Arif H. Kamal, MD, was pleasantly surprised when he saw the results of the Quality Training Program’s 6-month survey.
Fifteen practices participated in the 2013-2014 ASCO Quality Training Program pilot that Dr. Kamal, assistant professor of medicine and director of quality and outcomes with the Duke Cancer Institute, helped conduct. The Quality Training Program is a structured program that facilitates quality-improvement collaborative learning by using a hybrid approach of in-person, hands-on learning sessions and expert coaching using virtual methods.
In fall 2014, 6 months after the pilot concluded, participants were surveyed about the longer-term effects of the training program and about the quality-improvement projects they carried out as part of it.
Dr. Arif H. Kamal
Dr. Kamal knew that “many clinicians worry that the major impetus for quality-improvement initiatives in oncology is to address evolving financial, regulatory, and accreditation demands,” according to a submitted manuscript about the pilot program. However, for the quality-improvement projects selected by the practice teams in the pilot, that was not the case. Instead they “aimed for clinically meaningful targets when selecting projects,” Dr. Kamal said.
“At the end of the day, people can be and are extraordinarily motivated by the patient’s experience through their cancer journey,” Dr. Kamal said. “That is ultimately the primary motivation for participating in quality improvement.”
Applying Experiential Learning to Real-World Challenges
ASCO recognizes the desire of oncology professionals to improve the patient experience and clinical outcomes while also understanding the many competing priorities of the modern oncologic workplace. That is why in 2013 ASCO launched the Quality Training Program in a format that enables practices to apply experiential learning and practical skill building to a real challenge the practice team is confronting.
The Quality Training Program prepares teams of oncology providers to design, implement, and lead successful quality-improvement activities in their practice settings. The 6-month training program includes a structured and facilitated improvement project that is selected by each oncology team to solve a problem in their own clinical setting with guidance from experienced coaches.
The Quality Training pilot program consisted of three in-person learning sessions divided into four phases: pre-work, planning, implementation, and sustaining and spreading. During the 2-month pre-work phase, team members completed pre-assessments, knowledge surveys, and other pre-work activities.
Teams refined the goals of their project, developed a process map, collected diagnostic and baseline data, and selected measures of performance during the planning phase of the program. In the third phase of the pilot program, teams developed their project action plan, conducted at least one test of change, collected performance data, created a plan for sustainability, and prepared for a final presentation to their Quality Training Program peers.
The fourth and final phase of the program involved sustaining and expanding practice changes that resulted in measurable quality improvements.
Participants in the pilot study reported significant improvements in patient-centered care, more effective care, more efficient care, and safer care in a matter of weeks and months.
More than half the teams said the pilot helped in “communicating results with both local colleagues and those outside their institution, achieving measurable improvements after implementing the initiative, and sustaining that improvement,” according to survey data.
Fifty percent of teams reported applying methodology learned for their project to additional, new projects at their local institution.
Morbidity and Mortality Conferences: The Cleveland Clinic
Lindsey Martin Goodman, MD, was one of the doctors from the Quality Training Program who applied what she learned at her local institution. Dr. Goodman is a hematology and medical oncology fellow at the Cleveland Clinic. Her participation in the Quality Training Program taught her valuable quality-improvement skills which she used to implement monthly Morbidity and Mortality Conferences (MMC) for all caregivers at the Cleveland Clinic as part of CME-certified oncology grand rounds.
As a result, care providers reviewed cases on chemotherapy dosing and administration errors, hospital-acquired medical complications, communication breakdown between caregivers, and end-of-life care. An average of 3.5 action items resulted from each case, with 75% addressed within 90 days. Physician attendance was 59% higher at Morbidity and Mortality grand rounds than at other grand rounds, and 23% more physicians reported that they were very likely to change their practice behaviors from Morbidity and Mortality than from other grand rounds presentations.
Dr. Goodman received a 2014 Merit Award in Quality Care from the Conquer Cancer Foundation of the American Society of Clinical Oncology for her project. She presented the results of her findings at the 2014 ASCO Quality Care Symposium.
“Prior to the Quality Training Program, I had no quality-improvement experience or training, so the lessons we learned as we worked through our project were so beneficial,” Dr. Goodman said. “It laid a great groundwork in what quality improvement was. It gave me basic quality-improvement skills that I’m now able to use with other quality-improvement projects we’re working on at the Cleveland Clinic.”
Admittance into the ASCO Quality Training Program is based on an application process. Applicants must include a multidisciplinary team of two-to-four individuals willing to work on a quality-improvement project, including a designated team leader, and must be willing to travel for three in-person session meetings during the course of the 6-month training program.
The application process for the next round of the ASCO Quality Training Program is expected to begin later this year. Learn more about ASCO's Quality Training Program.