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 rate60/40 split in community vs. academic affiliationShift 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

0.1

0.703

0.259

0.148

0.148

0.259

0.305555556

0.6

0.25

0.111111111

0.1

0.2

0 0.2 0.4 0.6 0.8

Lack of evidence/data

Competing priorities

I nadequate communication

Lack of leadership

Lack of administrative andmanagement support

Not accredited under RCPSCMOC program

Percentage

2006 2007

Survey Results:

Barriers for participation

Progress to date

Targets 2005 2006 2007

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 CommunicationCME/CPDAccess to evidence Access to data

CoP tools

LongTerm 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 174-185.