Achieving a multilevel evidence-based approach to improve cancer care in the U.S. post-COVID era: What is the role of management?

In 2013, the Institute of Medicine already had declared the state of U.S. cancer care as "a delivery system in crisis." Beginning in early 2020, the ongoing COVID-19 pandemic has dramatically revealed the fragile nature of the U.S. health system. As a microcosm of that larger health system, cancer care can provide us with opportunities for innovative thinking and new solutions. This paper describes a series of public and private-sector cancer care initiatives that are the building blocks for a multilevel evidence-based approach to improve cancer care in the post-COVID era. Achieving these objectives requires significant managerial policy decisions, some risk taking, and the development of organizational strategies that involve collaboration within the managerial and clinical leadership. Such strategies should reflect adaptability to navigate the complex and changing science, policy and financing environment, while retaining the central values of patient-centered care. As suggested by Edward Deming, an early pioneer in quality-improvement initiatives, the problems are with the system, and the system belongs to management. Though future challenges are undefined and likely to be significant, the foundational elements of a multilevel, evidence-based approach for improving cancer care are established and able to be built upon and will offer application in the post-COVID era.

Achieving flexible competence: bridging the investment dichotomy between infectious diseases and cancer.

Today's global health challenges in underserved communities include the growing burden of cancer and other non-communicable diseases (NCDs); infectious diseases (IDs) with epidemic and pandemic potential such as COVID-19; and health effects from catastrophic 'all hazards' disasters including natural, industrial or terrorist incidents. Healthcare disparities in low-income and middle-income countries and in some rural areas in developed countries make it a challenge to mitigate these health, socioeconomic and political consequences on our globalised society. As with IDs, cancer requires rapid intervention and its effective medical management and prevention encompasses the other major NCDs. Furthermore, the technology and clinical capability for cancer care enables management of NCDs and IDs. Global health initiatives that call for action to address IDs and cancer often focus on each problem separately, or consider cancer care only a downstream investment to primary care, missing opportunities to leverage investments that could support broader capacity-building. From our experience in health disparities, disaster preparedness, government policy and healthcare systems we have initiated an approach we call flex-competence which emphasises a systems approach from the outset of program building that integrates investment among IDs, cancer, NCDs and disaster preparedness to improve overall healthcare for the local community. This approach builds on trusted partnerships, multi-level strategies and a healthcare infrastructure providing surge capacities to more rapidly respond to and manage a wide range of changing public health threats.