1. Quality in Cancer Surgery Dr. Craig McFadyen VP Cancer Services, Grand River Hospital Regional VP (Waterloo-Wellington), Cancer Care Ontario Medical Director Surgical Oncology, Grand River Regional Cancer Center Director Waterloo-Wellington Breast Assessment Unit

2. What is Quality ? Patient – Surgical treatment as soon as possible Surgeon – 30 day mortality and morbidity Pathologist – Well oriented intact tissue Medical/Radiation Oncologist – Concise path report, clear margins, healthy patient

3. Quality Right thing, the right way, at the right time, every time.

4. Quality in Surgery How do we measure it? What can we measure? Do these mean anything? How do we fix deficiencies?

5. Access Wait Times

6. Wait Times, a Primer

7. Access W 1 = Referral to consultation W 2 = Consultation to treatment

8. Wait Times W 2 – Consultation – Investigations Direct Due diligence – Wait time from decision to to treat until surgery

9. But what about the wait time that really matters to the patient? The total time from symptom to treatment Diagnostic Assessment Units – Skin – Breast – Lung

10. Waterloo Wellington Breast Assessment Unit

11. Standards in Treatment

12. CCO, the Program for Evidenced Based Care and Surgical Standards

14. Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer

15. Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer

16. Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer

17. Colorectal Cancer Standards Preop evaluation Margins Lymph node retrieval Rectal Cancer – TME – Neoadjuvant treatment

18. Standards- Institutions The volume - quality relationship

19. Institutional Standards

20. Thoracic Surgery – St Mary's Hepatic/Biliary and Pancreatic – Grand River

21. Standards Pathology Reporting Synoptic Reporting

22. Standards Care Multidisciplinary Case Conferences

23. Data and Feedback Wait times Rectal Cancer MCC’s

24. Data and Feedback Wait times Rectal Cancer MCC’s

25. Data and Feedback Wait times Rectal Cancer MCC’s

26. Future Clinical guidelines for – Prostate Cancer – Breast Cancer (Sentinel Lymph node biopsy) – Gastric Cancer – Melanoma

27. Questions