The Rossy Cancer Network’s (RCN) second anniversary is weeks away. Thanks to the RCN, the oncology teams at St. Mary’s Hospital Center, Jewish General Hospital, McGill University Health Centre and McGill Faculty of Medicine are now working together, exchanging knowledge, expertise and ideas, and launching several key initiatives with the shared goal of increasing survival and enhancing the quality of life of those living with cancer.
The RCN Director of Operations Giovanni Vatieri looks back at two years of tremendous growth, together with the challenges that characterize transformative change. He candidly discusses what the organization has accomplished and where it is headed.
QUESTION: What did it take to establish the RCN?
ANSWER: The RCN is a startup, a fledgling enterprise. One of the key attributes of any startup is the ability to grow. Over the past two years, the RCN has grown at a tremendous rate. Remember we started with very little. Job descriptions had to be written, people hired, surveys commissioned, projects selected, budgets set, steering committees created, reporting structures established. The list is long. Also, even though the RCN is a partnership of four respected, century-old institutions, we all had a steep learning curve. One simple example, we had to learn to navigate the unique complexities and cultures of all four institutions to accomplish what we set out to do.
QUESTION: What challenges has the RCN encountered?
ANSWER: The RCN was launched during a period of significant change. In the last 12 months, two of the three partner hospitals nominated new CEOs and McGill University hired a new Principal. The hospital and Faculty leaders are responsible for establishing the RCN’s strategic goals and monitoring progress. Additionally, all of the partner hospitals are under immense pressure from government to curb spending. I should also point out one RCN partner, the McGill University Health Centre, is moving multiple hospitals to a new site, an all-consuming project. These are all major challenges. Yet, despite these hurdles, the RCN partners launched a number of noteworthy projects (see sidebar) and rallied behind the RCN’s mission to improve the quality of cancer care and patient satisfaction.
QUESTION: The RCN is an outcomes-based philanthropic startup. Can you explain what this means and its impact?
ANSWER: The RCN is a rather unique entity. It receives funding from five foundations. The Gift Agreement, which represents our mutual obligations and entitlements, requires the RCN meet certain targets and objectives within a specific timeframe. Yet, the RCN is working within the constraints of a public health care system. On the one hand, the RCN is under pressure to rapidly improve the way cancer care is delivered. But this ‘need for speed’ is hampered by the reality that health care is a complex system. Decisions aren’t always made at the local level. Various government agencies are involved and, in many cases, must approve RCN initiatives. Additionally, the health care system is chronically underfunded. So even though the RCN might be able to afford to finance a project like a new IT system, the partner hospitals have to find the budget to maintain these systems. Also, we can’t negate the fact that, historically, the RCN oncology teams have not collaborated at this level in the past. So, we had to find common ground to get everyone to the table and working together. Plus, the health care professionals are so incredibly busy taking care of patients, they can only carve out a finite amount of time to work on RCN projects. It is a delicate dance and we’re all working hard to remain in step despite the constraints.
QUESTION: What has been one of the RCN’s quiet achievements?
ANSWER: It might not be the most visible, but the RCN has being working diligently to establish solid project management practices, which is crucial. In the last year, we have standardized how we select and administer projects. We have built an entire multi-institutional governance model, engaged patients, created cross-institution teams, monitored progress and reported outcomes. As a result we are better organized, more efficient and are optimizing our budget. In the last year, we established the RCN’s three new foci: patient-centred care; harmonization of care, processes and technologies; and creating and sustaining superior performance.
QUESTION: Is there anything the RCN would like to do over?
ANSWER: When we first launched projects, the RCN was anxious to dig in and get projects underway, but in our eagerness we underestimated the major importance of building grassroots teams to lead projects. The small team of project managers at the RCN jumped in to tackle a few major projects with varying and inconsistent levels of engagement of health care professionals. This wasn’t an issue of arrogance. It was an unfortunate combination of urgency and adaptation on our part, pure and simple. Basically, the RCN was brand new and we were learning on the fly. We quickly realized this top-down approach was less than optimal. We are now restructuring those initial projects, making sure we have cross-institutional representation and patient participation on all of our committees. In recent months, we’ve launched several projects using this new form of engagement. The self-check in project in radiation oncology and the reduction of wait times in chemotherapy are two examples (see articles in this edition of RCN News). These projects have gone extremely well and are moving forward at a much faster pace because the health care professionals see and understand the need for the projects, and how they will directly benefit patients.
QUESTION: What are you most excited about?
ANSWER: Almost two years ago, we launched the Ambulatory Outpatient Satisfaction Survey (AOPSS). AOPSS is a standard tool used by health care facilities across Canada and the United States. It measures patient perception of their care. It looks at everything from emotional support, coordination of care, physical comfort, whether patients felt they received enough information and education about their care, among other key indicators. The survey results have allowed us to achieve consensus regarding the RCN’s priorities; move forward with the establishment of cross-institutional project teams; and launch projects with tangible outcomes. We recently added an epidemiologist/statistician to our team. We now have an even better understanding of the data and are able to pinpoint the exact projects that will positively impact patient satisfaction.
QUESTION: After two years, where is the RCN in its evolution and what are the next phases of its development?
ANSWER: The RCN is still in the early phases of its development. In the first year, the work focused mostly on getting projects underway. The partner institutions continued to operate as distinct and individual organizations. Currently, we are in the 2nd phase of the RCN’s development, which is focused on creating a virtual network via the implementation of shared infrastructure and clinical initiatives and the associated metrics. As the RCN partners grow together, we will initiate more and more evidence-based quality improvement initiatives. The key difference will be how we approach these initiatives. Eventually, projects will be tackled with improved collaboration, more sharing and enhanced harmony. I expect we will achieve this level of collaborative maturity in the next 12 to 16 months. Once we reach this level, we will embark on the final stage of the RCN’s evolution, which will be marked by the deployment of best practices and an innate performance management approach that is the hallmark of world-class cancer centres.
Question: What is notably different two years after the RCN’s founding?
ANSWER: The health care teams are talking together about how they can improve cancer care and patient satisfaction. Never in the history of these three hospitals and the Faculty has there been so much communications. Nurses, doctors, surgeons, pharmacist, dieticians, clerks, IT specialists, project managers, administrators and patients are sharing ideas, supporting each other and working in a spirit of collaboration. There will always be some degree of competition – such is the nature of high-performing academic institutions. Notwithstanding this, the teams are coming together; those in direct contact with patients are now making the decisions and setting the direction. There is a genuine will and a strong desire to make cancer care better for patients. This is being facilitated due to the creation of the Rossy Cancer Network and the visionaries who saw a unique opportunity to change the way cancer care is delivered. We are at the start of a big project. We’ve almost completed two years. Going forward it will only build and build and get better and better.
Noteworthy RCN projects
- Deployed the Ambulatory Outpatient Satisfaction Survey (AOPSS) to get a better understanding of how patients perceive their health care experience;
- Reducing the wait time for patients undergoing chemotherapy;
- Improving communications with primary care providers to improve continuity of patient care;
- Improving communications with patients;
- Canadian Partnership Against Cancer grant for the Improving Patient Experience and Health Outcomes Collaborative (iPEHOC);
- Piloting a patient self check-in system in radiation oncology;
- Providing patients with more information regarding radiotherapy treatment and its short- and long-term side effects;
- Launch of the first edition of the RCN balanced score card;
- Established two arms of funding: the RCN Investing in the Future Educational Fund and the RCN Research Fund;
- Introduction of synoptic reporting, a standardized way to produce pathology reports;
- Cross-appointment of 109 physicians;
- Completion of the first phase of its remote access to patient information project;
- Introduction of a common patient consent form;
- Forward motion on the creating of a seamless IT network;
- Hosting the inaugural annual RNC Symposium, coming this fall.