Integrated Cancer Service Delivery – Virtually There ? Authors – Dr Christopher Bain, Information Manager; Mrs Jenny Byrne, Manager and Assoc Prof Michael Green, Acting DirectorWestern Central Melbourne Integrated Cancer Service. Level 7 , 372 Albert St, East Melbourne. Vic Australia. 3001.

Integrated Cancer Service Delivery – Virtually There ? Authors – Dr Christopher Bain, Information Manager; Mrs Jenny Byrne, Manager and Assoc Prof Michael Green, Acting DirectorWestern Central Melbourne Integrated Cancer Service. Level 7 , 372 Albert St, East Melbourne. Vic Australia. 3001.

Conclusions

The key findings of the review were that there are some notable barriers to the delivery of healthcare in a virtual model (a “virtual organization”) including:•Insufficient or inappropriate IT support •Issues around micro politics and organizational dynamics•Governance, legal and privacy issues •Clinical issues not being adequately addressed or clinical benefits not realised •Financial issues not being adequately addressed •Failure to identify or address stakeholders needs

This research has highlighted key issues that need to be addressed in order to successfully establish the ICS model, and achieve the intended improvements in cancer care. The findings fit with operational experience in establishing the model.

Contact Us

For more information about the WCMICS, please contact us at:

(03) 9656 2780

Or visit our website:

www.wcmics.org

Discussion (contd)

Equally, failure to achieve the kinds of cultural changes necessary in traditional organizations, in order to facilitate their participation on these collaborative arrangements, is another key theme. Other themes identified include issues around governance and privacy, both of individuals’ data and of organizational knowledge and “workings”.

Page’s article is especially insightful (Page, 2003) in relation to how some of these barriers can be overcome. He emphasises the role of gentle planned change interspersed with reflective feedback for stakeholders. (see quote below and figure above)

There is a dearth of quantitative and trial based literature in the area of “virtual organizations”. The terms “virtual teams”, “virtual communities” and “communities of practice” all are evident in the literature. Whilst the subtleties of definitional differences are beyond the scope of this poster, it was apparent that the lessons from the literature using all these definitions were of value to this project, since they heavily overlap. The following table highlights some examples of the key facilitators of, and barriers to, success in creating these virtual entities, irrespective of the nature of the articles retrieved, on the basis that an analysis of both can provide the answer to the key question at hand - what are the barriers to the successful provision of healthcare delivery via a virtual model?

Results

Discussion

Models of care delivery which are not premised on the traditional institutionally based silos are increasingly being explored in healthcare across the Western world.

Notably very few of the papers retrieved referred specifically to the cancer care context, but nonetheless we believe the results to be informative in this context and representative of a relatively immature literature base in this subject area (especially in the health literature) Nonetheless the literature around “virtual organizations” (and similar terms) is such that there are some clear themes that emerge. These include the theme of appropriate IT support being self evident as a necessary precursor to the establishment of such collaborative arrangements. (see quote below)

Abstract

Recently in Victoria there has been a large amount of work involving clinicians, hospitals and government, in relation to the establishment of a Cancer Services Framework (CSF) for the state. Critical to the CSF is the provision of co-ordinated, best practice, multi-disciplinary care for patients with cancer, via the establishment of 9 Integrated Cancer Services (ICS). This poster presents the results of a literature review in relation to virtual healthcare delivery, in order to extract key lessons for the ICS’ to facilitate their ongoing development, and in turn to deliver better services for our patients.

Introduction

Background

Methodology

References

Where there is “no common culture or social capital, weak intermediaries and short term motivations…….iterative processes offer the most promising path to successful network development” (Page, 2003) Limitations

Limitations

“Incentives that promote IT adoption without emphasis on interoperability have the potential to ……fail to enable (the) full clinical quality and economic efficiency gains” (McKeon Stosuy and Manning, 2005)

Fauske, J. (2002). "Preparing School Leaders: Understanding, Experiencing, and Implementing Collaboration." International Electronic Journal For Leadership in Learning 6(6).

Jansen, W; Steenbakkers, G.C.A and Jagers, H. (1998) Co-ordination and use of ICT in Virtual Organizations. PrimaVera Working Paper 98-05. PrimaVera Working Paper Series,University Van Amsterdam.

McKeon Stosuy, M. and Manning, B (2005). “’Joining Up’ e-Health & e-Care Services: Meeting the Demographic Challenge." Stud Health Technol Inform(114): 65-81.

Page, S. (2003). “’Virtual’ Health Care Organizations and the Challenges of Improving Quality." Health Care Manage Rev 28(1): 79-92.

Reproduced with permission from Page (Page, 2003)

Step of Literature Review Number of Articles

Original Search 755

Omitted After Title and Abstract Review 696

Full text unable to be obtained (to date) 20

Articles for Final Analysis 39

The context for this research is the development of ICS’ in Victoria in recent years. Similar models have been developed in the UK and Canada, although there are some key differences in the models used. There has been no formal evaluation of the relative success or failure of the ICS model to date, so this research provides an opportunity to review the relevant literature in the area, and to assess progress through the lens of “virtual organizations”.

There are a range of drivers for models of care delivery which are not premised on the traditional institutionally based silos. They include, amongst others, cost efficiencies and a truly patient centred view of health care delivery. This concept ties to our definition of a “virtual organization” as: “a combination of various parties (persons and/or organizations) located over a wide geographical area which are committed to achieving a collective goal by pooling their core competencies and resources”. (Jansen et al, 1998). The implementation of such models (in this context, the ICS model) provide challenges for all parties. For hospitals the challenges are for organizations to work together at multiple levels – from service planning and governance to the sharing of IT. For the ICS’, the challenges are of bringing disparate parties together both within and across organizations, whilst all the while building a “virtual organization” from the ground up. For government, there is risk attached to such a venture – both in terms of financial risk, and political risk in the event of failure. All parties take on these risks and challenges in the expectation that patient care may be improved.

There was no restriction on the kinds of articles retrieved be they systematic reviews, RCT’s (unlikely), expert opinions or magazine style articles because this field of work is still in an immature state, certainly from a health perspective. In addition it could be argued that a more precise definition of a “virtual organization” could have been used, thus avoiding any issues over results relating to “virtual teams” or “communities of practice” as opposed to “virtual organizations”.

Important Factors – Some examples

Facilitators/ Positive/ Enabling

Barriers/ Negative/ Disabling

Clinical Provision of a patient centric paradigm

Insufficient evidence of effect on clinical outcomes

Information Technology

Seamless access to records across a region

Privacy and security threats

Stakeholder needs/drivers

Shared initial need between organizations

Loss of autonomy for clinicians

Logistical Iterative and slowly expanding approach

Separate administrative systems

Organizational dynamics

Shared goodwill around intent

Lack of creative leadership and appropriate culture

Governance and Privacy

Supportive role of government

Turf barriers

Financial Sufficient funding Seeking of short term economic leverage by participants

The question being asked was – what are the barriers to the successful provision of healthcare delivery via a virtual model?

A literature search was conducted of the PubMed medical, science and health services literature database for publications in the last 5 years, using the terms “virtual” and [“health” or “healthcare”]. The search returned 755 results. These were narrowed down to relevant articles related to service delivery and care models and then analysed

Reproduced with permission from Fauske (Fauske, 2002)