Breaking Down Departmental Lines to Form Disease Specific Centers

How to transition from a traditional departmental based organisation into one which is disease / cancer region based with each tumor group / center comprised of a range of specialty e.g. surgery, medical oncology, Radiation oncology, specialised advance practice nurse, within the context of a comprehensive general academic hospital setting.

Our Cancer Center is currently part of a Comprehensive Academic Medical Center. The organisation is along traditional departmental lines. Therefore the Cancer Center has under its governance the following departments: Haematology, Medical Oncology, Radiation Oncology, and Oncology Nursing. It has cancer surgeons that belongs to the hospital surgical department and paediatric oncologist that belongs to the hospital paediatrics department. To evolve into the next phase and I feel necessary for academic excellence and optimisation of training and service provision, I want to organise the cancer center into tumor specific groups comprising of surgeons, medical oncologist, radiation oncologist, and nurses specialised in different area of the body e.g. breast, gastrointestinal tract, lung etc. This will require a change from traditional organization, incentivization and funding that is all based on departments. For the change, I will need the buy-in of affected departments e.g. surgery, O&G, Paediatrics who will need to be willing to relinquish their staff, we need to be able to account for case loads so that these department will not lose out but losing staff working in the more ‘glamourous’ field of cancer. What are the possible solutions in this transformation? Are there hybrid solutions? An important point is that we are not stand alone cancer centers such as MD Anderson or Memorial Sloan Catering but a Cancer Center within a comprehensive general Academic hospital set-up so maybe more like Mayo Clinic or Cleveland clinic.


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Participant comments on Breaking Down Departmental Lines to Form Disease Specific Centers

  1. I think you will see a substantial improvement in efficiency and patient satisfaction by “bringing the resources to the patient”, such as dedicated days of the week for Breast Cancer Clinic, or GI malignancy Clinic, or Liver tumor Clinic, etc. The patients and families would have the benefit of being seen the same day by the surgeon, medical Oncologist, and Radiation Oncologist on the same day, and meet with their other team members at the same time, such as a Nurse Navigator specific to that disease. Also consider having a mini-tumor board on those days where the more difficult cases are discussed by the multi-disciplinary team. I am a Medical Oncologist, caring for adult patients with cancer. We are not an academic center, but with schedule all of these appointments on the same day for the patients and families, and have found improved satisfaction, improved understanding of the plan moving forward, and buy-in from the team. When I refer a patient to an academic center for a specific oncology diagnosis, for example “Sarcoma”, that patient is seen by the sarcoma surgeon, med onc, rad onc, etc., on the same day, in the same clinic location. So these disease specific clinics are housed within Medical Oncology, with the surgeons, etc., coming for that day or half day with the understanding that their focus will be on patients who have a common cancer. The medical assistants, schedulers, receptionists, nurse navigators, etc., have found improved job satisfaction and improved efficiency. Bringing the MDs on board to this idea will by default bring the staff on board.

  2. By shifting to the model that you’ve indicated, it allows you to align specialties of planned growth with the multi-disciplinary team needed to support this revenue center. Because as volume grows, support services may be impacted by an increase in demand. If aligned, you’ll see increased communication and ensure that plans are in place to ensure that they can meet the demand.
    Also consider leveraging Lean at your system to see each of these as a value stream.

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