A multidisciplinary team approach to improving psychosocial care in patients with cancer.

The demand for patient-centered care has reinforced the need for a systematic approach to planning appropriate psychosocial services. A proposed strategy to address this need is to use a multidisciplinary team comprised of oncology nurses, physicians, mental health professionals, social workers, ethicists, and other healthcare professionals to provide comprehensive psychosocial care to patients and their families. This article describes key aspects of a broad-based team approach used to develop evidence-based, multidisciplinary practice change that could improve psychosocial care and outcomes.

Improving bed turnover time with a bed management system.

Efficient patient throughput requires a high degree of coordination and communication. Opportunities abound to improve the patient experience by eliminating waste from the process and improving communication among the multiple disciplines involved in facilitating patient flow. In this article, we demonstrate how an interdisciplinary team at a large tertiary cancer center implemented an electronic bed management system to improve the bed turnover component of the patient throughput process.

Developing a transfer center in a tertiary cancer center: streamlining access and communication to accommodate increasing demand for service.

Hospital-to-hospital transfers in a tertiary cancer center present an unusual set of problems involving a diverse group of acutely ill patients with highly specialized needs. The level and urgency of care required and the costs of providing optimal management often are exceedingly high. We present the administrative issues involved during a major revamping and streamlining of the Transfer Center at The University of Texas MD Anderson Cancer Center. The impetus for change included overuse of the emergency facility as a triage center for transferred patients, lack of adequate preadmission medical and financial screening of patients in anticipation of a transfer, a suboptimal level of physician-to-physician handoff communication, and insufficient protocols for prioritizing potential admissions and thus optimizing the institution's limited resources. During implementation of these revised policies, additional concerns were identified, including reluctance to modify established protocols and an inability to ensure the arrival of non-emergent transfer patients at our institution during daytime hours. Prioritizing admissions based on the degree of urgency and available resources required ongoing flexibility in accepting new concepts and ideas. The success of the project is documented in this report, as are suggestions for how other centers that experience similar challenging reorganizations can apply the lessons learned from our endeavors.

Improving psychosocial care for improved health outcomes.

The core of healthcare quality is continuous improvement of processes and results. For cancer patients, psychosocial care can affect overall outcomes. In this article, we outline the efforts that a national comprehensive cancer center is using to bring psychosocial care to the same level of awareness, importance, and integration as clinical care. Improving all aspects of patient care, psychosocial as well as biological, must be pursued if progress in overall quality of cancer care is to be achieved.

The performance management system: applying and evaluating a pay-for-performance initiative.

The clinical operations and programs division at the University of Texas M. D. Anderson Cancer Center undertook an initiative, as part of a new performance management system, to determine the effectiveness in aligning individual performance goals to institutional goals and linking performance to rewards (i.e., distinguishing high performers from low performers). The initiative was completed in two phases--the first involved a pilot group of administrators and managers, and the second encompassed the entire clinical area of the institution. Progress was monitored using a survey specific to the performance management initiative, an institutional employee opinion survey, and employee performance review and merit data. We demonstrated support for both goals in the findings from our performance management survey and for our second goal with the institutional employee opinion survey results. Our correlation analysis of the linkage between performance and merit data provided further evidence that the initiative's implementation affected our goal of better distinguishing high performers from low performers. Although our results indicate that we made significant progress toward meeting our goals, we outlined limitations and implications of our results for other organizations to consider as they embark on their own performance management initiatives. Thinking of performance management as a complete system that encompasses goal alignment, education, communication, and continuous feedback can lead to the recognition of top performers. This recognition is important as organizations try to retain their top talent and improve the performance of all employees in an effort to positively influence the patient experience.