Redefining quality indicators of the Oncology Center toward more patient-centered care by adopting the British Columbia Health Quality Matrix
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Abstract
The State of Qatar has a diverse population, with 90% expatriates from 94 nationalities. The National Cancer Centre in Qatar caters to a diverse patient and staff base of 60+ and 30+ nationalities. Catering to patients from diverse cultural backgrounds, advanced technology and increased patient expectations, an initiative to review and revise the existing Quality Indicators was undertaken, keeping person-centricity as the pillar of care. This project was piloted in the Radiation Oncology department. It utilized various tools, including Patient Reported Experience Measures, Principles of Person-centered Care, risk assessment, cultural shift, brainstorming, bottleneck analysis, and continuous monitoring. The project achieved redefining the Quality Indicators by modifying the existing indicators and adding 6 new indicators more appropriate to Department aligning to dimensions of Quality and resulted in improved patient satisfaction, outcomes, and care quality. The initiatives showcase comprehensive strategies to enhance person-centeredness and adapt to unique clinical and environmental needs.
Introduction
National Cancer Care and Research Centre (NCR) is Qatar’s sole cancer care provider, commissioned in 2004 under the Ministry of Public Health (MOPH). A diverse functional environment provides immense opportunities for Person-centred Care if addressed appropriately. British Columbia (BC) Health Quality Matrix was utilized as the backbone for this initiative, as it defines Quality through the lens of five interconnected areas of care, which is highly relevant to Oncology through seven Dimensions for each area of care. Quality Indicators were developed aligning to the seven dimensions of Quality, Viz Safety, Respect, Accessibility, Appropriateness, Effectiveness, Equity and Efficiency, considering elements of individual and system perspectives.
World Health Organization emphasise on “enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition” and it is the responsibility of the Healthcare leaders to implement policies and practices to ensure the fundamental. The correct selection of Indicators is essential in achieving the desired outcome. One needs to focus on the implementation strategies and analyse the bottlenecks scientifically to ensure that the Quality Indicators created provide the desired result. Focused effort was taken in developing measurable elements reflecting safety beyond physical safety and to cater to the patient requirements from diverse geographical and cultural backgrounds.
Generating Baseline Data and Analysing Bottlenecks
One of the key elements of the comprehensive approach was generating the baseline data and analysing bottlenecks. By identifying bottlenecks, the team could determine what was holding back progress and what needed improvement. Core functional groups were created, and meetings were organized with stakeholders within and outside the department to mitigate the bottlenecks. Engaging and empowering the team was very critical in producing positive results.
Change in Culture
The initiative’s success also relied on Change management, a transition from organization-centred to person-centred care. In person-centred Care, the intention is to achieve the treatment goal of the patient as a person by partnering with the patient and family and considering a holistic approach to ensure that the care is delivered in a safe environment. This is not just limiting the care to be provided to manage disease. Equal importance need to imparted to ensure the well being of staff by engaging and empowering and creating a culture of safety, where the staff feels confident in pointing out the errors and creating an Inclusive workplace culture that values, appreciates and welcomes employees of all backgrounds and diverse characteristics.
Patient-Centeredness and Safety
One of the key dimensions of quality is safety. Safety through the eyes of Person-Centered Care goes beyond physical safety. It provides equal importance to emotional safety and cultural safety. Emotional safety is feeling safe as opposed to being safe, and cultural safety reflects contextually safe practices that recognise the impact of the public/social context, religious beliefs and values on the patient’s lives and, consequently, their safety. One of the ways of achieving emotional and cultural safety in Person-Centered Care is to transform from a retrospective approach of analysing what matters to a prospective approach of asking what matters to the patient.
Team Engagement
Team engagement is crucial in change management and bringing positive results. Training, effective communication, cultural inclusiveness, rewards and recognition, group activities, celebrating team achievements and a no-blame culture are ways we engage our team. We strengthened our Onboarding, Induction, Orientation and Training program, extending to one year with periodic evaluations for new staff, including but not limited to the orientation of the organization’s culture,
culture of the region, training need analysis and introduced an induction buddy for an easy acclimatization and a mentor for personal and professional growth of a mentee. Various awards were introduced on core values of Hamad Medical Corporation, Voice of Customer Award, Person Centeric award and Safety Champion award. Lastly, to ensure the success of the initiative, timely dissemination of information was crucial. Information was not just confined to the boardroom but was disseminated among the team members thoroughly monthly Voice of Customer reports, Quality Indicator dashboards and Quarterly department dashboards. This helped create a culture of collaboration and ensure that everyone was working towards the same goals.
Conclusion
The initiative to improve patient-centeredness in radiation oncology was successful due to a comprehensive approach. The introduction of new indicators, the analysis of bottlenecks, the implementation of a culture change, and the team engagement initiative all contributed to the success. The importance of person-centeredness was recognized, and a shift towards a patient-centric approach was implemented. Understanding the patient as a person and accommodating the needs and priorities goes a long way in mitigating the barriers to healthcare access by enhancing communication, promoting cultural inclusions by awareness, sensitizing and competence programs, thereby enhancing cultural and psychological safety, service excellence, clinical outcomes, Quality Added Life Years and minimizes the Economic burden of the society.
There are various definitions and domains of Quality by IOM, BC Health Quality Matrix, IHI and several authors. Each hospital and department can use these models to tailor its approach according to its clinical requirements and environmental and economic needs.
FAQs
Q: What is the difference between Patient-centered vs. person-centered care?
A: Patient-centered care is treatment-focused, meeting the requirements to manage disease, while person-centered care aims to meet the needs of the patient as a person. Person-centred care also prioritises ensuring workforce well-being, which is paramount to delivering quality person-centred care.
Q: What are some approaches to implementing Person-centred care?
A: Understanding What Matters to the patient, Care Partner Program, Access to Medical Records, Patient and family partnership by creating Advisory councils, using empathic words and inclusion, Creating an environment of Being feeling Safe, creating meaningful Measurable Elements which include Psychological and cultural safety elements and Shared Decision Making (SDM) are some ways to implement Person-centred Care.
Q: What are some of the Cultural factors that should be considered in Healthcare settings?
A: Language, religious beliefs, belief in alternative medicines, health literacy and misconceptions, gender, dietary requirements, and education are some of the cultural barriers to Healthcare. Healthcare professionals should be aware, sensitive, and competent in understanding the cultural elements to safeguard patient preferences and create a safe healthcare environment.
