in clinical trials and encourage compliance so patients can stay in those trials. It is important that the team understands research and integrates trials (including group trials, population studies, and treatment trials) across all stages of the patient journey.
This ensures the care team offers patients advanced treatment options and supports them with expertise in these therapies. Additionally, by having research conversations within the outpatient visit, patients can take an active role in their treatment decisions, resulting in an enhanced sense of ownership during what is often an overwhelming experience.
Strategy in action: An academic cancer center wanted to integrate research and standard of care into a unified workflow. The team designed a collaborative care model that included embedding research teams in the clinical workflow at key points in the care journey.
The research team works out of the shared workrooms, and the research nurse and coordinator participate in patients’ workup, screening, and treatment planning. They collaborate closely with physicians to screen all new patients and patients who may have a change in diagnosis. This integration has increased enrollment in clinical trials and enhanced care compliance while in trials.
Refocus the patient journey for better experience and operations
While implementing these strategies requires significant work in exploring processes, care models, and resource utilization, putting patients at the center of the care journey can make a significant impact. The conversations around these strategies will challenge deeply held beliefs and codified rituals. Complete openness to change is key. Leader support, focused change management, and rigorous daily management are vital to implementing these four strategies. Health systems that do so effectively will offer a better patient experience, improve provider satisfaction, enjoy greater patient retention, and ensure efficient operation.
