Systems thinking is an accepted approach for healthcare organizations to deliver better patient care. By designing programs that focus on patients as a whole person and member of the care team, as well as financial sustainability, teams can promote systemic and cultural changes that support better care for chronic conditions.
In a Becker’s webinar, Redefining Chronic Care: A Systems Approach to Compassionate, Patient-focused Innovation sponsored by Wolters Kluwer, three healthcare leaders discussed how systems thinking is transforming cancer care and creating a new standard for personalized treatment and organizational improvements:
- Don S. Dizon, MD, director, pelvic malignancies program and hematology-oncology outpatient clinics, Brown University Health Cancer Institute; director of medical oncology, Rhode Island Hospital; founder, Oncology Sexual Health First Responders Program (Providence, R.I.)
- Jessica Quinlan-Woodward, RN, manager, oncology nurse navigation, Allina Health (Minneapolis)
- Holly Urban, MD, vice president, business development-strategy, clinical effectiveness, Wolters Kluwer Health
Here are three key takeaways from their conversation:
- An empathic, evidence-centric approach to care is the North Star for systems thinking.
When organizations apply systems thinking to cancer care, they consider the complete patient journey with a care pathway. To ensure that patients have a seamless experience from beginning to end, collaboration among all care team members is essential.
Ms. Quinlan-Woodward noted that systems thinking for cancer care can be particularly challenging because oncology treatments are complicated and multimodal. “That complexity requires us to communicate really well across many departments and ensure that care delivery across departments and interventions is synced up,” she said.
Allina Health’s team members are trained to look at the patient as a whole person. Patients are individuals who happen to have a cancer diagnosis, but they also have families, jobs, hobbies and dreams. “When we do a thorough assessment of an individual — mind, body and spirit — we understand that individual better and are more effective in creating a care plan that really meets their needs and goals,” Ms. Quinlan-Woodward said.
Dr. Dizon agreed that the patient must be considered as a part of the care team to ensure shared decision-making at every step of the journey. That requires two-way communication with patients, whether through a patient advisory committee or other forms of market research. “As I consider how to reinvigorate and grow a cancer health system in a crowded marketplace like Boston, part of the solution is listening to what people want from us and how we have responded,” he said. - Systems thinking balances patient well-being with economic sustainability.
The cost of oncology care in the United States is an increasing concern. Approximately 48% of oncology care spending is driven by acute hospital care. Best practices for reducing unplanned acute hospital care include identifying patients at risk for unplanned care, utilizing enhanced care coordination models and using standardized, evidence-based care pathways for symptom management.
Dr. Holly Urban, a healthcare technology expert in system thinking, described how medical oncology and hematology consultants in Philadelphia developed evidence-based symptom management protocols that nurses and on-call physicians followed uniformly. “Since they implemented these pathways, the percent of patients sent to the emergency department as a result of a clinical call decreased by 60%,” she said.
By avoiding unnecessary acute care, the patient experience was better and the hospital also saw improved financial results. “It’s all about designing the system for the outcome you want,” Dr. Urban said. “If you can deliver a good financial outcome and a good patient outcome, it’s a win and it allows programs to be sustainable.” - When deployed intentionally, technology can drive personalized patient interventions.
When it comes to a systems-level approach to oncology, Dr. Dizon believes one of the biggest potential benefits for cancer centers is personalizing care with technology. “We need to use AI to support risk stratification so we can find people with certain conditions and pull in care pathways, so everyone isn’t treated in the same way,” he said.
Hospitals and health systems that deploy technologies successfully are intentional about their plans and they get support from senior leaders. At Allina Health, for example, Ms. Quinlan-Woodward uses the SBAR model (Situation, Background, Assessment, Recommendation of how to move forward) before suggesting a new technology.
Dr. Dizon underscored the importance of implementation science when deploying technologies to support patient care. “Before you implement, what will be the barriers, what data is needed, what’s the end point, what are the short-term metrics? Do the groundwork before you invest and be intentional about why you want certain programs,” he said.
