US Oncology Manufacturing-Inspired Practice Management Model Producing Quality and Efficiency Improvements
The model, developed by the US Oncology Practice Quality and Efficiency (PQE) Program committee, stresses defining and measuring a problem, determining root causes, mobilizing change initiatives and sustaining improvements, said David Fryefield, MD, PQE committee chair and US Oncology network member. Oncology practices that have introduced the PQE model have realized declining patient wait times, increased efficiency of chemotherapy staff and infusion room resources, improvements to the timeliness and completeness of orders, and improved efficiency for physicians, who can then devote more time to patient care.
“When we started this process, we wanted to focus on what we could realistically accomplish — not what we may want to do,” said Dr. Fryefield, who discussed the PQE model over the weekend at the annual conference of the American Society of Clinical Oncology (ASCO).Â “It was important that the program could be easily adopted by any oncology practice, large or small. We didn’t want any barriers to program adoption, so we strived to keep the cost of the program and the impact on the physician workload to a minimum. This is designed to be a quality program for the common doctor.”
PQE introduces elements of Lean Six Sigma, an approach commonly used in systematically managing workflow in just-in-time manufacturing settings, to oncology practices. The goal is to ensure that every patient treated in a US Oncology affiliated practice receives the right treatment, delivered the right way, at the right time.Â Process improvement models have been utilized in healthcare delivery for a number of years, particularly in hospitals.Â But no standard benchmarks existed for oncology practices — until now.
“At the beginning, most practices that we surveyed were engaged in some quality related activities, but there was very little consistency,” said Dr. Fryefield, medical director at Willamette Valley Cancer Center in Eugene, Ore.
“There were plenty of good ideas, but not the full package.Â The PQE program was designed to bring consistency to the quality and efficiency related activities within the network practices.”
A PQE guiding principal is that an unmeasured process is an uncontrolled process. Applying the Six Sigma methodology to introduce stringent practice-efficiency processes has produced results across the network. Overall, practices have experienced a:
–Â 33 percent decline in patient wait times
–Â 16 percent increase in chemotherapy chair utilization
–Â 12-16 percent improvement in timely and complete physician orders
–Â 10-15 percent increase in availability of physicians to see new patients
While each practice is unique and must examine the effectiveness of its own processes and protocols, the methodology is the same.Â In the case of patient wait times, barriers contributing to the problem are identified, e.g., lab reports not being ready for the physician at the time of the patient visit or an order for the lab not being written by the physician before the visit. Each barrier is addressed and corrected with value-added solutions, meaning the outcome is quantifiably improved patient care without the addition of cost, time or staff.Â In the case of lab reports, a re-education with scheduling staff and physicians may be all that is necessary to ensure lab reports are available at the scheduled visit, ultimately resulting in a reduction in patient wait times and a more utilized and balanced patient schedule.
The PQE committee was formed to develop a single quantifiable quality program that could be universally adopted by network practices.Â It identified five critical program elements and introduced them to the US Oncology network in 2005.
PQE program elements and the percentage of current network adoption rates are as follows:
1.Â Ownership of quality improvement by the practice’s governing board (71%)
2.Â Implementation of the network’s evidence-based best practices guidelines program, Pathways (95%)
3.Â Adoption of the PQE Balanced Scorecard, a standardized set of quality metrics (49%)
4.Â Adoption of standardized patient, referring physician and employee surveys (53%, 50%, 21% respectively)
5.Â Adoption of the PQE-LSS (Lean Six Sigma) process improvement methodology (70%)
“These measurements are proving to make us better caregivers and better stewards of our resources,” said Dr. Fryefield. “You must start by being willing to ask the questions and take a hard look at what you’re doing. The PQE model provides the structure and resources to make the changes that are necessary to provide the right treatment, delivered the right way, at the right time.”
About US Oncology, Inc.
US Oncology, headquartered in Houston, works closely with physicians, manufacturers and payers to identify and deliver innovative services that enhance patient access to advanced cancer care. US Oncology supports one of the nation’s foremost cancer treatment and research networks accelerating the availability and use of evidence-based medicine and shared best practices.
US Oncology’s expertise in supporting every aspect of the cancer care delivery system — from drug development to treatment and outcomes measurement — enables the company to help increase the efficiency and safety of cancer care.
According to the company’s last quarterly earnings report, US Oncology is affiliated with 1,247 physicians operating in 472 locations, including 91 radiation oncology facilities in 39 states.
SOURCEÂ US Oncology, Inc.