Reducing wait times and increasing cancer patient satisfaction in ambulatory care

The Challenge: More cancer survivors place added stress on ambulatory care

Advances in medicine and technology have vastly increased the number of cancer survivors in Canada. Yet this good news presents challenges of its own. Care and treatment for the increasing number of cancer survivors is placing added stress on hospitals’ budgets and resources for ambulatory care. (Ambulatory care is surgeries, diagnostic procedures and treatments that do not require patients to remain in hospitals overnight.)

The Improvement Project: Design new system for hospital’s ambulatory care

Sarah Downey (Vice-President), Barbara Fitzgerald (Director Of Nursing) and Malcolm Moore (Chief of Medical Oncology and Hematology) at Princess Margaret Hospital, with active support of Robert Bell, President and CEO of the University Health Network in Toronto, set out as EXTRA participants to design, implement and evaluate a new system for the hospital’s ambulatory care that improves patient experiences, creates powerful inter-professional teams and increases the effectiveness of clinical operations. The bulk of the team’s research involved literature searches and surveys of the best practices of internationally respected cancer centres. The goal was to gain insights into LEAN process improvements, models of change in ambulatory care and patient empowerment.

The Result: Nurses accountable for experiences of their patients

Through its research findings, the team created a new model of ambulatory care that aligns inter-professional teams of nurses and clerks to specific disease sites. At the same time, existing partnerships between physicians and nurses have been modified so that nurses are now assigned to deal primarily with patients rather than individual physicians and departments, making individual nurses accountable for the experiences of their patients. In addition, a new position of patient coordinator has been identified to manage day-to-day clinical operations within each disease site.

The Impact: Starting on time, finishing on time

A pilot project that implemented this new model of care at the hospital’s Gynecologic Oncology Site Group generated impressive results. The time to make referrals for secondary care decreased from as many as 17 days to fewer than five days. The percentage of patients deemed to be seen on time for treatment increased from 28 to 70. And the percentage of “on-time starts” of consultations and treatments increased from 80 to 94, while “on-time finishes” rose from 53 to 65.

Sarah Downey image

Sarah Downey
Princess Margaret Hospital
Toronto, Ontario

Barbara Fitzgerald image

Barbara Fitzgerald
Director Of Nursing
Princess Margaret Hospital
Toronto, Ontario

Malcolm Moore image

Malcolm Moore
Chief of Medical Oncology and Hematology
Princess Margaret Hospital
Toronto, Ontario

Robert Bell image

Robert Bell
President and CEO University Health Network
Toronto, Ontario

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