March 3, 2014 IN SIXTY: Cancer Patient Journey

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1. Routine Visit to Doctor Referral to specialist Scheduling of tests Referral to surgery WAIT Referral to Oncologist Referral to Surgery Treatment Staging If necessary, return to oncology or surgery to choose another round of treatment WAIT Recovery Results Rapid Assessment 3. Treatment 4. Follow -up Go to 3: Treatment 6. Five Years Later 5. Later Living Cancer Free End of Life Recurrence? Patient Visit Tests to rule out simple explanations GP Disbelief/ Misdiagnosis Untreatable: Go to 5: (Supportive/ Palliative Care) Unclear Diagnosis Watchful Waiting Preventative Measures Medical, Surgical, Lifestyle Interventions Surgery ? Tests, Pathology, Imaging Diagnos is Results Suspicion of Cancer No Yes  Learn everything you can about this type of cancer  Talk to your family  Check insurance and finances  Talk to your employer  Find a support group More tests, pathology, imaging Treatable Cancer WAIT Scheduling Goo d New s Good News WAIT Radiation Therapy ? Stem Cell or Bone Marrow Transplant ? Try special request Investigate Clinical Trials Private Payment Fund Raising Drugs not covered Chemo Therapy ? Referral No Yes Treatmen t not sufficient Decisions to continue with further treatment Consider: Risks Side effects Quality of life Financial impacts Supportive/ Palliative Care Goo d New s 2. Diagnosis

1. Routine Visit to Doctor Referral to specialist Scheduling of tests Referral to surgery WAIT Referral to Oncologist Referral to Surgery Treatment Staging If necessary, return to oncology or surgery to choose another round of treatment WAIT Recovery Results Rapid Assessment 3. Treatment 4. Follow -up Go to 3: Treatment 6. Five Years Later 5. Later Living Cancer Free End of Life Recurrence? Patient Visit Tests to rule out simple explanations GP Disbelief/ Misdiagnosis Untreatable: Go to 5: (Supportive/ Palliative Care) Unclear Diagnosis Watchful Waiting Preventative Measures Medical, Surgical, Lifestyle Interventions Surgery ? Tests, Pathology, Imaging Diagnos is Results Suspicion of Cancer No Yes  Learn everything you can about this type of cancer  Talk to your family  Check insurance and finances  Talk to your employer  Find a support group More tests, pathology, imaging Treatable Cancer WAIT Scheduling Goo d New s Good News WAIT Radiation Therapy ? Stem Cell or Bone Marrow Transplant ? Try special request Investigate Clinical Trials Private Payment Fund Raising Drugs not covered Chemo Therapy ? Referral No Yes Treatmen t not sufficient Decisions to continue with further treatment Consider: Risks Side effects Quality of life Financial impacts Supportive/ Palliative Care Goo d New s 2. Diagnosis Primary Areas of Focus GOAL STATEMENT: To reduce the time from suspicion of cancer to first treatment to no longer than 60 days, by no later than 2016, in a sustainable manner that improves the quality of the cancer patient experience.

IN SIXTY: Disease Site Group Priorities 1.Breast 2.Colorectal 3.Lung 4.Prostate 5.Lymphoma

1.Establish Manitoba Cancer Partnership Steering Committee 2.Implement efficiency & quality improvement initiatives within each care environment 3.Implement effective and efficient coordination, integration, and transitions between care environments. 4.Enhance Community Cancer Program Services 5.Implement Rapid Diagnostic Networks 6.Reduce Disparities of Access to Cancer Control Programs 7.Enhance capacity for assessment, measurement, monitoring, and reporting IN SIXTY: The Deliverables

1.Establish Manitoba Cancer Partnership Steering Committee 2.Implement efficiency & quality improvement initiatives within each care environment 3.Implement effective and efficient coordination, integration, and transitions between care environments. 4.Enhance Community Cancer Program Services 5.Implement Rapid Diagnostic Networks 6.Reduce Disparities of Access to Cancer Control Programs 7.Enhance capacity for assessment, measurement, monitoring, and reporting IN SIXTY: The Deliverables

Manitoba Cancer Partnership Steering Committee Deputy Minister Manitoba Cancer Partnership Steering Committee Co-Chair: Arlene Wilgosh Co-Chair: Dhali Dhaliwal Health Senior Leadership Council Emergency Working Group Clinical Lead Admin Lead Clinical Lead Admin Lead Clinical Lead Admin Lead Clinical Lead Admin Lead Clinical Lead Admin Lead Information Mgmt Working Group Primary Health Care Cancer Working Group Cancer Diagnostic Working Group Surgery Working Group Vulnerable Cancer Patients Working Group Program Evaluation and Monitoring Working Group Patient Participation Advisory Group Project Mgmt Team Clinical Lead Admin Lead Clinical Lead Admin Lead Medical - Radiation Oncology Working Group Community Cancer Hub Working Group Patient Participants Improvement Sub-Group(s) Improvement Sub-Group(s) Improvement Sub-Group(s) Improvement Sub-Group(s) Improvement Sub-Group(s) Current and future cancer patients & their families Rapid Improvement Community of Practice Improvement Sub-Group(s) Clinical Lead Admin Lead Cancer Disease Specific Groups ( Breast, Colorectal, Lung, Prostate, Lymphoma)

1.Establish Manitoba Cancer Partnership Steering Committee 2.Implement efficiency & quality improvement initiatives within each care environment 3.Implement effective and efficient coordination, integration, and transitions between care environments. 4.Enhance Community Cancer Program Services 5.Implement Rapid Diagnostic Networks 6.Reduce Disparities of Access to Cancer Control Programs 7.Enhance capacity for assessment, measurement, monitoring, and reporting IN SIXTY: The Deliverables

60 days

29 % of Manitoba’s breast patients moved from suspicion of cancer to treatment in 60 days or less (2010)

90 % of Manitoba’s breast patients moved from suspicion of cancer to treatment in 160 days or less (2010)

IN SIXTY – Use of Lean Six Sigma to Drive Improvement DMAIC Methodology Define MeasureAnalyzeImproveControl Find Solution Implement & Verify Solution Control Solution Define the problem properly so that you solve the right problem right Measure the as- is process in order to characterize the problem and to enable measurement of improvement Hunt for clues using analysis and experience Test hypotheses and get a repeatable solution Keep new process locked in

What does this mean for a breast cancer patient?  Direct referral  Same day service for mammography, ultrasound, and biopsy  Breast surgery slating improvements: o Coordination of surgery and plastics o Central referrals o Slating “ownership” review Systemic Opportunities

1.Establish Manitoba Cancer Partnership Steering Committee 2.Implement efficiency & quality improvement initiatives within each care environment 3.Implement effective and efficient coordination, integration, and transitions between care environments. 4.Enhance Community Cancer Program Services 5.Implement Rapid Diagnostic Networks 6.Reduce Disparities of Access to Cancer Control Programs 7.Enhance capacity for assessment, measurement, monitoring, and reporting IN SIXTY: The Deliverables

1.Establish Manitoba Cancer Partnership Steering Committee 2.Implement efficiency & quality improvement initiatives within each care environment 3.Implement effective and efficient coordination, integration, and transitions between care environments. 4.Enhance Community Cancer Program Services 5.Implement Rapid Diagnostic Networks 6.Reduce Disparities of Access to Cancer Control Programs 7.Enhance capacity for assessment, measurement, monitoring, and reporting IN SIXTY: The Deliverables

Evolution of the Community Cancer Program

1.Establish Manitoba Cancer Partnership Steering Committee 2.Implement efficiency & quality improvement initiatives within each care environment 3.Implement effective and efficient coordination, integration, and transitions between care environments. 4.Enhance Community Cancer Program Services 5.Implement Rapid Diagnostic Networks 6.Reduce Disparities of Access to Cancer Control Programs 7.Enhance capacity for assessment, measurement, monitoring, and reporting IN SIXTY: The Deliverables

1.Establish Manitoba Cancer Partnership Steering Committee 2.Implement efficiency & quality improvement initiatives within each care environment 3.Implement effective and efficient coordination, integration, and transitions between care environments. 4.Enhance Community Cancer Program Services 5.Implement Rapid Diagnostic Networks 6.Reduce Disparities of Access to Cancer Control Programs 7.Enhance capacity for assessment, measurement, monitoring, and reporting IN SIXTY: The Deliverables

Objective: Use existing data sources maintained by CPJI’s partner organizations to measure the pre-Initiative cancer patients’ journey from suspicion to treatment, beginning with breast cancer. Methods: Used record linkage to combine the Manitoba Cancer Registry and various population-based health services and clinical datasets for all Manitoba women diagnosed with breast cancer in With clinical advisors, developed an algorithm for assigning key points along the cancer journey. The algorithm was built on a sample of cases and validated through chart review before being applied to the population. Standard summary statistics and cumulative incidence (time to event) curves were used to describe the patients’ experience. IN SIXTY: The Deliverables

Community EMR & FFS Abstract eReferral and Patient Access Registry Tool Radiology Information System (RIS) and Picture Archiving System Lab Information System (LIS) Hospital EMR and Discharge Abstract Systems Hospital Admission Discharge Transfer System EDIS – Regional Emergency Department Information System CancerCare Manitoba Electronic Health Record (ARIA) MANITOBA CANCER TRACKING SYSTEM - Suspected Cancer - Diagnosed Cancer CANCER PATIENT JOURNEY TRACKER DATA MART IN SIXTY: Tracking the Journey Integration of Key Systems Providers Public Reporting

Thank-you Questions…?