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Multidisciplinary Team Service Redesign: a Step to Improved Quality of Care for Lung Cancer Patients
Clinical Oncology xxx (2016) 1e2 Contents lists available at ScienceDirect
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letter
Multidisciplinary Team Service Redesign: a Step to Improved Quality of Care for Lung Cancer Patients Madam d In 2012, Greater Manchester reported the highest rate of premature deaths from cancer in England, with significant variability in mortality across local authorities [1]. The National Lung Cancer Audit showed
significant variations in the rate of histological confirmation and surgical resection rates between trusts [2]. Inefficient cancer multidisciplinary teams (MDTs) are failing to resolve this at considerable expense [3].
Fig 1.. (a) Lung cancer multidisciplinary team (MDT) configuration and new patient numbers before and after implementing the four sector model. The final model was adopted after a majority vote based on considerations relating to the desire to establish a balance in the number of new patients/sector, utilise existing communication/service links and result in the least disruption to consultant job plans. (b) Bar charts showing consultant oncology and thoracic surgery consultant MDT attendance before (Q3 2014) and after implementation of the sectorised model (Q3 2015); MDT redesign has significantly improved MDT core member attendance. Lower surgical attendance at South Sector MDT is due to the audit commencing on the week the South Sector MDT went live. Problems with surgical cover in the initial weeks have now been resolved and at least one surgeon is in attendance every week. http://dx.doi.org/10.1016/j.clon.2016.06.012 0936-6555/Ó 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Salem A, Bayman N, Multidisciplinary Team Service Redesign: a Step to Improved Quality of Care for Lung Cancer Patients, Clinical Oncology (2016), http://dx.doi.org/10.1016/j.clon.2016.06.012
2
Letter / Clinical Oncology xxx (2016) 1e2
In 2014, Greater Manchester and East Cheshire lung cancer services comprised nine MDTs, seven of which were single-hospital based. The Manchester Cancer Lung Pathway Board hypothesised that single-hospital based MDTs were ineffective and pooling of MDT services, by combining single-hospital based MDTs to form larger crossorganisational sector MDTs, would improve MDT efficiency, drive-up quality of care and decrease variability between providers. The following steps were involved in this process: Survey of existing MDT arrangements. MDT redesign: Potential sectorisation models were appraised by a mix of evenly split trust representatives. Figure 1a shows the final model that was adopted. Agreement on unified sector MDT charter: To ensure effective running of the new MDTs, a sector MDT charter was drafted based on previously published recommendations [4]. This includes guidance on effective chairing and appropriate patients for discussion to ensure no meeting lasts >2 h. Creation of task-finish groups: Formed from representatives from each trust, these groups were tasked with implementing MDT redesign. An audit has confirmed that MDT redesign, with built-in cross-cover for core members, has significantly improved consultant thoracic surgery and clinical oncology attendance (Figure 1b). This arrangement will probably result in an enhanced peer-review environment and provides a weekly forum for professional development. MDT redesign
has also permitted us to push for more transparency and accountability, with cross-organisational working within each sector. From initial consultation until the final sector MDT went live, this process took 12 months. Early engagement of all stakeholders was vital and consensus agreement of all involved clinicians key. Similar redesign projects should be considered elsewhere. A. Salem*y, N. Bayman* * Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK y Division of Molecular and Clinical Sciences, University of Manchester, Manchester, UK
References [1] Farrington J. Early detection of cancer in Greater Manchester. Report on data and intelligence. Available at: http://www. mahsc.ac.uk/wp-content/uploads/2015/07/Early-diagnosisreport.pdf; 2014. Accessed 1 April 2016. [2] The Healthcare Quality Improvement Partnership. Health and Social Care Information Centre. The Royal College of Physicians. National Lung Cancer Audit Report 2014. Report for the audit period. Available at: http://www.hscic.gov.uk/catalogue/ PUB16019/clin-audi-supp-prog-lung-nlca-2014-rep.pdf; 2013. Accessed 1 April 2016. [3] Munro AJ. Multidisciplinary team meetings in cancer care: an idea whose time has gone? Clin Oncol 2015;27(12):728e731. [4] National Cancer Action Team. The characteristics of an effective multidisciplinary team (MDT). Available at: http://www.nhsiq. nhs.uk/media/2444560/ncatmdtcharacteristics.pdf; 2010. Accessed 1 April 2016.
Please cite this article in press as: Salem A, Bayman N, Multidisciplinary Team Service Redesign: a Step to Improved Quality of Care for Lung Cancer Patients, Clinical Oncology (2016), http://dx.doi.org/10.1016/j.clon.2016.06.012
Clinical Oncology journal homepage: www.clinicaloncologyonline.net
Letter
Multidisciplinary Team Service Redesign: a Step to Improved Quality of Care for Lung Cancer Patients Madam d In 2012, Greater Manchester reported the highest rate of premature deaths from cancer in England, with significant variability in mortality across local authorities [1]. The National Lung Cancer Audit showed
significant variations in the rate of histological confirmation and surgical resection rates between trusts [2]. Inefficient cancer multidisciplinary teams (MDTs) are failing to resolve this at considerable expense [3].
Fig 1.. (a) Lung cancer multidisciplinary team (MDT) configuration and new patient numbers before and after implementing the four sector model. The final model was adopted after a majority vote based on considerations relating to the desire to establish a balance in the number of new patients/sector, utilise existing communication/service links and result in the least disruption to consultant job plans. (b) Bar charts showing consultant oncology and thoracic surgery consultant MDT attendance before (Q3 2014) and after implementation of the sectorised model (Q3 2015); MDT redesign has significantly improved MDT core member attendance. Lower surgical attendance at South Sector MDT is due to the audit commencing on the week the South Sector MDT went live. Problems with surgical cover in the initial weeks have now been resolved and at least one surgeon is in attendance every week. http://dx.doi.org/10.1016/j.clon.2016.06.012 0936-6555/Ó 2016 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
Please cite this article in press as: Salem A, Bayman N, Multidisciplinary Team Service Redesign: a Step to Improved Quality of Care for Lung Cancer Patients, Clinical Oncology (2016), http://dx.doi.org/10.1016/j.clon.2016.06.012
2
Letter / Clinical Oncology xxx (2016) 1e2
In 2014, Greater Manchester and East Cheshire lung cancer services comprised nine MDTs, seven of which were single-hospital based. The Manchester Cancer Lung Pathway Board hypothesised that single-hospital based MDTs were ineffective and pooling of MDT services, by combining single-hospital based MDTs to form larger crossorganisational sector MDTs, would improve MDT efficiency, drive-up quality of care and decrease variability between providers. The following steps were involved in this process: Survey of existing MDT arrangements. MDT redesign: Potential sectorisation models were appraised by a mix of evenly split trust representatives. Figure 1a shows the final model that was adopted. Agreement on unified sector MDT charter: To ensure effective running of the new MDTs, a sector MDT charter was drafted based on previously published recommendations [4]. This includes guidance on effective chairing and appropriate patients for discussion to ensure no meeting lasts >2 h. Creation of task-finish groups: Formed from representatives from each trust, these groups were tasked with implementing MDT redesign. An audit has confirmed that MDT redesign, with built-in cross-cover for core members, has significantly improved consultant thoracic surgery and clinical oncology attendance (Figure 1b). This arrangement will probably result in an enhanced peer-review environment and provides a weekly forum for professional development. MDT redesign
has also permitted us to push for more transparency and accountability, with cross-organisational working within each sector. From initial consultation until the final sector MDT went live, this process took 12 months. Early engagement of all stakeholders was vital and consensus agreement of all involved clinicians key. Similar redesign projects should be considered elsewhere. A. Salem*y, N. Bayman* * Department of Clinical Oncology, Christie NHS Foundation Trust, Manchester, UK y Division of Molecular and Clinical Sciences, University of Manchester, Manchester, UK
References [1] Farrington J. Early detection of cancer in Greater Manchester. Report on data and intelligence. Available at: http://www. mahsc.ac.uk/wp-content/uploads/2015/07/Early-diagnosisreport.pdf; 2014. Accessed 1 April 2016. [2] The Healthcare Quality Improvement Partnership. Health and Social Care Information Centre. The Royal College of Physicians. National Lung Cancer Audit Report 2014. Report for the audit period. Available at: http://www.hscic.gov.uk/catalogue/ PUB16019/clin-audi-supp-prog-lung-nlca-2014-rep.pdf; 2013. Accessed 1 April 2016. [3] Munro AJ. Multidisciplinary team meetings in cancer care: an idea whose time has gone? Clin Oncol 2015;27(12):728e731. [4] National Cancer Action Team. The characteristics of an effective multidisciplinary team (MDT). Available at: http://www.nhsiq. nhs.uk/media/2444560/ncatmdtcharacteristics.pdf; 2010. Accessed 1 April 2016.
Please cite this article in press as: Salem A, Bayman N, Multidisciplinary Team Service Redesign: a Step to Improved Quality of Care for Lung Cancer Patients, Clinical Oncology (2016), http://dx.doi.org/10.1016/j.clon.2016.06.012