CoP in cancer surgery Knowledge Transfer & Exchange Community of Practice April 1st meeting Michael Fung Kee Fung, MB, BS, FRCS Lead, Knowledge Translation, Surgical Oncology Program, Cancer Care Ontario

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CoP Improvement Process Re-design Realignment Qualitative Teams Trust Leadership Professional Development Quantitative Guidelines Data Elements Evidence-based Products/Projects

CoP Deliverables Disease site specific priorities, expressing the vision of practicing physicians aligned with hospital operating plans A single set of common regional guidelines and pathways, most of which can be implemented without major capital expenditures, improving quality of care and culture A core group of clinical leadership and facilitators, knowledgeable in all major aspects of the hospital’s business, who become a major source of informal inter- organizational and inter-professional collaboration for the benefit of all patients in the Champlain region. An improved work climate, which strengthens culture of collaboration and facilitates recruitment and retention

Clinicians who responded to the survey: Reported change in practice according to regional standards (56%) Indicated more interest in participation in MCC and other regional professional development opportunities (five times more respondents in 2007 would like to participate in MCC compared to the previous year results) Believe that the key CoP functions are to facilitate regional linkages and the culture of collaboration (89%), innovation support (85%), knowledge sharing (84%) Who responded? 55% response rate 60/40 split in community vs. academic affiliation Shift toward more multidisciplinary representation compared to 2006 survey surgeon 24 surgical oncologist 6 medical oncologist 3 radiation oncologist 3 radiologist 2 pathologist 2 nurse 12 administrator 8 gastroenterologist 5 total 65 Survey Results: Barriers for participation

Progress to date Targets Lapcolon guideline uptake (MIS vs. open approach) 25%35% Develop regional clinical inpatient and outpatient pathways with common assessment and diagnostic criteria 0%18% pts at TOH Number of surgical cases submitted for MCC 11%27%34% Develop regional standard for the Sentinel node biopsy as an option for axillary staging 0%+12pts Winchester + 35 pts Cornwall

Integrated CoP Knowledge Spiral Model Quality of care Strategic Foundation: Knowledge Management “CoPs are groups of people who share a concern, a set of problems, or a passion about a topic and who deepen their knowledge and expertise in this area by interacting on an ongoing basis” Project Management Communica tion CME/CPD Access to evidence Access to data CoP tools Long Term Objective: Knowledge Transfer Social capital Organizational Memory CoP Outcomes Innovation Evidence gaps/ quantitative Practice gaps/ qualitative Process gaps/ improvement science

Reference: Fung Kee Fung, M. et al, Development of communities of Practice to facilitate quality improvements in surgical oncology. Quality Management Health Care, 2008, 17:2, pp