Embedding continuous quality improvement processes in multidisciplinary teams in cancer care: exploring the boundaries between quality and implementation science
Tracy E. Robinson A B C E , Anna Janssen B C , Paul Harnett C , Kylie E. Museth C , Pamela J. Provan C , Danny J. Hills D and Tim Shaw B CA Monash Centre for Health Research and Implementation, School of Public Health and Preventive Medicine, Monash University, Level 1, 43–51 Kanooka Grove, Clayton, Vic. 3168, Australia.
B Research in Implementation Science and eHealth, Faculty of Health Sciences, University of Sydney, Sydney, NSW 2006, Australia. Email: anna.janssen@sydney.edu.au; tim.shaw@sydney.edu.au
C Sydney West Translational Cancer Research Centre, Crown Princess Mary Cancer Centre, Westmead Hospital, Westmead, NSW 2145, Australia. Email: paul.harnett@sydney.edu.au; kylie.museth@health.nsw.gov.au; pamela.provan@sydney.edu.au
D School of Nursing and Midwifery, Monash University, Wellington Road, Clayton, Vic. 3800, Australia. Email: danny.hills@monash.edu
E Corresponding author. Email: tracy.robinson@monash.edu
Australian Health Review 41(3) 291-296 https://doi.org/10.1071/AH16052
Submitted: 22 February 2016 Accepted: 17 May 2016 Published: 4 July 2016
Journal Compilation © AHHA 2017 Open Access CC BY-NC-ND
Abstract
Objective The aim of the present study was to identify key enabling factors for engaging multidisciplinary teams (MDTs) in cancer care across the spectrum of translational research and quality improvement (QI) projects.
Methods The study was conducted in two large Sydney metropolitan hospitals. Qualitative methods, including structured observations of MDT meetings and semi-structured interviews with MDT leaders and champions, were used to identify how teams interact with and generate research and implementation initiatives. Enabling factors for and barriers to the engagement of MDTs in translational research and QI were identified.
Results Four key enabling factors emerged from the analysis of data generated from observing 43 MDT meetings and 18 semi-structured interviews: (1) access to high-quality data around individual and team performance; (2) research-active team leaders; (3) having experts, such as implementation scientists, embedded into teams; and (4) having dedicated research or QI-focused meetings. Barriers included a lack of time, administrative support, research expertise and access to real-time data.
Conclusions The identification of enabling factors for and barriers to translational research and QI provides evidence for how multidisciplinary cancer care teams may best be engaged in research and QI that aims to improve service and care outcomes.
What is known about the topic? MDTs are key to the delivery of cancer care in Australia, but there is scant research into how teams can best be engaged in translating research from basic science through to implementation science and QI.
What does this paper add? This paper provides new evidence from an immersive study of cancer care MDTs in two large metropolitan hospitals in Sydney (NSW, Australia), regarding the key enabling factors for and barriers to successful engagement in translational research and QI in cancer care.
What are the implications for practitioners? Cancer care professionals in MDTs are presented with an opportunity to embed translational research and QI into cancer care. MDTs can operate as an ideal vehicle to look beyond individual patient outcomes to broader trends and population health outcomes.
References
[1] Rajasekaran AB, Silvey D, Leung B, Honeybourne D, Cayton RM, Reynolds J, Trotter S, Roland MA. Effect of a multidisciplinary lung investigation day on a rapid access lung cancer service. Postgrad Med J 2006; 82 414–6.| Effect of a multidisciplinary lung investigation day on a rapid access lung cancer service.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28zktF2ksg%3D%3D&md5=69b7c632ba13c5b67bf8ec89d9bf5de3CAS | 16754713PubMed |
[2] Bjegovich-Weidman M, Haid M, Kumar S, Huibregtse C, McDonald J, Krishnan S. Establishing a community based lung cancer MD clinic as part of a large integrated health care system: Aurora health care. J Oncol Pract 2010; 6 e27–30.
| Establishing a community based lung cancer MD clinic as part of a large integrated health care system: Aurora health care.Crossref | GoogleScholarGoogle Scholar | 21358947PubMed |
[3] Houssami N, Sainsbury R. Breast cancer: multidisciplinary care and clinical outcomes. Eur J Cancer 2006; 42 2480–91.
| Breast cancer: multidisciplinary care and clinical outcomes.Crossref | GoogleScholarGoogle Scholar | 16904313PubMed |
[4] Pawlik TM, Laheru D, Hruban RH, Coleman J, Wolfgang CL, Campbell K, Ali S, Fishman EK, Schulick RD, Herman JM. Evaluating the impact of a single day multidisciplinary clinic on the management of pancreatic cancer. Ann Surg Oncol 2008; 15 2081–8.
| Evaluating the impact of a single day multidisciplinary clinic on the management of pancreatic cancer.Crossref | GoogleScholarGoogle Scholar | 18461404PubMed |
[5] Kesson EM, Allardice GM, George WD, Burns HJ, Morrison DS. Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13,722 women. BMJ 2012; 344 e2718
| Effects of multidisciplinary team working on breast cancer survival: retrospective, comparative, interventional cohort study of 13,722 women.Crossref | GoogleScholarGoogle Scholar | 22539013PubMed |
[6] Westfall JM, Mold J, Fagnan L. Practice based research: ‘Blue Highways’ on the NHS roadmap. JAMA 2007; 297 403–6.
| Practice based research: ‘Blue Highways’ on the NHS roadmap.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXhtVSmtrw%3D&md5=f43f98f2436414401af4021435a02eb0CAS | 17244837PubMed |
[7] Department of Health. Multidisciplinary cancer care: literature review. Melbourne: Victorian Government; 2012.
[8] Norman GR, Schmidt HG. The psychological basis of problem-based learning: a review of the evidence. Acad Med 1992; 67 557–65.
| The psychological basis of problem-based learning: a review of the evidence.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK38zpt1Cgsw%3D%3D&md5=dd5b7cfce4370dcf3a1d3fb97eeb2a5eCAS | 1520409PubMed |
[9] Mann KV. Educating medical students: lessons from research in continuing education. Acad Med 1994; 69 41–7.
| Educating medical students: lessons from research in continuing education.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK2c7hsVSntA%3D%3D&md5=08e0e484c4c08dd4f8ae20c1346cf409CAS | 8285999PubMed |
[10] Merriam SB. Updating our knowledge of adult learning. J Contin Educ Health Prof 1996; 16 136–43.
| Updating our knowledge of adult learning.Crossref | GoogleScholarGoogle Scholar |
[11] Holm HA. Quality issues in continuing medical education. BMJ 1998; 316 621–4.
| Quality issues in continuing medical education.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1c7nvFChtA%3D%3D&md5=0225f6dfcd266e252188415b0c226625CAS | 9518922PubMed |
[12] Armson H. Translating learning into practice: lessons from the practice based small group learning program. Can Fam Physician 2007; 53 1477–85.
| 17872876PubMed |
[13] Peters DH, Tran NT, Adam T. Implementation research in health: a practical guide. Geneva: World Health Organization; 2013.
[14] Portela MC, Pronovost PJ, Woodcock T, Carter P, Dixon-Woods M. How to study improvement interventions: a brief overview of possible study types. BMJ Qual Saf 2015; 24 325–6.
| How to study improvement interventions: a brief overview of possible study types.Crossref | GoogleScholarGoogle Scholar | 25810415PubMed |
[15] Eccles MP, Mittman BS. Welcome to implementation science. Implement Sci 2006; 1 1–3.
| Welcome to implementation science.Crossref | GoogleScholarGoogle Scholar |
[16] El Saghir NS, Keating NL, Carlson RW, Khoury KE, Fallowfield L. Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide. Am Soc Clin Oncol Educ Book 2014; e461–6.
| Tumor boards: optimizing the structure and improving efficiency of multidisciplinary management of patients with cancer worldwide.Crossref | GoogleScholarGoogle Scholar | 24857140PubMed |
[17] Keating NL, Landrum MB, Lamont EB, Bozeman SR, Shulman LN, McNeil BJ. Tumor boards and the quality of cancer care. J Natl Cancer Inst 2013; 105 113–21.
| Tumor boards and the quality of cancer care.Crossref | GoogleScholarGoogle Scholar | 23274388PubMed |
[18] Lawton R, Taylor N, Clay-Williams R, Braithwaite J. Positive deviance: a different approach to achieving patient safety. BMJ Qual Saf 2014; 23 880–3.
| Positive deviance: a different approach to achieving patient safety.Crossref | GoogleScholarGoogle Scholar | 25049424PubMed |
[19] Proctor E, Luke D, Calhoun A, McMillen C, Brownson R, McCray S, Padek M. Sustainability of evidence-based healthcare: research agenda, methodological advances and infrastructure support. Implement Sci 2015; 10 e1–13.
| Sustainability of evidence-based healthcare: research agenda, methodological advances and infrastructure support.Crossref | GoogleScholarGoogle Scholar |
[20] Reeves S, Kuper A, Hodges B. Qualitative research methodologies: ethnography. BMJ 2008; 337 512–14.
| Qualitative research methodologies: ethnography.Crossref | GoogleScholarGoogle Scholar |
[21] Reed J, McNicholas C, Woodcock T, Issen L, Bell D. Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory. BMJ Qual Saf 2014; 23 1040–8.
| Designing quality improvement initiatives: the action effect method, a structured approach to identifying and articulating programme theory.Crossref | GoogleScholarGoogle Scholar | 25319412PubMed |
