Improving quality of patient centred care in cancer

Hospitals involved in this study will participate in a quality improvement intervention, based on the Breakthrough Series. The Breakthrough Series is a collaborative model of learning developed by the Institute for Healthcare Improvement (IHI). This model focuses on health care systems improving the quality of their health care through sharing and learning from each other’s experiences and resources. It typically involves a number of hospitals working towards improving a similar, pre-determined area/s of care, over a set amount of time. Representatives from each hospital will meet and discuss their experiences, the strategies they used and share resources related to their efforts in improving the pre-determined area of care. The Breakthrough Series Approach has not been previously adapted such that consumers play a central role in guiding the process of change. This study will adapt the current Breakthrough Series Model to incorporate consumer involvement in identifying priority quality of care concerns, developing solutions and monitoring the success of those solutions. The theoretical underpinnings of the original Breakthrough Series Model will provide the basis of this intervention. A modified Breakthrough Series approach will be used to deliver a multi­faceted consumer driven intervention aimed at improving patient­-centred care. This iterative and collaborative process will involve multi­disciplinary teams led by a Cancer Council New South Wales (CCNSW) consumer advocate. The teams will identify and work towards achieving hospital set goals, based on key patient priorities identified in the baseline data (Consumer Preferences Survey). The intervention will be carried out in a collaborative manner using the expertise and support of the multidisciplinary teams, the CCNSW, and change champions’. The intervention will occur as follows: 1) Selection of influential consumer advocates to lead change in each experimental hospital. 2) Pre-intervention workshop. 3) Hospital data and goal setting. A collaborative sub-committee will be established to provide support and higher-level advocacy to each hospital and monitor adherence to the intervention via monthly teleconferences. The intervention will be conducted as a stepped wedge cluster randomised controlled trial with 6 sites. The 6 sites will be paired based on approximate size and location (rural/urban) of the hospital. All 6 units will start in the control condition. One site from each of the pairs (i.e. 3 of the 6 sites) will be randomly selected to switch to the intervention condition at 2 months after the commencement of baseline data collection, and will remain in the intervention condition for the remainder of the study intervention period (i.e. 10 month intervention). The remaining three chemotherapy units will switch to the intervention condition at 8 months after the commencement of baseline data collection, and will remain in the intervention condition for the remainder of the study intervention period (i.e. 4 month intervention). In total there will be 6 measurement periods.