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Implementing “Many Layers of Change”

Authored by

Association of Community Cancer Centers


J Clin Pathways. 2020;6(9):24.

ACCCAlthough change is inherent in oncology, the COVID-19 pandemic has raised the bar. As the calendar year draws to a close, the Association of Community Cancer Centers (ACCC) is leaning in to change. With membership, allied oncology stakeholders, and partner organizations, ACCC is looking forward while staying grounded in the present—sharing knowledge and resources to support the stability and adaptability of the cancer care delivery infrastructure. 

From the start, cancer programs and practices have harnessed tremendous creative energy to find solutions to the evolving challenges of providing cancer care during the COVID pandemic. This column provides a single snapshot of how the virus has affected administration, policy, workflow, and operations at one ACCC-member practice. 

For all of health care, COVID-19 has required short-term and longer-term redesign of policies, processes, and workflows. Screening, cleaning, masking, staffing, and scheduling changes were just the start. According to ACCC Board Member Amy Ellis, chief quality officer at Northwest Medical Specialties (NWMS), a large independent multispecialty practice in Tacoma, WA,  “there are almost no words” to describe the amount of work the practice had to accomplish to ensure that patients’ quality care would continue as seamlessly as possible, as the virus surged in their state. In March, with the news of SARS-CoV2 infection in the area, the practice mobilized. NWMS immediately established screening procedures, which in the early days included calling every patient in advance of their scheduled visit. Within that first week, NWMS not only put its screening system in place, the practice had also re-arranged its clinic space for patient and provider safety, and reassigned some staff. By the end of the following week, the practice launched telemedicine to reduce the volume of patients and staff coming on-site to the clinics.

While telemedicine has been a tremendous benefit, the rapid deployment of the new technology required redesigning workflows to accommodate the support patients and providers need to take full advantage of telemedicine. Ultimately, for NWMS, this led to a total reconfiguring of the practice’s patient access team. 

“After we had the clinics ready to go, we established our Viral Illness Task Force (VITF),” recalled Ms Ellis. “We didn’t want to call it the COVID Task Force because we wanted to take these lessons learned and apply them to flu season and any type of viral illness.” The VITF team immediately began writing new policies. These included a COVID-19 policy, clinic isolation policies, testing policies for staff and patients, policies for managing COVID-positive patients who are still eligible to receive chemotherapy, travel policy for staff, and more.  

Some changes required hiring new staff including door screeners whose duties include cleaning between patient visits, taking temperatures, and administering questionnaires to patients before every visit. Others required existing staff to take on new roles. To manage those who report being symptomatic, the practice opened a “sick clinic.” As the pandemic continued, about 60 staff members transitioned to working remotely. To maintain optimal staffing, the practice had to close two of its satellite clinics. 

By mid-October “after implementing these many layers of change,” Ms Ellis reported that the practice is now focusing on quality improvement, conducting mini-PDSA (Plan-Do-Study-Act) cycles to target any emerging inefficiencies. 

Being able to “lean on” other practices and peers during the past months has helped the practice to be successful throughout the pandemic, Ms Ellis said. “As a member of the Quality Cancer Care Alliance, during the early months of the pandemic, NWMS participated in weekly calls with 17 practices across the country to share policies, procedures, and learn from each other. ACCC does the same. You’re linking people together to share common thoughts and ideas. I think that was essential to our success—having peers to ask, ‘Hey, what did you do for this?’ or ‘How did this work out for you?’ That was very, very important to us.”

Quality officers, such as Ms Ellis, are new additions to many cancer programs. She views quality staff as serving as agents of change. In an extraordinary time—such as a public health emergency—when new workflows and processes have to be rapidly put in place, quality staff play an important role. “You really have to have someone who can have eyes on everything. For example, our depression screen scores dropped during COVID because telemedicine happened. Now, we had to figure out how to administer these screenings over the phone. We were so used to doing it in the office. We were so dependent on this one process that when you added this telemedicine piece in, the process broke. That quality person’s job is to make sure that every aspect of the workflows is efficient, that really that foot is on the gas at all times.” 

Despite the challenges of the past months, telemedicine has been a “saving grace,” said Ms Ellis. Not only has it provided patients access to care, the experience has strengthened the staff. “Our team grew so strong together. It will definitely be a huge win when we get on the flip side of this.” 

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