7 Steps for Building a Top-Tier Cancer Center
1. Articulate a vision. Hospitals should start building a cancer center by developing and articulating a vision for the service, according to Timothy Eberlein, MD, director of the Siteman Cancer Center at Barnes-Jewish Hospital and Washington University School of Medicine in St. Louis. Hospital leadership needs to agree on a vision for the center that includes the size of the center, its mission and its goals in patient care. Barnes-Jewish Hospital's vision was to develop an integrated, multidisciplinary cancer center that would work towards achieving world-class status for quality of care. Now, the Siteman Cancer Center has the third largest oncology center in patient volume in the United States, according to Dr. Eberlein.
2. Gain support for the vision. The second step is garnering support from various stakeholders for the vision. Dr. Eberlein says gaining buy-in to the vision and strategic plan was one of the biggest challenges when developing the Siteman Cancer Center. Before Siteman was built in 1999, oncology care at Barnes-Jewish and Washington University was not integrated, but was instead departmentally-centered. Gaining buy-in for the vision thus meant persuading stakeholders to support a shift in the delivery of care. "This was new; it was a different paradigm," Dr. Eberlein says. "Our strategy in the institution had been to support the departments. And of course, that's almost the antithesis of a cancer center, which is a multi-departmental, integrated model."
One way the hospital gained buy-in was by setting smaller goals that would eventually lead to a more ambitious plan. "Rather than say our goal is to be the third biggest cancer center in the United States, we chose to say we want to progress towards being a world-class cancer center," Dr. Eberlein says. "If we had made [being the third-largest center] our goal, we would have had a very difficult time convincing leadership to make that large of an investment. We took incremental steps, but each of the steps was toward a goal of excellence."
3. Develop a strategic plan. Once leaders of the hospital and service line support a common vision, they need to develop a strategic plan. Barnes-Jewish Hospital began with a three-year strategic plan that outlined how the institution would build a successful cancer center. They then followed the plan "pretty religiously," Dr. Eberlein says. Once the center was built and received designation as a National Cancer Institute cancer center, the hospital then created another three-year strategic plan, this time to be designated a comprehensive cancer center by the NCI. Creating incremental strategic plans allowed the hospital to gain leadership support, follow the plan closely and achieve its goals.
4. Create specialized teams. To begin staffing a cancer center, hospitals need to recruit multidisciplinary skilled clinicians. One of the keys to a successful cancer center is having several teams that specialize in a specific type of cancer, according to Nathan Levitan, MD, president of the University Hospitals Seidman Cancer Center in Cleveland. For example, UH Seidman Cancer Center has 10 teams representing 10 major types of cancer, such as brain and spine cancer, breast cancer and lung cancer. This structure allows physicians to "keep up with the furious pace of new developments because they don't have to master everything for every cancer," Dr. Levitan says.
Specialized teams can also provide patients with a single recommendation that has been agreed upon by multiple individuals. He says, "When we think of state-of-the-art care, we think of having subspecialty physicians that have real expertise in one or two types of cancer, and we think of teams [in which] the doctors will actually discuss and debate among themselves what the best treatment is and provide that recommendation."
These teams should include medical and surgical oncologists, social workers, nutritionists and nursing staff, according to Paul Okunieff, MD, director of University of Florida Shands Cancer Center in Gainesville and chair of the UF Department of Radiation Oncology. An academic medical center may also consider adding scientists to the teams, Dr. Okunieff says, so they can "understand the clinical needs, focus their research to overcome barriers and create logistically and economically viable implementation plans." He suggests the teams go on a retreat intermittently to self-examine and discuss how they can improve patient care as a team.
5. Invest in advanced technology. Hospitals building cancer centers also need to invest in advanced technology that has been shown to improve outcomes. For example, some centers are using robotic surgery because it is associated with less recovery time. Dr. Levitan says intraoperative MRI is useful when operating on brain tumors because it allows the surgeon to detect, during surgery, any part of the tumor that was not taken out in the initial procedure and remove the tumor. New diagnostic technology, such as PET-MRI scanners and breast tomosynthesis, and radiation therapy technology, such as CT scanners that recalibrate its beam to avoid treating healthy tissue, can also benefit patients, Dr. Levitan says. Some hospitals and health centers, such as Rochester, Minn.-based Mayo Clinic and Boca Raton (Fla.) Regional Hospital are spending upwards of $120 million on centers for proton therapy, a new treatment designed to more precisely target cancer. There is debate, however, concerning the efficacy and cost-effectiveness of this therapy.
6. Offer clinical trials. After establishing a robust clinical program with specialized teams and advanced technology, hospitals should consider offering clinical trials as a way to increase treatment options for patients. "A clinical trials program is a very important part of a state-of-the-art cancer center because it gives patients access to drugs that might not otherwise be available because they're not FDA approved," Dr. Levitan says. Dr. Okunieff says UF Shands Cancer Center tries to get as many patients as possible on clinical trials because it gives them the opportunity to try new medications and therapies that may result in better outcomes.
7. Focus on the patient experience. As an additional step, hospitals that aim to be recognized for strong cancer services need to focus on the patient experience when delivering care. A patient's experience is shaped by everything and everyone in the care environment. "Every interaction cancer patients have, whether with someone who is transporting them, someone who is delivering a meal — anything that touches the patient — is a healing interaction. And depending upon how these individuals approach the patients, they can really be a part of the healing environment or not," Dr. Levitan says. The UH Seidman Cancer Center, which opened a new freestanding 120-bed cancer hospital in June 2011, was designed to create a healing environment for the patient, according to Dr. Levitan. "The environment of care is as important to the healing process as are the drugs or the surgery or the radiation."
Dr. Okunieff also emphasizes the role of patients' experiences in their overall care. "There has to be a culture of the patient comes first," he says. "You need care and caring, because without the latter, you'll never get to do the former." He suggests that if the provider does not behave or speak compassionately, the patient may not return to the center regardless of its clinical quality. One way physicians can demonstrate their caring is to make themselves easily accessible to patients, Dr. Okunieff says. "Give patients your cell phone number, they won't abuse it. Just make sure people know that you care."
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