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Impact of infrastructure positions on cancer services

Research updates

Issue 6, December 2010

The Cancer Service Infrastructure Support Program involves the funding of positions in Area Health Services to enable the further development of integrated cancer services.

Positions funded under this program include:

• directors of area cancer services (DACS)
• cancer services development managers (CSDMs)
• lead clinicians
• cancer nurse coordinators
• psycho-oncology staff
• cancer genetics staff.

The aim of these positions was to develop and enhance cancer and palliative care services in each Area Health Service through the following domains:

• Clinical leadership
• Coordination of care
• Multidisciplinary care
• Patient centred care.

Each of these positions has been developed in the context of each Area Health Service to ensure local priorities were addressed.

Purpose

An evaluation of the entire infrastructure support program was undertaken.

One component of the evaluation was to determine the impact of directors of area cancer services, cancer services development managers and lead clinicians on clinical leadership, coordination of care, multidisciplinary care and patient centred care.

Positions funded by the Cancer Service Infrastructure Support Program in NSW

Method

An extensive literature review and consultation with key stakeholders resulted in the development of an evaluation framework consisting of:

• A written survey of the 132 staff employed under the infrastructure program.  One-hundred and ten responses were received (85% response rate).
• Service level case studies in each Area Health Service involving 190 interviews of staff employed under the infrastructure program, service managers, chief executives and senior clinicians.

Results

Improving Clinical Leadership

Systems and Processes Implemented to Improve Clinical Leadership

Clinical leadership activities are undertaken by all positions.  As expected:

• Lead clinicians play a greater role in treatment related leadership activities.
• DACS and CSDMs have a greater focus on AHS wide collaboration and service development and improvement.
• The employment of a  range of positions under the infrastructure support program ensures that all aspects of clinical leadership are achieved.

Improving Care Coordination

Percentage of positions undertaking care coordination activities

• The DACS were involved in improving care coordination through the implementation of new systems and  support for the use of evidence based treatment protocols.
• CSDMs played a greater role in the development of protocols and education.

Improving Multidisciplinary Care

Percentage of positions undertaking multidisciplinary care activities

• The CSDMs played a significant role in improving multidisciplinary care through the facilitation and support for Cancer Institute NSW Multidisciplinary team  development and improvement activities.
• Lead clinicians played a greater role in the implementation of multidisciplinary care initiatives.

Improving Patient-centred care

Percentage of positions undertaking patient centred care activities

• All positions have been  involved in undertaking patient centred  care activities.
• The role of the CSDM in patient centred care activities varied considerably between Area Health Services.  With some involved in all activities and others believing this objective was more appropriate for clinicians to focus on.

Infrastructure positions barriers

Percentage of positions identifying barriers

The main barriers identified as limiting the effectiveness of infrastructure support positions include:

• Limited time due to the majority of staff also carrying a clinical load.
• A lack of funding to implement strategies and undertake projects.
• A lack of administration support resulting in staff time being spent on administration.

The Cancer Institute NSW and the Area Health Service do not appear to be barriers to the achievement of the infrastructure objectives.

Infrastructure position enablers

Percentage of positions identifying enablers

The main enablers to the infrastructure support positions achieving their objectives include:

• Funding provided by the Cancer Institute NSW to support the positions.
• Project funding provided by the Cancer Institute NSW.
• Support from the Area Health Service.
• Support from clinicians.

Conclusion

All three roles have positively impacted on clinical leadership, coordination of care, multidisciplinary care and patient-centred care. The main factors identified as limiting the impact of the positions included:

• Lack of clarity around the roles.
• Significant workload.
• Lack of additional funding to implement strategies and travel  throughout the AHS.
• Lack of administrative support.

The Cancer Institute NSW is now reshaping the Cancer Service Infrastructure Support Program to ensure funding aligns to the goal of optimal patient outcomes. This will include the development of cancer service indicators and a related performance management framework.