Improving cancer service performance
Monitoring cancer outcomes and reducing clinical variation is one way to ensure that all cancer patients, regardless of where they live, receive the best evidence-based cancer treatment available.
A high quality, effective, efficient and sustainable cancer
system must deliver, and optimise, outcomes for people with cancer.
Monitoring cancer outcomes and reducing clinical variation is one
way to ensure that all cancer patients, regardless of where they
live, receive the best evidence-based cancer treatment
available.
The Cancer Institute NSW provides program and research funding
to Area Health Services (AHSs) to support cancer research,
screening, data collection and cancer services. Historically, the
funding and performance model has been de-centralised and program
based and supported by specific key performance indicators (where
measures were available) and/or quality improvement processes. This
has limited the embedding of a quality improvement cycle supported
by robust information and thus the impact of the funding.
The Cancer Institute NSW is implementing a Performance
Monitoring Framework (PMF) to ensure a strong and consistent
process that focuses on the key operational and financial issues
confronting cancer services. The performance management framework
aims to streamline reporting to key performance indicators for
cancer control and to use the information generated to inform
performance monitoring and drive quality improvement in cancer
services in NSW.
Purpose
Under the PMF, grant funding to AHS's will be underpinned by a
set of key performance indicators which align to the NSW Cancer
Plan 2011-15.Cancer services will be supported by the PMF
to identify and reduce variations in cancer outcomes. Strong data
management systems, with valid and reliable data, as well as
comparative data, underpin the framework.
Indicators for clinical performance monitoring and evaluation,
developed in collaboration with NSW Oncology Groups and the
proposed Cancer Networks and Local Health Networks (LHNs), have
been developed, and will continue to be refined and reported
against.
The system promotes the integration of health system monitoring
into health information systems and planning cycles to inform and
drive system changes and improve performance. The systematic
appraisal and monitoring of health care via performance indicators
also allows for monitoring of the impact of health system changes
that have occurred. This provision and feedback of information
forms the basis of regular review meetings to be held between LHNs,
Cancer Networks and the Cancer Institute NSW.
Method
The development of the framework involved four phases:
- Review of international cancer service indicators and
consultation with stakeholders to determine indicators for
NSW.
- Development of a reporting strategy including data systems and
sources.
- Development of a performance review and quality improvement
cycle.
- A change management process was developed concomitantly.
Results
A Performance Management Framework, underpinned by a set of key
performance indicators(KPIs), (Table 1) has been developed and
comprises of:
- Clearly stated performance requirements and targets.
- A highly qualified clinical and quality expert review panel to
review and guide performance.
- Articulated KPIs and performance thresholds for each target
that, if unmet, will trigger a formal intervention and/or
escalation activities.
- A robust performance management process that includes biannual
face to face performance reviews.
- Defined performance criteria to assess whether LHNs/CNs is
addressing the cancer service performance and KPI targets at
facility, clinical network/stream and LHN levels.
- Transparent monitoring and reporting processes to ensure
performance issues are identified early and responses are
timely.
- Clearly defined levels of response to address performance
issues that include:
- clear roles and responsibilities at the LHN/CN level for
meeting targets and supporting and implementing performance
improvement; and
- clear roles within the Cancer Institute NSW to manage
performance review process and provide necessary support and
guidance to LHNs/CN.
Proposed indicators for first round of funding
- BreastScreen Participation rates
- BreastScreen Accreditation status
- Number of Pap tests conducted by Women's Health Nurses
(WHN's) by Local Government Area (LGA)
- Number of Full Time Equivalent Women's Health Nurses
- Percentage of pap test performed on under screened and
un-screened women
- Average waiting time for radiotherapy treatment by priority
group.
- Percentage of patients who have undergone cancer surgery with
30 day post-operative mortality in specific DRGs
- Number of patients with a notifiable cancer who are admitted to
hospital with febrile neutropenia.
- Number of patients undergoing radiotherapy who are admitted to
hospital between day 2 of treatment and day 30 post cessation of
treatment.
- Patients' experience of the service (quantitative &
qualitative)
- Case completion within 6 months of diagnosis and 1st course of
treatment completion within 18 months of diagnosis.
- Number of dataset extensions implemented in collaboration with
MDT groups.
- Proportion of cases with an ECOG status recorded for
Colorectal, Lung, Lymphoma and Upper GI.
- Proportion of Stage IV cases with referral to palliative care
recorded.
- Number of tumour-specific meetings where reports are presented
to clinicians.
- Number of clinical trials by tumour type
- Increase in number of patients enrolled on clinical trails
- Proportion of staff with 0.2 FTE or greater of dedicated
research time
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Draft performance management framework
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Proposed performance review structure
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Conclusion
Information generated by the monitoring of key performance
indicators is integral to an effective performance management
framework and the subsequent adoption by cancer services of a
continuous quality improvement cycle to improve outcomes for cancer
patients. Robust information increases accountability and allows
benchmarking of performance at a service level thus maintaining a
focus on the continual improvement of cancer outcomes in NSW.
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