Gaining traction and propelling change Rubber on the road

Gaining traction and propelling change: rubber on the road

Adjunct Associate Professor Jeremy MillarDirector, Radiation Oncology, Alfred Health, Monash University

School of Public Health and Preventive Medicine

Alfred Health RO Clinical RegistryVCR - prostate cancerVCR - Rectal cancerVCR - Bladder cancer

Victorian Prostate Cancer Registry


Rap sheet


Australian Prostate Cancer RegistryVictorian pilot Lung cancer registryBiogrid, esp colorectal, prostateAustralian Plasma cell disordersBreast cancerThyroid cancer registry Alfred Health oesophageal cancer registrProstate seed brachytherapy registry





Source: Porter ME. What is value in health care? N Engl J Med. 2010 23;363(26):2477–81.


Source: Porter & Lee. The Strategy That Will Fix Health Care. Harvard Business Review October 2013.



Clinicians!



The dogs bark, but the caravan moves on…

-Arab proverb

Individual change

�Education

�Opinion Leaders

�Peer-review processes

� Financial

�Ownership of idea and process

�Appeals to ethical professional principles

�NOT CONTROLS


Source: Ham C. Improving the performance of health services: the role of clinical leadership. Lancet. 2003 7;361(9373):1978–80

Organisational change

� Education & training of clinical leaders

� Support of clinical leaders

� Allow time

� Organizational development

� Support teams

� Rapid iterations


Source: Ham C. Lancet. 2003

Victorian Cancer RegistryAll DiagnosesVictorian Cancer RegistryAll Diagnoses

State and National Death RegistriesState and National Death Registries

5311 cases5311 cases

776 deaths776 deaths

Variation in death rate

Cancer service regions


State and National Death RegistriesState and National Death Registries

5311 cases5311 cases

776 deaths776 deaths


Link to medical records & patientsLink to medical records & patients

VPCR – what worked well?


Cumulative & Stacked Accrual by Hospital

Cabrini

Peter Mac

Austin

What registries can achieve


NCCN risk category at baseline and treatment provided

Source: Prostate Cancer Registry 2012

* Frydenberg, Millar et al MJA 2000; 172:270-274

Treatment patterns


What registries can achieve

0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%

LDR

EBRT

RP

Big problem

Moderate problem

Very small/Smallproblem

Source: Prostate Cancer Registry 2012

Sexual BOTHER according to primary treatment approach


Victorian Prostate Cancer Registry




Confessions


� Concern about “data ownership”

� Pre-existing datasets / registries

� Clinical workload

� Minimal objective dataset

� Funding

� Rapid case-ascertainment

� Unbiased complete case-ascertainment

� Extending the registry


Accent-u-ate the positive…

Elim -in-ate the negative…


� Establishment of higher goal

� Principles based

� Health service administrative champions e.g. Epworth

� Government champions

Organisational influences on clinicians


� Establish trust with clinicians

– Communication & consultation– Meet them face-to-face (hopefully with one or more of their own)– Win intellectual argument– Involvement– Identification of influencers. Support them.– Process-driven– Respect– Governance Group– Awareness of clinical sensitivities

� Clinical Champions

� Relieve clinicians of workload

Individual clinicians

Change to clinicians’ environment


� Need to demonstrate the registry’s ability to improve patient care

� publish methodology/findings

� Where possible, integrate into clinical practice

� data collection as part of normal clinical process� feedback of results timely and relevant

� Good governance structures

� credibility� maintain independence from government and groups within

specialist areas

� Incentives

� Funded forums to discuss outcomes/research stemming from registries/ability to be involved in publications


Thanks to

Sue Evans

John McNeil

Joanne Dean

Julie Wood

Fanny Sampurno

Catherine Pound

Catherine Mulvany

Documents

Gaining traction and propelling change Rubber on the road