Revolutionizing Oncology: The Center for Practice Transformation and Integration

The continually changing landscape of cancer care in the United States—including the development of new clinical treatments and technological advancements—has caused difficulties for cancer programs and practices with less resources hoping to incorporate new therapies and diagnostics within their organization. To address this need, the Association of Cancer Care Centers (ACCC) created the Oncology Practice Transformation and Integration Center (OPTIC) to provide ongoing support and resources to its members across the country.

Implementing Innovative Processes

At the ACCC 50^th Annual Business Meeting and Cancer Care Summit (#AMCCBS), OPTIC hosted a preconference session led by Christina Southey, consultant and improvement advisor, to enable participants understand the underlying drivers of innovation adoption and apply these insights within their respective practice or program settings. The session also emphasized the return on investment and patient outcomes. Through interactive workshops, attendees delved into methodologies for identifying challenges and conducting root cause analyses to determine the feasibility of potential changes.

The session began by prompting attendees to reflect on recent endeavors to introduce new initiatives within their programs and practices over the past year. Examples ranged from integrating a triage nurse and implementing artificial intelligence, to fast-tracking genetic testing and proposing new job roles. Subsequently, participants engaged in identifying impediments to the implementation of these initiatives within their institutions. Challenges highlighted included a lack of coordination between clinical and quality improvement staff, the necessity of securing buy-in from both administration and clinical personnel, ensuring the availability of data to substantiate the need for change, and navigating the variations in workflows across different practices and providers within the same organization.

Southey then discussed the dynamics of adopting an innovation with a focus on the strategies to facilitate the acceptance of new ideas. She highlighted the work of American sociologist, Everett Rogers, who discussed 5 distinct categories that characterize an individual’s openness to new concepts in his book, Diffusion of Innovations. These categories include innovators, early adopters, early majority, late majority, and laggards. Drawing parallels with the widespread adoption of smartphones, Southey encouraged attendees to reflect on their own position within this spectrum, highlighting how varying experiences and perceptions shape individuals' attitudes towards innovation. By acknowledging diverse perspectives, the discussion underscored the nuanced reasons behind reluctance to embrace change, emphasizing the importance of understanding, and addressing these concerns effectively.

Adopting the Innovation

According to Southey, 5 essential attributes that facilitate the successful adoption of new processes are:

• Understand the relative advantage; involves proving tangible improvements over the current status quo
• Compatibility of the process
• Complexity; determines how difficult it is to implement
• Trialability; allows for low-risk experimentation
•  Observability; enables learning from successful implementation elsewhere.

Southey emphasized the importance of initiating quality improvement efforts by clearly defining the problem and acknowledging areas of underperformance within the organization. While recognizing disparities between current and desired states, she also recommended not comparing internal progress against external institutions, as operational dynamics may vary significantly. Subsequently, participants were tasked with crafting an aim statement which entailed delineating the problem, stakeholders involved, measurable goals within a timeframe, guidance on resource allocation, sponsorship, strategies, and potential barriers. Emphasizing the involvement of senior leadership, Southey wagers that aim statements should align with organizational goals and strategic plans while considering the unique needs of each institution.

Key Recommendations

• Assess compatibility of innovation through data analysis. Southey advocated for a comprehensive 3-part data review for organizations to gain a better understanding of the current situation, determine whether proposed change aligns with their needs, and avoid prolonged analysis that could detract from testing of improvements.
• Conduct interviews with key stakeholders (providers, staff, and patients). By integrating findings from diverse data sources, organizations can formulate a project charter with defined objectives.
• Identify root causes to determine potential changes that address underlying issues affecting outcomes. Multiple methods exist, but the use of fishbone diagrams to determine cause and effect allows for collective brainstorming to identify recurring themes and contributing factors. Observation and reflection are integral to this process.
• Test change using the “plan-do-study-act” (PDSA) cycle. This approach involves setting objectives, devising a plan for implementation, and executing it on a small scale while documenting encountered challenges. Based on the findings, adjustments can be made during the broader implementation. This ensures the sustainability of improvements and fosters lasting changes within the organization.

Lessons Learned + Future Opportunities

Primary insights from the session included: recognizing the critical attributes of innovation adoption, familiarizing oneself with common improvement frameworks, leveraging all available data, comprehending the driving forces behind change, and conducting small-scale testing before broader implementation.

Attendees expressed an interest in integrating the PDSA approach into their current programs and practices, noting its adaptability and effectiveness, and bringing more patient stories and data into decision-making. Gaining insight into how innovation is perceived by others was also deemed valuable. In response to participant feedback, OPTIC will organize follow-up virtual sessions to delve deeper into identified topics, ensuring continued learning and exploration.

For those interested in contributing ideas or accessing resources, contact Ashley Lile at alile@accc-cancer.org. Additional materials and resources are available through the ACCC website and OPTIC Resource Library.