To concentrate efforts to decrease delays in the diagnosis and treatment of lung cancer, the Victorian Lung Cancer Service Redesign Program (VLCSRP) was established in 2016 to support lung cancer service redesign projects. Currently five such projects are being piloted in health services across Victoria. Each project consists of five phases: a set-up, diagnostic, solution, implementation / evaluation and sustainability phase. This paper identifies the key challenges and learnings from the diagnostic phase of the VLCSRP.
Service redesign methodologies were used to identify baseline performance, from point of referral to the start of first treatment for lung cancer. The Victorian Lung Cancer Registry (VLCR) was engaged to support a standard approach to data collection and evaluation. Both quantitative and qualitative data was collected including information on clinician and consumer experience. A number of Community of Practice forums were held to support collaborative learning.
A number of barriers to the timeliness of care were identified. Root cause analysis was conducted and key areas of focus prioritised. Challenges were initially experienced in integrating pilot sites within VLCR due to local health service factors including delays in achieving governance approval to access health service data, site relocation of cancer services and implementation of a new electronic medical record system. The need for separate ethics submissions for consumer & clinician interviews with a wide variance in approval timeframes caused further delays. While the requirement for systematised data capture added complexity to the project processes/ methodology it produced more robust comparable data between participating health services.
This study identified key areas of variance in the management of lung cancer in Victoria. Additionally, it highlighted the need for greater planning around baseline data collection, including lead time for ethics approval and introduction of new data capture systems such as clinical registries.