5 Steps to Build a Breast Cancer Center of Excellence

In October, the Cancer Treatment Centers of America at Midwestern Regional Medical Center in Zion, Ill., was recognized by the National Quality Measures for Breast Centers Program as a Certified Quality Breast Center of Excellence. To achieve this honor, CTCA needed to meet 36 quality measures on imaging, surgery, cancer registry, pathology, radiation and patient satisfaction. The designation follows years of work by the breast care team and administration, according to Stephen Ray, MD, DABMA, medical director of the breast center and oncoplastic and reconstructive surgery.

Leaders from CTCA at Midwestern share 5 crucial steps in developing a breast cancer center of excellence.

Dr. Stephen Ray shares steps for creating a center of excellence.1. Articulate a vision. One of the most important steps in creating a center of excellence is recognizing a need in the institution and articulating a vision for meeting this need. CTCA at Midwestern had a vision of forming a breast cancer center due to the unique needs of this patient population. Roughly one-third of the hospital's cancer patients are breast cancer patients, according to Dr. Ray. "It became clear to us years ago that we needed to have a focus to address the specific needs of this group of patients," he says.

Maintaining this vision throughout the process of becoming a center of excellence is essential for keeping team members on track when they face obstacles. "We deeply believed it was possible to make this happen," Dr. Ray says. "At multiple places during this process, we ran into a wall and we just stayed with it, never letting up, and finally some of those barriers broke down. The net effect was that the vision we held onto was materialized."

2. Form a multidisciplinary leadership group. Centers of excellence are typically noted for their integration of care, which relies on the collaboration of different specialties. In planning for the breast cancer center, CTCA at Midwestern gathered a multidisciplinary group including medical oncologists, surgical oncologists, radiation oncologists, radiologists, nutritionists, pathologists, mind-body medicine practitioners and pastoral counselors.

This breast program leadership group meets weekly to discuss how these specialists deliver care to breast cancer patients and how this delivery could be improved. "Those meetings [and] the commitment of the core team drive progress," says Lana Poirier, director of quality at CTCA at Midwestern.

Lana Poirier shares steps to create a center of excellence.3. Identify metrics. To deliver excellent care, hospitals need to determine their baseline performance and the measures they will use to define improvement. In addition to the hospital's internal quality standards, CTCA at Midwestern used national standards from the National Quality Measures for Breast Centers Program. Benchmarking performance against national standards enabled the breast center leaders to compare the center's outcomes with those of centers across the nation.

4. Develop a data collection system. After identifying metrics, hospitals need to develop a robust data collection system to organize data in a way that allows for easy reporting to outside organizations such as accrediting programs.

This step was one of the most difficult for CTCA at Midwestern, and was compounded by the hospital's recent adoption of electronic medical records three years ago, according to Dr. Ray. One challenge was that while the hospital already tracked certain data, it was not necessarily categorized under the specific metric the accreditation organization uses to recognize centers of excellence. The breast cancer team had to go back through three years of data collected in the EMRs and align the data with the specific metrics the hospital would be judged on.

CTCA at Midwestern also sought to collect data in real time, which required additional changes.

5. Redesign processes. Creating a center of excellence requires leaders to reevaluate their entire delivery system of care using metrics they identified. CTCA at Midwestern looked at its breast cancer care and redesigned processes to improve clinical and patient satisfaction outcomes.

For example, initially breast cancer patients waited roughly five days between first visiting CTCA at Midwestern and receiving their complete treatment plan. The breast cancer team redesigned the intake process, including improving communication between different clinical care providers. This redesign reduced the time to treatment plan to three days, which resulted in patient volume and patient satisfaction benefits. Originally, 78 percent of breast cancer patients who were first evaluated at CTCA at Midwestern committed to having treatment there. After the redesign, this number increased to 94.9 percent.

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