Perceived Barriers to Achieving CoC Cancer Program Accreditation – What’s Standing in Your Way?

February 6th, 2013

When a cancer program considers whether the pursuit of the Commission on Cancer (CoC) program accreditation is an attainable goal, the questions on the topic seem to come at an overwhelming pace. Must we hire more staff? Where will we find a patient navigator? How will we provide all the new services required? While it may seem as though there is too much to grapple with, there is a path to pursuing cancer program accreditation lying just under the surface of the sea of confusion.

Making the decision to seek CoC accreditation signals a cancer program’s desire to become a valued partner in the health of the community it serves; providing the highest quality cancer care and allowing patients to seek that kind of care close to home. The decision to pursue the path to accreditation should involve the facility or program administration – whether that is the board of directors, medical staff or task force – and include their review and understanding of the CoC standards. Understanding the commitment and timeline involved is crucial to the successful outcome of this pursuit.

Once the decision to go forward has been made, cancer committee takes the lead. Preliminary steps are:

  • Form a cancer committee, if one is not in place. Use the latest version of CoC standards to guide the membership and meeting schedules. Accurate and complete cancer committee minutes are important in meeting requirements for accreditation. Keep in mind that a first survey will require submission of three years of cancer committee minutes.
  • Appoint a cancer liaison physician, which should be a well thought-out choice. This physician will be the champion for the program. The standard addressing the specific duties will provide guidance for this choice.
  • Establish a cancer registry. The cancer registry is one of the most important components for an accredited cancer program. In fact, the CoC considers it central to the accreditation process.  It is not necessary that a program have a registry on-site. This function can be contracted but must be in compliance with CoC standards. In order to quality for an initial survey, the cancer program must document two years of abstracted data and one year of successful patient follow-up using the CoC standards and coding instructions in describing all reportable cases.
  • Review, discuss, and understand the 12 Eligibility Requirements as described in the CoC Program Standards. These requirements address the basic structure and services that comprise an accredited program.
  • Complete and submit a New Program Information Form to the CoC.  By submitting this information, the program is advising the CoC that there is an interest in pursuing accreditation. This also allows cancer programs to receive important communication from the CoC which will assist the program in its work.  It does not commit the program in any way and there is no fee for submitting this form.

Once these initial steps are in place, the members of cancer committee should begin using the latest version of the CoC Cancer Program Standards to build and improve the cancer program. Quality and data studies are identified and implemented using the specific standards. All disciplines providing care for cancer patients can and should participate in identifying quality and patient improvement studies within their departments. This is an ongoing task in a progressive cancer program.

Understanding, and keeping in mind, the benefits of becoming a CoC-accredited cancer program will serve all members of cancer committee, the facility administration, and all departments providing cancer care, well as work to achieve this goal moves forward. It is nationally recognized that CoC-accredited programs have established performance measures for the provision of high-quality cancer care. A program can participate in the National Cancer Data Base (NCDB) and have access to comparison benchmark reports and other resource tools made available to accredited programs. This data can be used to continually monitor and improve the level of cancer care. The public becomes aware of a program’s designation through CoC marketing, and the CoC Hospital Locator. Certain payers monitor the CoC site to determine which facilities offer the high level care associated with accreditation and use that information in contracting efforts.

The patient and community benefit when there is a CoC-accredited cancer program available to them. They learn that a comprehensive range of state-of-the-art services, a multidisciplinary team, the best treatment options, access to prevention and detection programs, and other support services are close to home. In addition, they will have the opportunity to participate in clinical trials and know that there is ongoing monitoring and improvements in cancer care.

Many cancer programs have been pleasantly surprised to find that they already meet some or many of the standards. The task then becomes formalizing policies or procedures per the standard language, identifying and documenting needed improvements in the cancer committee minutes, and then documenting the work and outcomes.

There are two important points to remember when working toward achieving CoC cancer program accreditation. The first is this:  the CoC does not tell programs HOW to meet the standards. At first this may seem counterproductive, but it isn’t. The CoC recognizes that cancer programs vary widely as to size, staff, resources, geographic areas they serve (rural vs. urban), and number of patients seen. Cancer programs can meet the standard in any way that “works” for them. It should be noted that many of the services on which cancer programs are surveyed can be “on-site or by referral”. This allows for programs too small to have an on-site radiation facility, for example, to refer their patients for treatment with the caveat that the referral program meets the CoC standards for that service.

The second point refers to the definition of a “cancer program”. This applies to the structure and services provided, not a building, per se. There is no requirement for a cancer center building or specialized department within a facility. Although many programs desire a separate cancer center per se, no initial or future investment of this type is required in order to attain or maintain cancer program accreditation. Many facilities have a fully functional CoC-accredited cancer program in which various services are spread over a campus or are referred to providers within a community or region.

There will be times when the interpretation of a standard is not as clear as it could be. When a program faces a barrier to compliance or needs assistance in understanding what the CoC is looking for at survey time, contacting our CoC-trained consultant, Ms. Brutico, can be of benefit.  Ms. Brutico is experienced in interpreting the standards, identifying quality and improvement projects, and reaching solutions for cancer programs. Working with programs can involve short-term or long-term projects and most work is accomplished without traveling to your site. The required consultative visit prior to an actual survey – for programs seeking their first survey – is one of our services, as well.

Achieving CoC Cancer Program Accreditation will take time and a clear commitment. Contact Pathway Cancer Program Consulting today at (775) 315-2320 to discuss how we can assist you in reaching your goal of CoC Cancer Program Accreditation.

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How Well Is Your Cancer Program Fighting Gravity?

February 6th, 2013

Peter F. Drucker, professor of management and famous management consultant, once said that “The purpose of business is to create and keep a customer.” His comment applies equally well to healthcare providers in general and cancer programs in particular. The key question is how successful your cancer program is at attracting and keeping customers in these times of rapid change, complexity, uncertainty and increased competition.

There are a number of internal and external factors that, like gravity, pull prospective and current customers (e.g., patients and referring physicians) away from your cancer program and, thus, undermine your cancer program’s ability to achieve its goal. Attracting customers to your cancer program is, therefore, one challenge.  Keeping them is another challenge entirely. Competition, awareness of your cancer program’s capabilities, its reputation, your current appointment scheduling policies, the behaviors of management, physicians and employees, etc. all contribute to your ability to attract and keep your customers or turn them away.

Two recent studies, one by the Pew Research Center and one by the American Hospital Association, provide some interesting insights in how to better “fight gravity.” The first study, published by Pew Research Center, found that:

  • Ÿ59% of U.S. adults have looked online for health information in the past year
  • Ÿ35% of U.S. adults go online to research a medical condition that they – or someone they know – might have. The Pew Research Center calls these individuals “online diagnosers”.
  • Ÿ53% of online diagnosers talked with a clinician about what they found online.
  • Ÿ41% of online diagnosers had their condition confirmed online.
  • Ÿ30% of internet users have consulted online reviews or rankings of healthcare services or treatments.

This study clearly underscores the importance of cancer programs having a strong and positive presence in the community and online. Raising awareness of and interest in your cancer program among your customers – the community you serve as well as referring physicians you work with is, therefore, paramount. Unfortunately, many cancer programs have a poor presence online and do very little to systematically communicate their capabilities and successes to the community and referring physicians in a sustained manner (see also my previous blogs “Why Many Cancer Program Websites Deserve and “F”…and “How The Grinch Is Chasing Your Patients Away“) Their marketing and business development efforts are underpowered.  The result is that their patient volumes go up or down – seemingly by chance – without realizing how much they can actually influence their patient volumes.

The second study by the American Hospital Association presents a framework for engaging healthcare users (a.k.a. “customers”) as part of your cancer programs to attract and keep your customers. For this study, it defined engagement as “a set of behaviors by health professionals, a set of organizational policies and procedures and a set of individual and collective mindsets and cultural philosophies that foster both the inclusion of patients and family members as active members of the health care team and encourage collaborative partnerships with patients and families, providers and communities.”

The framework for engaging healthcare users is based on four levels and principles.

Four Levels

  • Ÿ  Individual
  • Ÿ  Healthcare team
  • Ÿ  Organization
  • Ÿ  Community
 Four Principles

  • Ÿ  Information Sharing
  • Ÿ  Shared Decision Making
  • Ÿ  Self-Management
  • Ÿ  Partnerships

The report provides numerous examples for engaging healthcare users, many of which can be used effectively in your cancer program.

Enjoy reading both reports and share your thoughts with us as to what has worked well and what did not in attracting and engaging your customers.

Yours in Oncology Excellence,

Paul Schilstra

President

For more information, please contact primeASCENT by calling 410-444-6024 or click here. You can check us out on Facebook, LinkedIn and Twitter as well!

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The Productivity Paradox

November 7th, 2012

It’s an administrator’s dream. It is the executive team’s dream. It is an accountant’s dream. Everybody and everything in the cancer program is 100% efficient and productive. The physicians, the physician assistants, the nurses, the infusion bays, the linear accelerators, Pharmacy, the Lab, all are efficient and busy 100%. The cost per patient and the cost per FTE are all as low as possible because everybody is operating at 100% efficiency. Sounds great, right?  The question is: how do you achieve this blissful situation?

The answer may surprise you. The answer is that you can’t.  It is physically and mathematically impossible, so don’t even think about it.  There actually are four major reasons for why this is impossible.

  1. Variation
  2. Incorrect definitions of efficiency and productivity
  3. Poorly defined cancer program goals
  4. Bottlenecks and constraints (and lack of systems thinking!)

 

Variation

In a recent blog, I wrote about the importance of Queuing Theory, which proves mathematically that 100% efficiency leads to disaster.   The culprit is variation or fluctuation. Variation in demand, capacity, treatment duration and quality all conspire to make 100% efficiency an impossibility and striving for it will lead to patient waiting lines that are infinitely long. There is actually a mathematical formula in Operations Research that shows this clearly.

Efficiency versus Productivity

When revenues or profit margins stall or decline, the focus is often immediately directed at the productivity of the physicians.  After all, they are supposed to bring in new cancer patients. Then there may be questions about the productivity of the major medical devices and the recently installed oncology information system, or there are questions about the productivity of the staff. This is where the quest for turning around the cancer program begins to fall apart and, as a result, this quest will only yield partial and temporary success at best.

There are two main reasons for this. One reason is that the terms efficiency and productivity are often used interchangeably, even though they have very different meanings. Efficiency measures the amount of output in relationship to the amount of input. For example, one oncologist in your cancer program requires fewer resources than his colleagues, even though he or she generates equally good outcomes and treats the same number and mix of patients, based on cancer site and complexity. Such a physician would be considered more efficient than his or her peers. Productivity, on the other hand, measures the degree to which a cancer program achieves or moves closer to its goals.

Cancer Program Goals

And what are the goals of a cancer program? I suspect that many cancer program directors have been given performance objectives and goals that are not all that well defined and that are based on performance measurements that cannot be easily translated into effective actions. In our country, your cancer program needs to make money now and in the future (after all, “no margin, no mission”) by caring for cancer patients effectively, safely, efficiently, comfortably, conveniently in an affordable manner and participate in research. Your cancer program would, therefore, be considered productive if it pursuing initiatives that bring it closer to these goals. Consequently, productivity measures something very different from efficiency.

This is one of the reasons why I question the usefulness of RVU-based productivity studies. Apart from their already dubious foundation, RVUs are also far removed from a physician’s or cancer program’s goals. Instead of measuring how well the physician generates money and takes care of cancer patients effectively, safely, efficiently, comfortably and conveniently, or is successful in research, RVUs only measure a physician’s mix and level of activity. As such, RVUs don’t make much sense from an operations management perspective and I am not aware of any other industry where such a measurement is a major performance indicator.

The other reason is that, all too often, productivity or efficiency reviews are directed at one resource (e.g., one physician or one piece of equipment or one department) at a time. The result is a misguided quest for sub-optimization of a part of the cancer program.  Which brings me to …

Bottlenecks & Constraints

Cancer care much resembles a chain of people, departments, space and technology. As a result, the strength of your cancer program “chain” is defined by its weakest link.  Trying to strengthen each link separately, without regard for how this affects the strength of the other links in the chain, only leads to another weak link “popping up” somewhere else in the chain. In plain English, you need to view your whole cancer program as one integrated system, whereby bottlenecks define your cancer program’s productivity, i.e., its ability to achieve its goals.  Don’t view your cancer program as simply the sum of its individual parts, e.g., imaging, surgical oncology, medical oncology, radiation oncology, pharmacy, etc.  A bottleneck, by the way, can be anywhere.  It can be the market, physicians, staff, equipment, space, supplies, drugs or capital and operating funds. Furthermore, trying to optimize the use of non-bottleneck resources will not improve a cancer program’s ability to meet or exceed its goals but may actually make matters worse. So it’s the bottleneck that should be focused on first.  An hour saved or quality improved on the bottleneck represents a real gain, whereas an hour saved on a non-bottleneck has either no impact at all or may make matters worse for the bottleneck resource.

Let’s say that senior management expresses concerns about lackluster revenues or margins and questions the productivity of the medical oncology and radiation oncology departments. The manager of each of these departments is then charged to figure out to how to increase productivity (read: efficiency). This same approach of sub-optimizing the individual parts of a cancer program is also often followed in quality improvement efforts.  This is how the journey to sub-optimization often begins, without generating the long-term benefits that are being sought. And his is also one of the reasons why Lean and Six Sigma projects often lead to disappointing results.

So what are we missing then?  Well, what is missing is a holistic perspective, whereby the cancer program is viewed as one integrated system of people, processes, tools and technology, What matters not is whether each part in that system (e.g., person, equipment or something else) is achieving its own individual goals but whether the cancer program as a whole system is able to achieve or get closer to its goals. In other words, we need a system’s perspective of cancer care to understand interdependencies between its departments and capabilities, before we embark on Lean and Six Sigma improvement efforts.

Let’s take a look at two different scenarios and see how bottlenecks can limit a cancer program’s ability to achieve its goals to make money, to take care of cancer patients effectively, safely, efficiently, comfortably and conveniently, and to participate in research.

Scenario 1: Let’s say that a cancer program’s patient volumes have been declining. It is staffed by two medical oncologists and two radiation oncologists.  Neither the physicians nor its infusion bays and linear accelerator are not very busy. Now, maybe this program lost patients over time because it developed a reputation for poor quality and customer service. Maybe a popular oncologist left the cancer program a while ago and patients are now being referred to other programs in the region, which are perceived to provide better cancer care. Whatever the reason for the decline, it currently does not have any capacity constraints. So what constraint then is limiting its ability to achieve its goals? In this case, the constraint may either be its poor reputation, its very limited marketing efforts or a local market that has shrunk due to increasing competition or a decrease in population. This will require some further research to determine what the root cause is. An energetic marketing campaign will probably need to be pursued, possibly combined with the transformation of the cancer program to restore its tarnished reputation.

Scenario 2: In this scenario, the cancer program is busy all right but there are some troubling signs indicating that not all is well. The waiting areas are often packed with people, patients often have to wait long for their (next) appointment, the infusion bays are usually full and the linear accelerator is operating at full capacity. In addition, staff and physicians appear harried and running around, and there never seems to be enough time to get all the work done in time. The center typically has to stay open longer or has to reschedule some patients because of delays, and staff frequently has to work over-time. And the cancer registry is struggling to keep with tracking new and current cancer patients, as well as survivors. As a result, revenues are beginning to plateau and costs are beginning to creep up.  To make matters worse, the number of medical errors appears to be increasing as well. Remember what I said earlier about 100% “productivity”?

This scenario is obviously much more complicated and requires a good understanding of the available capacity of each resource (e.g., physicians, staff, Imaging, Pharmacy, Lab, Pathology, rooms, beds and equipment) and patient flows between these resources. In addition, the quality of their respective outputs should also be studied.  Specifically, you need to assess the interdependencies between all these resources and determine which resource is the bottleneck that causes the cancer program to “derail.” Once the culprit has been found, the problem can be addressed by following a five-step process. Lean and Six Sigma can then subsequently be deployed to further improve the cancer program until another bottleneck or constraint emerges. But this makes for a good topic for another blog.

Does any of this sound familiar? Have you seen examples of how the Productivity Paradox or constraints and bottlenecks are causing trouble for your cancer program? Please share your thoughts with us.

Yours in Oncology Excellence,

Paul Schilstra

President

For more information, please contact primeASCENT by calling 410-444-6024 or click here. You can check us out on Facebook, LinkedIn and Twitter as well!

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The Art And Science Of Cancer Care

October 9th, 2012

A Personal View From A Two-Time Leukemia Survivor and Pre-Med Student

  The word medicine, in today’s world, seems to indicate a hard science in search of cures for many kinds of human ailments, such as cancer. However, I believe that the true definition of medicine is the practice of healing. Medicine is both an art and a science because it involves both human and technological interaction. The art of compassionate care and social interaction must be combined with the science of human physiology and curative methods. When such a combination of art and science is able to create healing, or at least the improvement of a person’s physical and mental wellbeing, then it is effective medicine.

  The compassion, care, and human emotion required in the artistic side of medicine all make medicine very social. For example, there are the interactions between a caregiver and a patient in a conversation, as part of a sign of affection, or in kind words of comfort. A team of doctors and nurses discussing patients’ cases is also an example of the social side of medicine. This team has social values and acts on those values. Such values would be the ideals and priorities shared by the members of that team and they form an important component of a patient’s course of treatment.

  I think of the scientific and the social sides of medicine not as two separate and mutually exclusive aspects of medicine, but as two important tools that need to be combined for effective healing.

  Having been a two-time leukemia survivor, as well as an intern with my own pediatric oncologist, I have gained a deep and personal appreciation for both aspects of medicine. For example, when I followed my oncologist and mentor on rounds, it was interesting to hear how differently the patients were being discussed outside their rooms as compared to inside their rooms. Patients on charts were simply a list of facts and medical information. Their details were analyzed with a focus on optimal medical outcomes. On the other hand, patients in their hospital rooms are live, sensitive beings, with emotions, opinions, and often with many forms of discomfort.

  I am intrigued by how a doctor starts with a lifeless chart of facts, walks into the room of a real person, and, if he or she is a truly effective physician, turns the diagnostic and planning process into a positive and compassionate social interaction with the patient. In this way, a doctor improves the emotional and physical wellbeing of that person.

  When examining the relationship between the scientific and social aspects of medicine, it seems to me that each aspect is necessary for the other to be effective in caring for patients. My oncologist was very skilled at combining the two. His ability to effectively combine them is what made him a leader in pediatric cancer care and what also made his patients smile brightly whenever he walked into their rooms. I know because that is what I experienced when he cared for me.

  Unfortunately, many doctors have not fully mastered that combination the way my oncologist had. I experienced this also during my many hospital stays and visits for my two leukemia treatments, which took place at three different hospitals. It is quite uncomfortable to have to deal with a doctor who acts indifferently, is uncomfortable talking to people, incapable of looking them straight in the eyes, or is rude when you, as a patient, feel miserable. Poor bedside manners definitely do not help you get through your demanding cancer treatment.

  It is my personal mission to gain a better understanding of how doctors can better combine the scientific and social aspects of medicine in order to increase the amount and quality of physical and emotional healing. Training doctors in combining the scientific and social sides of cancer care is going to be important if we want to increase cancer survival rates and improve the quality of life for cancer survivors.

Clarissa Schilstra

  Clarissa is currently a student at Duke University and writes her own blog on her website at www.teen-cancer.com. She is actively involved in fundraising for pediatric cancer patients and frequently meets with donors to educate them on how their donations are benefiting these patients.

For more information, please contact primeASCENT by calling 410-444-6024 or click here. You can check us out on Facebook, LinkedIn and Twitter as well!

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How The Grinch Is Chasing Your Patients Away …

September 5th, 2012

Beware of the Grinch!  No, I’m not talking about your competitors.  I’m talking about the Grinch in your organization.   At this very moment, he is busy chasing your cancer patients away and undermining all your improvement and marketing efforts.  And the best part is that you may not even be aware of it!  The Grinch is very good at gradually interfering with your cancer program over time so you won’t notice it much, just like the proverbial frog in the pot.  After all, he knows that you are already busy with so many competing priorities.  The goal of the Grinch is two-fold:

- Prevent new patients from coming to your cancer program in the first place.

- Make sure that visiting your cancer program is as unpleasant and uncomfortable as possible.

Here’s how he does it.  Every day, the Grinch makes sure that your cancer program:

  1. Uses a name that does not reflect the services it actually provides.  The Grinch likes to have your cancer program pretend that it is more than it really is.  It is not uncommon for freestanding medical or radiation oncology centers to call themselves “Cancer Center” or “Cancer Institute”, while only offering one form of cancer treatment, e.g., surgery, medical oncology or radiation therapy only.  This approach may very well lead to patients feeling misled and deciding to go elsewhere for treatment.


  2. Is hard to find.  The Grinch often makes sure that you cancer program is difficult to find on the internet.   There are still a few programs out there that do not have a web site and can, therefore, not be found through an internet search.  I know, because I have tried many times.


    3. The Grinch also likes to make sure that your building is located behind or between lots of other buildings and that there are a very few clear signs to guide new patients to your program.  I have tried to visit cancer programs using Google Maps AND my GPS and still I had a great deal of trouble locating these programs.  Now, my business depends on it so I was persistent.  But patients may not be so understanding.

  3. Offers insufficient parking space.  The Grinch loves to use small parking lots because it requires cancer patients and those accompanying them to spend a lot of time looking for a parking spot.  This ensures that patients and their companions have to walk much farther from another parking lot to get to your building.


  4. Is a long distance from the parking lot and main entrance.  This too is a big favorite of the Grinch.  Nothing gets more uncomfortable than when a weak, immuno-suppressed and suffering cancer patient has to be driven to a cancer program and he or she, together with the driver, have to figure out how to make this happen.  The following example happened to us while our daughter was going through her relapsed leukemia treatment as a teenager.  My daughter was suffering from severe nausea and bad headaches, while being neutropenic, and needed to come in for her next treatment.  The hospital allowed front door drop-off for patients but my wife had to park the car in a parking garage around the corner, while my daughter had to wait in a wheelchair in the lobby area for quite some time.  Needless to say, having to wait for my wife was a most uncomfortable experience for her.  After they reunited, they still had to walk far to reach the oncology clinic.   We encountered a similar situation a few times when my wife had to take her to the ER because of some severe complication.  I can assure you that these were the most uncomfortable and stressful experiences for both my daughter and my wife.


  5. Is staffed with unfriendly physicians, nurses or other employees.  The Grinch is very good at infiltrating your organization.  He can be disguised as a rude, moody, dismissive or socially awkward physician, nurse or a person staffing the front desk.   While anxious cancer patients are looking for comfort, hope and some empathy, the Grinch is hard at work to make sure patients experience the opposite.   In addition, the Grinch who sits at the front desk can be especially effective in chasing away patients, simply by being curt, rude, ignorant or otherwise unhelpful.   You only have to multiply the average revenue value of each newly diagnosed cancer patient with the number of new patients who, after having called your cancer program, decided to seek care elsewhere, to determine the total amount of revenue that your cancer program lost thanks to a Grinch at the front desk.


  6. Does not convert phone calls into appointments.  All too often, the Grinch makes sure that the folks staffing the front desk and answering incoming phone calls – your cancer program’s ambassadors and first point of contact with new patients! – are distracted by multiple responsibilities, while being insufficiently trained, unappreciated and under-paid.   The poor folks at the front desk often have to answer the phone, schedule new and current patients, serve as general administrative assistant, serve coffee, etc. Experts estimate that perhaps as much as 30% of all incoming phone calls from inquiring new patients are not converted into appointments.  That could represent a lot of money and a lot of patients not coming to your cancer program.


  7. Consists of cramped, cluttered, dirty or noisy places.  Imagine being a weak, unstable, lousy feeling and not very mobile patient.   You come to the cancer center for a consultation or for treatment and now the Grinch makes you navigate a crowded waiting area with only a few chairs, while the TV is blaring and phones are ringing, and narrow cluttered hallways to get to your destination.  After your scheduled activity, you have to journey back to the front desk, pay your co-pay and schedule your next visit, while the TV is still blaring and phones continue to interrupt the lady scheduling your next visit.  This is exhausting, if not traumatic, if you are in poor shape. I have seen this situation all too often and it’s a turn-off.


  8. Makes patients wait a lot.  Newly diagnosed cancer patients are anxious to meet with an oncologist as soon as possible so the Grinch will make sure that scheduling that first appoint is going be delayed as much as possible through a combination of an unhelpful person answering the phone, as well as policies that require patients to have all their medical information, e.g., lab results, diagnostic images, etc., ready before scheduling that first consult.  Later on, the Grinch makes sure that patients have to wait a lot, for seeing their physician or for undergoing treatment.   This works best when patients are batched in the waiting area so that the doctor’s time is fully utilized.   This way, the Grinch makes sure that patients realize that they – and their time – are not important but that the physician’s time is, regardless of how weak and uncomfortable they may feel.


  9. Focuses on the disease only and not on the patient and family.  The Grinch, disguised as a physician or mid-level provider, can be very effective at increasing the overall sense of discomfort and lack of empathy.  All the Grinch has to do is to only show interest in the cancer or his own priorities in life, not the patient or whatever he or she is feeling or experiencing.  Whether the Grinch is really good at treating cancer does not matter much.  By being curt, crass, uncommunicative or dismissive of patients and their companions, they manage to leave cancer patients feeling uncared for, unsupported and lonely.  This, in turn, can create an effective foundation for a patient not surviving their cancer.   We have encountered the Grinch a few times ourselves and I know of friends who were cared for by a Grinch with, unfortunately, negative consequences.


  10. Discharges patients through a sloppy and harried process.   The discharge process – for both inpatients and outpatients – presents a great opportunity for the Grinch to mess things up.   There are actually two types of opportunities:  making the patient wait a long time before being discharged and then the discharge instructions.   The discharge process, combined with a lack of proactive monitoring, provides a good opportunity to further reduce a cancer patient’s changes of survival and a reasonable quality of life.


    11. You finally get the good news after many hours in the clinic or days in the hospital: you can go home!  You’re all excited and eager to go home.  But now you have to wait … and wait … and wait some more.  The doctor is not available or can’t be found to sign the discharge order, the nurses are busy taking care of other patients, etc.   Finally, after what seems like an eternity, the nurse comes in with the discharge instructions, and that brings me to ….

    Cancer patients are taking a myriad of medications at home, many to treat cancer, while many others need to be taken to counteract the many side effects or anticipated complications caused by the treatment.   Rushing through the discharge process with some hastily scribbled and illegible hand-written instructions about a complex regimen of what to take, when and how provides a good foundation for poor patient compliance.  In addition – and this is where the effectiveness of the treatment comes in – it may actually lead to a medication being taken incorrectly.   When my daughter was treated for leukemia the first time as a toddler, she was given a prescription of 6-mercaptopurine (6-MP) to be given to her at night.   Nobody told us when relative to her evening meal.   We dutifully gave her 6 MP every night with dinner, thinking that this might make it easier on her stomach.  It wasn’t until much later during the maintenance phase that we learned that 6MP should have been given to her on an empty stomach.   When her leukemia came back years later, we wondered as parents, whether this contributed to her relapse.

  11. Employs unfriendly staff in the parking garage.  There is one last opportunity that the Grinch will take advantage of in making the patient experience as miserable as possible: the parking garage.   Again I can speak from personal experience.   After a grueling time in the hospital or clinic, all the hard and good work performed by a terrific team of physicians, mid-level providers and the nurses was almost forgotten thanks to the Grinch manning the parking garage.   All you need is an insufficient number of ways to pay for your parking ticket and a limited number of rude and indifferent folks behind the window, clearly untrained and clearly not caring one bit, and your patients and visitors will feel soundly insulted and angry.   They say that most people remember the first encounter (the front desk) and the last encounter (often the parking lot) the most, so this is an effective way for the Grinch to leave a lasting and negative impression with patients and visitors.  It certainly worked for my family and added to an already stressful period in our lives.

    12.  

So, how then do you counteract the Grinch’s undermining activities?   Just like in the story “The Grinch Who Stole Christmas”, it starts with love and caring, in this case about the fundamentals of helping cancer patients go through a physically, emotionally and financially taxing journey with an uncertain outcome.   All of us in the oncology business should be mindful of the humbling fact that cancer is bound to become very personal for any of us, as about one in two men and one in three women will develop cancer at some point in their life.   Every time I see a cancer patient I remind myself that, “there but for the grace of God go I”.

Care, empathy, and addressing the issues listed above should, therefore, be a good start.  Furthermore, it is critical that you enable, empower and engage all members of your team to embrace a culture of empathy for the patient and continuous improvement through training, clear behavioral and performance goals, recognition and incentives.

I recently wrote about the patient experience in my blog from August 13.  Also, in my previous blog from August 28, I talked about the performance improvement methods you should add to your tool kit.   They too will enable you to address many of the patient experience issues I just shared with you.  Finally, you may find this article from the Cleveland Clinic also quite useful.

How have you identified and addressed these patient dis-satisfiers?   If so, were you able to effectively address them?  I look forward to hearing from you about what worked and did not work during your efforts to improve the patient experience.

Yours in Oncology Excellence,

Paul Schilstra

President

Contact primeASCENT by calling 410-444-6024 or click here today if you want to learn more. You can check us out on Facebook, LinkedIn and Twitter as well!

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    Clearing The Underbrush Plus A Unique Article On Leadership

    August 28th, 2012

    So, what is in your performance improvement tool kit?  While I don’t believe in silver bullets, I do believe that a number of tools and methods can be very helpful in addressing many of the complex challenges that cancer programs face today.  Here are a few of my favorites that, combined, will enable your cancer program to become a learning and adaptive organization that continues to improve and grow.

    • Lean.  Yes, I know, much has been made of the Toyota Production System as a role model for lean and healthcare, and rightfully so.  Unfortunately, it is often presented as doing more with less, which is usually not very reassuring for employees.   On top of that, the use of Japanese jargon in Lean can turn many people off.

      • But let there be no mistake, Lean is like clearing the underbrush: a very effective tool for simplifying things and clearing up the clutter caused by confusion, bottlenecks, work-arounds and other sources of frustration.  Most processes in healthcare started organically at some point in the past.  Over time, healthcare care – and cancer care – became more complex and more people got involved, resulting in complex, spaghetti-like workflows, policies and procedures.  They may do the job but, after a while, it isn’t looking pretty. These convoluted situations often result in frustration for patients, physicians and staff, or worse, serious errors, poor outcomes and high costs.

      Lean enables you to simplify patient and work flows, make things easier and better for patients and staff over time.  What I especially like about Lean is that it requires patients, physicians and staff all to be enabled, empowered and engaged in improving care through collaboration, daily huddles, and constant experiments.

      Once the “underbrush has been cleared” in caring for cancer patients and survivors, it will be much easier to begin striving for perfection, i.e., reducing errors and improving outcomes.  Which brings me to …

    • Six Sigma.   Introduced by Motorola and widely adopted by GE, Six Sigma is a very helpful tool for reducing errors and variation.  The basic idea is that having a good outcome 99% of time is not good enough.  Six Sigma provides a great tool kit for striving for perfection and it can be used together with or after Lean.   The ideal is to get to about 3.4 defects or errors per one million opportunities.  Or, to put it in another way, it strives for care-related activities to be free of errors 99.99966% of the time.

      • Let’s look at the airline industry.  If flights were to land safely only 99.99% of the time, it would mean that one in every ten thousand flights would crash.  Given today’s sheer volume of flights and the number of passengers on board on any given day, this would be unacceptable.

      Now let’s apply this to radiation oncology and assume that a center treats 250 new patients each year with an average of 25 fractions per patient.   If a serious error occurs only 0.01% (i.e., one out of 10,000 visits) of the time, that means that about one visit out of the 6,250 visits each year encounters a serious error.  That’s a significant number and would be bad for the patient.  In addition, it exposes the cancer program to serious liability and public relations challenges.  Six Sigma provides a comprehensive set of tools to steadily reduce errors and improve outcomes.  It should, therefore, also be included in your performance improvement tool kit.

    • Theory of Constraints (TOC).   This tool is complementary to Lean and helps you understand and address problems caused by bottlenecks and constraints in processes as you try to increase your patient throughput.   In addition, it offers a rather useful and straightforward version of cost accounting.  Developed in the 1980s, TOC helped transform the manufacturing industry by “pulling the rug” from under the established body of knowledge in operations management, just as Lean did.

      • The first take-away from TOC is that productivity should not be measured as % utilization, e.g., a linear accelerator is busy 100% of the time, but that productivity is measured on the basis of all those activities that get you closer to increasing patient throughput and profitable growth.   If you are doing things in your cancer program that do not bring you closer your goals, you shouldn’t be doing them.   This is similar to Lean’s nine types of waste.   TOC also defines three simplified financial performance indicators that are much easier to manage than the abstract – and often misleading – traditional cost accounting indicators.

      The second take-away from TOC is that bottlenecks/constraints determine the pace with which your cancer program treats patients and generates profitable growth.  In other words, only by increasing flow through the constraint can overall throughput be increased.  This may seem quite obvious but the hard part is to determine what that MAIN bottleneck is that determines you cancer program’s patient throughput.  Is it the market?  Is it staff?  Is it equipment?  Is it another department, e.g., Lab or Pharmacy?  Is it too many errors and “near misses”?  Is it the availability of physicians?  Is it outdated policies and procedures?  The list of potential constraints can be quite large.

      The third take-away is that TOC offers a systematic, five-step methodology for identifying and dealing with constraints to increase patient throughput.

    • Queueing Theory. It is the mathematical study of waiting lines, or queues. The theory enables mathematical analysis of several related processes, including arriving at the (back of the) queue, waiting in the queue (essentially a storage process), and being served at the front of the queue. The theory focuses on the calculation of several performance measures, including the average waiting time in the queue or the system, the expected number waiting or receiving service, and the probability of encountering the system in certain states, such as empty, full, having an available server or having to wait a certain time to be served.

      • This tool offers two very useful insights when dealing with inflows of patients or tasks.  One take-away is that a resource should never be at 100% capacity or wait times will become infinite.  Since exact arrival, treatment and departure times can rarely be predicted exactly, there is variation on both sides of the resource.   This in turn drives waiting times.  So when, your boss asks you for 100% productivity, he or she may be asking for the impossible.

      The other take-away is that schedules and waiting lines may need to be arranged differently, depending on the situation of the business.  Airlines, for example, separate passengers into multiple groups (e.g., domestic versus international, with or without boarding passes and with or without luggage) and then check them in through dedicated lines, each with multiple kiosks and staff as “servers”.  The reason is that this still is the fastest and most efficient way for travelers to check in.  Supermarkets, on the other hand, often have one waiting line for each cash register, probably because of lack of space.  But as we all know, if you’re stuck behind another customer with issues or a lot of groceries, you’ll end up waiting longer than the folks next to you in the other line and it may not be easy to change lanes at that point.

      Cancer centers are also complex in that they have to take care of new patients, patients scheduled for treatment, patients scheduled for treatment but with unexpected complications and patients without prior appointments that need to be seen immediately because of unexpected complications.  Managing staffing levels while making sure that patients do not have to wait long can be daunting in this environment.  It can even be more daunting when patient volumes fluctuate substantially.  Queuing Theory, together with Lean and the Theory of Constraints, can be a useful tool for streamlining scheduling and capacity planning when patient volumes fluctuate.

    • Distributions.  Knowing a little bit about statistics and distributions can be quite useful in identifying opportunities for improving your cancer program.    First, there is the Pareto Rule, a.k.a. the “80/20” rule, which can help you prioritize what issue(s) to focus on most.   A typical example of this analysis is that only four cancers account for, say, 80% of all new patients treated at your cancer program.  I recently worked with a cancer center that attracted patients from mostly three out of fourteen nearby zip codes.  This led to the identification of an untapped market opportunity.

      • Second, you need to know a bit about distributions because the inappropriate use of averages can lead to erroneous conclusions.   While most of us are familiar with the Normal Distribution (a.k.a. the “Bell Curve”), many things in real life do not follow the Normal Distribution.   For example, Length of Stay or the time patients wait typically follow different distributions.  The distribution of a particular performance metric determines whether using the average (or mean) provides a meaningful picture of what is going on.  By plotting the graph, looking at the mean, median (or 50% percentile) and standard deviation (variance), you can get a much more accurate view of how well your cancer program is performing or where opportunities for improvement are.

    • Simulations.  No improvement initiative should be undertaken without simulations. It can be a powerful and eye-opening experience to be part of a simulation in which team members redesign processes in a dedicated room or area with appropriate mock-ups to see if their assumptions about the improvements really hold up in reality.   Most likely, you’ll find that some improvements bring to light new and unexpected bottlenecks or constraints.

      • Simulation enables you and your team to modify processes in a way that is realistic and achievable.  In addition, simulation provides a great way to actively engage and challenge the members of your team in your performance improvement efforts. In some instances, sophisticated simulation software packages can help you predict the impact of improvements on workflows, capacity and wait times.

    Oh … and don’t forget out about the people stuff!  Nothing gets done without understanding people and how they behave in social settings such as cancer programs.  I have learned the hard way that understanding behavioral preferences (measured through, for example, Myers-Briggs) or how people prefer to communicate and process information (i.e., visual, verbal, kinetic) can help you enable, empower and engage your team in your journey toward ongoing improvement and growth.

    Last but not least, much depends on sustained leadership.  There is a great deal of good literature on leadership but I found this article in the Harvard Business Review – A Leader’s Framework for Decision Making – especially helpful in dealing with complexity.  You may also find it useful.

    What methods and approaches have helped you the most in bringing about positive changes in your cancer program?   I look forward to hearing from you about what worked and did not work during your transformation efforts.

    Yours in Oncology Excellence,

    Paul Schilstra

    President

    Contact primeASCENT by calling 410-444-6024 or click here today if you want to learn more. You can check us out on Facebook, LinkedIn and Twitter as well!

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    Two Studies On The Patient Experience & Take-Aways For Cancer Programs

    August 13th, 2012

    Improving the patient experience has become a significant priority for healthcare providers ever since the Centers for Medicare & Medicaid Services (CMS) began linking reimbursement to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Two studies provide interesting insights that may also help cancer programs improve the total experience of their patients.

    The Beryl Institute published a report in 2011, in which providers were surveyed about their definitions of the patient experience and what they focus on most. Interestingly, the report concludes that patient experience is not clearly and consistently defined. In addition, the report concludes that most healthcare providers focus on reducing noise and improving the discharge process and patient rounding as their top three priorities.

    In contrast, PriceWaterhouseCoopers’ Healthcare Research Institute just published its report “Customer experience in healthcare: The moment of truth”, in which it surveyed customers of healthcare providers and – to a lesser degree – healthcare insurance companies.

    According to PWC’s report, providers and insurers are adopting lessons from industries with high volumes of customer interactions such as airlines, retail, hotel and banking, but that they are paving their own way to meet consumer wants and needs.

    The report further states that seventy-two percent (72%) of consumers ranked provider reputation and personal experience as the top drivers of provider choice. Nearly 70% of survey respondents want multiple services in one location and about 65% value online and mobile information exchange. Striking is also that 70% of those surveyed stated that staff attitude is a determining factor in their decisions about their providers. Finally, the report provides a useful comparison between healthcare providers and the airlines, banking, hotel and retail industries.

    PWC recommends, among other things, that providers should:

    • Focus solutions on transparency, knowledge, and convenience.
    • Take advantage of multiple access points to educate and engage consumers.
    • Open up forums for customer feedback.
    • Empower and enable employees to change the customer experience.
    • Be proactive and go beyond the transaction.
    • Dedicate leadership to enhance the customer experience.

    Now, I’ll be among the first to express skepticism about airlines, banks, hotels and retailers being perfect role models. Anyone who flies on a regular basis will know that full planes, frequent delays and grumpy flight attendants handing out small peanut bags don’t make for excellent customer experiences. Likewise, banks are currently not very popular either as they are being perceived as major contributors to the current economic situation.

    That said, there are role models in each of these industries, whose approaches are worth learning from. Among airlines, Southwest is consistently praised for its customer service, something I wholeheartedly agree with.   Banks may not be as responsive as they used to be, but they are excellent at defining and knowing their customers.   They have us all figured out through our income, our spending and savings patterns, and our borrowing habits.  They are consummate users of the data collected through salary deposits, your mortgage, ATMs, on-line transactions, etc. Among hotels, Disney is well known for its customer-centric corporate culture and well-trained staff which seduces us to come back for more time after time. Likewise, the online shoe and clothing retailer Zappos has gained fame for its culture and intense focus on customer service.

    So, what can cancer programs learn from all of this?  Here are some important take-aways about improving the patient experience from the two studies.

    • Better define and understand your customers, especially patients, their families and referring physicians, by better using the data in oncology and hospital-wide information systems. Cancer programs can learn a great deal from banks in this regard.
    • Cancer patients are looking for a lot more than reducing noise and improving the discharge process and patient rounding.   Specifically, they are looking to survive their cancer, to secure a good quality of life during and after treatment, to be safe from harm, to be comfortable physically and emotionally, to be supported during and after their journey, to have easy access to convenient and affordable care. These needs should be at the center of your cancer program’s strategy to improve the patient experience.
    • The PWC study, combined with the by now well-known examples of organizations with great customer-centric cultures, clearly offers proof that customers highly value courteous and positive attitudes of physicians and all employees, including the folks staffing the parking garage, the front desk staff, the clinical team and the folks in the business office.  It only takes one or two really bad encounters to completely turn off a customer. Enabling and empowering employees to “go the extra mile” to take care of a patient is, therefore, critical to establishing a customer-centric culture.

      • My wife, daughter and I experienced this first hand. We left a local pediatric hospital when our daughter, then a toddler, was treated for her leukemia because of the very poor attitudes of physicians and staff. When her leukemia returned ten years later, we ended up “firing” her attending physician at another pediatric hospital because he was unresponsive, dismissive and he started working around us. Fortunately, we ended up with a terrific attending physician and the rest of the clinical team was fantastic. There is no doubt in our minds that the wonderful environment during her relapse treatment contributed to our daughter’s steady recovery.

    • Finally, the PWC study confirms that customers want to be engaged, i.e., to be involved, enabled, empowered and treated as active partners in their care. This too I can confirm from personal experience. Regular face-to-face meetings, combined with a multitude of electronic/digital communication tools to interact, are important means for effectively engaging customers.

    How is your cancer program defining and improving the patient experience?  I look forward to hearing about your success stories.

    Yours in Oncology Excellence,

    Paul Schilstra

    President

    Contact primeASCENT by calling 410-444-6024 or click here today if you want to learn more. You can check us out on Facebook, LinkedIn and Twitter as well!

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    About Oncology Information Systems And Pianos …

    August 2nd, 2012

    Way back, I started my career designing and implementing decision support systems for hospital administrators at a major hospital IT vendor. It was really cool to pull data from a variety of hospital-wide and departmental information systems and then turning these data into actionable information for improving the quality and efficiency of service lines.

    A few years later, I “drifted” into consulting and started assisting the very customers for whom I had designed this decision support system. At first, I was very excited.  I looked forward to learning from these administrators about how they use data to identify opportunities for improvement in their service lines. Wouldn’t you know it but I was wrong. To my surprise, I quickly realized that the administrators often struggled with to what to look for, let alone what to do about it.

    Later on, I saw the same pattern repeated over and over again with departmental as well as hospital-wide information systems. That’s when I realized that information systems are like pianos: everyone can make noise with them but few can make beautiful music. In other words, users do not always leverage information systems effectively to get the most out of them.

    The same holds true for oncology information systems. The disconnect between what the system is designed to do and what users really do with them is usually the result of one or more of the following root causes:

    • The oncology information system has not yet fully matured and still has limitations in its capabilities and user-friendliness.
    • Vendors provide incomplete training and a limited implementation process, leaving the users to figure out all the nuances of how to best use the system.
    • A classic problem is that users often try to “bend” the new oncology information system to the old ways of doing things, rather then leveraging it as a tool to improve the quality and efficiency of patient care or the current work and patient flows.
    • Many users do not have an analytical framework that enables them to leverage the data in the system and turn these data into actionable information for improving patient throughput or the quality and efficiency of patient care.

    So how should oncology information systems (OIS) be used for improvement?  Here are a few suggestions.

    • Increase in patient volumes and revenues by identifying service line growth opportunities based on case mix, patient origin, referrals and payer mix. A good OIS can help you identify cancer cases with a high growth potential.
    • Improvement of patient access through analysis of demand patterns, identification of bottlenecks and an evaluation of scheduling and registration policies and procedures.
    • Improvement of patient and work flows through the identification of bottlenecks that lead to delays, waiting and frustration of patients, physicians and staff.
    • Outcomes and patient safety improvement as patient records in the OIS enable you to conduct a variety of studies across small and large groups of patients and benchmark your program against others. Important areas to consider include medical errors, 5-year disease-free or progression-free survival and the use of palliative, rehabilitative, supportive and reconstructive services.
    • Resource utilization and cost reduction by looking at patterns of care and how providers vary in their use of resources in relationship to outcomes and safety for patients with the same disease.
    • Survivorship management and outcomes improvement by tracking the physical, mental and emotional complications that patients may experience after their treatment is completed. This information can be used as feedback to improve treatment methods over time, as well as provide cancer survivors with the holistic support they look for at a great cancer program.

    You already made the investment in an OIS. Armed with a good analytical framework, you can use your OIS effectively for truly transforming your cancer program.

    Let me know how you have been using an oncology information system to improve your cancer program. I look forward to hearing about your successes.

    Yours in Oncology Excellence,

    Paul Schilstra

    President

    Contact primeASCENT by calling 410-444-6024 or click here today if you want to learn more. You can check us out on Facebook, LinkedIn and Twitter as well!

     

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    Being Different: What It Means For Cancer Programs

    June 26th, 2012

    It does not happen often that somebody challenges well-established business models and strategies.   There is a growing list of organizations and individuals that came up with a completely different and original way of how organizations can be better, faster or different.  Amazon.com, Apple, Cirque du Soleil, IKEA, Southwest Airlines, Toyota, Zappos, etc. are examples of such exceptional companies.

    The video clip embedded below by Youngme Moon, PhD, currently the Donald K. David Professor of Business Administration and Senior Associate Dean, Chair of the MBA Program, at Harvard Business School, is a great example such a challenge.  The point of this video, and the book it refers to, is not to provide “fully baked” answers for how to differentiate your organization’s products and services, but to make you stop, think and ask some challenging questions about your growth strategy.

    Why should cancer programs take notice?  Well, many cancer programs, especially the smaller ones in highly competitive areas, still try to be all things to all people and don’t do much about differentiating themselves from their competitors.  More to the point, they treat just about any cancer case that comes through the door, regardless of whether they truly have the expertise, as well the depth and breadth of capabilities, to care for these patients effectively.  In addition, from a promotional perspective, most cancer programs are like the cereal boxes in the isle of your supermarket.  They pretty much look the same.  Only the cancer programs at major academic medical centers tend to stand out a bit better.

    So here are the two main lessons that leaders of cancer programs should take away from this video clip.

    1. Be and look different from nearby competitive cancer programs, e.g., through your organizational culture, services and outcomes, and the way you promote your cancer program to patients, their families and their referring physicians.

    2. Focus on a limited number of cancers or types of patients and develop deep expertise, capabilities and experience in taking care of these patients.  This could perhaps even be coordinated at a regional level to reduce the technology “arms race” that is currently raging between cancer programs.

    Enjoy this brief video clip: www.youngmemoon.com/trailer.html.  Dr. Moon also provides some helpful ideas in this interview at www.youtube.com/watch?v=LxEEGldE9dQ.

    So what is your cancer program doing to stand out and compel newly diagnosed cancer patients to come to your cancer program?

    Yours In Oncology Excellence,

    Paul Schilstra

    President

    Contact primeASCENT by calling 410-444-6024 or click here today if you want to learn more. You can check us out on Facebook, LinkedIn and Twitter as well!

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    Why Many Cancer Program Websites Deserve an “F” …

    May 21st, 2012

    Many cancer programs are looking to increase their patient throughput according to the Association of Community Cancer Centers.  Increased competition, continued issues with health insurance and the availability of new treatments that shorten the total treatment time (e.g., hypo-fractionation and SBRT) have a resulted in a drop in patient throughput at many centers.   As a result, effectively promoting themselves to attract more patients has become very important for many cancer programs across the U.S.

    I research cancer program websites across the U.S. as part of my work, in order to better understand what cancer programs offer and how they promote themselves to cancer patients, their families and referring physicians.  To be blunt, the majority of cancer program websites deserves an “F” for being anything but helpful.  Consequently, many cancer programs simply come across as unremarkable, as well indistinguishable from each other.

    There are a number of common mistakes that cancer programs make on their websites – and, thus, in their marketing efforts – that causes them turn off or confuse newly diagnosed patients, including but not limited to the following.

    • Sensory Overload. Some cancer programs have web pages that are crammed with lots of boxes containing bits and pieces of information, all in different colors and fonts.  In addition, there may be rapidly changing pictures, a few video clips and perhaps even some music or someone talking in the background.   You just don’t know where to look first.  The result is that anxious and newly diagnosed patients become confused in this torrent of information and sensory overload.
    • One Paragraph. The other extreme is where cancer programs simply use one paragraph to describe themselves.  If you want to know more, you have to call them.  The problem with this approach is that, first of all, you leave the patient with lots of questions and, second, the patient now has to call someone to find out more.   This approach also requires patients to take notes during these calls because odds are that they have to process a lot of information over the phone.  Last but not least, the person answering the patient’s call better have a thorough understanding of the cancer program’s capabilities, as well as excellent phone manners and communication skills, to help that patient.  Sadly, this is often not the case.  Since newly diagnosed patients are already in a high state of anxiety, this is not an effective way to help them.
    • The Maze. The maze approach is common among the larger community-based or academic cancer programs.   Much of the information that cancer patients are looking for is there but they’ll have to go on a “scavenger hunt”.  The “best” mazes make it difficult to find out whether they even treat cancer.   For example, there will not be a direct link to their cancer program from the home page. You have to first select your health problem from a long, alphabetically ordered list, say breast cancer, and then it may take you there.   Then you have to go through lots of other screen clicks to piece together the information you are looking for.  In most maze-like websites, information is scattered across different web pages in a near random fashion.
    • It’s About Us. The vast majority of cancer programs have a value proposition (a.k.a. unique selling points) that looks something like this.
    • We provide compassionate care.
    • Our treatment options are on par with the best cancer programs in the world.
    • We offer the latest technology.
    • Our doctors are the best and our staff is really nice.
    • Trust us, we’ll take good care of you.

    While these are nice statements, they are inward looking and fail to address the real questions and concerns of newly diagnosed patients.  In most cases, these claims are not backed up by any substantive and quantitative facts.

    • Don’t Need Proof. Most cancer programs do not provide substantive proof to show that they really are the best cancer care option in their region.  The assumption often is or was that, since we built our cancer program, patients will keep coming.  This approach to a value proposition, combined with “It’s about us”, causes so many cancer programs to be unremarkable, as well as indistinguishable from each other. In the long run, it will jeopardize their viability as competition increases and patients become more internet-savvy.
    • Stale Information. It’s hard to believe but many websites have not been updated in a few years.  For example, cancer programs often include a link to their Annual Reports on their website but when you click on that link, the most recent Annual Report was 2008 or even older.  Why bother then?  One criterion by which a cancer program is often judged is the annual volume of patients it treats for a particular type of cancer.   Make sure that all information is up to date to enable your customers to make an informed decision about where to go.  Refreshing your cancer program’s website regularly also helps you optimize your website for search engines.
    • Page Not Found. Don’t you hate it when you click on a link to critical information and an error message states that your search engine could not find the page or document that you were looking for?  It happens often, unfortunately, and this is yet another sign that the website needs some “dusting off”.

    Having a compelling website is very important for your cancer program’s marketing initiatives.  Websites are nowadays one of the first places where newly diagnosed patients, their relatives and friends or their referring physicians will look to research the best treatment options for their disease.  If your cancer program’s promotional messages are ineffective and confusing on its website, chances are that these messages are equally ineffective and confusing in the other promotional media that your cancer program is using, e.g., brochures, advertisements, social media, etc.  For these reasons, it is important to get the messages on your cancer program’s website right in order to convince newly diagnosed cancer patients and their referring physicians that they should select your center to receive the best care.

    So, what do cancer programs need to do to stand out and create a powerful and compelling website?   There are five steps they need to do address a patient’s questions and concerns while effectively differentiating themselves from their competitors.  These five steps are also critical for creating a comprehensive and integrated promotional strategy for your cancer program.

    1. Start with really understanding who your customers are and what they are looking for.  Keep in mind that patients, their families and referring physicians base their decisions on a blend of facts, feelings and perceptions, just like when you buy a new home, a car or an appliance.  Patients want to be reassured effectively that you will take good care of them and that you will be a committed partner in their journey. So give them what are looking for.

    2. Create a powerful and compelling value proposition from the patient’s and referring physician point of view with compelling reasons to believe the claims made (i.e., offer proof).

    3. Organize all relevant information in a clear, easy to understand format so that a newly diagnosed cancer patient can quickly learn how your cancer program will help them through their difficult journey.

    4. Educate and empower the patient in their research of options through a creative and attractive blend of stories, graphics, photos, text and video clips.  In addition, enable them to connect with other patients, survivors and members of the clinical team. Patients will, thus, feel much better supported and empowered during their difficult journey.

    5. Refresh your cancer program’s website regularly with new information. This ensures that patients have access to the latest and greatest and it also helps you with search engine optimization (SOE).

    The ultimate outcome of this effort should be that newly diagnosed cancer patients select your cancer program instead of another and competing program in your region.

    Yours in Oncology Excellence,

    Paul Schilstra

    President

    Contact primeASCENT by calling 410-444-6024 or click here today if you want to learn more. You can check us out on Facebook, LinkedIn and Twitter as well!

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