Introducing cancer patient pathways as a health care reform – why and howa Scandinavian comparative study

A brief version of presentation held at

The annual meeting - Research on «pakkeforløp»Stockholm 11.16.18

Per Magnus Mæhle, Oslo University Hospital and Faculty of Medicine, Univ of Oslo

OUS Kreftsenter CCC

The roadmap to this presentation• What is the issue of our inquiry• What kind of cases – similarities and differences• A story of and to which problems do we want to contribute to answers

three phases and an overture• Similarities and differences across the three cases – a preliminary approach

The presentation is preliminary findings of a project accomplished by - Per Magnus Mæhle, Oslo University Hospital og Dept of Health Management

and Economy, Med.fak., UiO, in a cooperation with- Senada Hajdarvic, Department of Nursing, Umeå University- Erna Håland, Dept. of Education and Lifelong Learning, Norwegian University

of Science and Technology- Rikke Aarhus, Research Unit for General Practice, Aarhus University

OUS Kreftsenter CCC

What is the issue of our inquiry and to which problems do we want to contribute to answers

Introducing cancer patient pathways as a health care reform –why and how - A Scandinavian comparative study Ambition: Useful learning of how health care reforms and transformation should be accomplishedContribute to theory development on Institutional change in public sector organizations

OUS Kreftsenter CCC

The phases constituting the cases

First step of lifting up on the agenda

Staging the need for a reform

Constituting a situation of urgency

Enabling dynamics and building capacity for change

Contextual issues interfering with the process

OUS Kreftsenter CCC

2005 2007 2009 2011 2013 2015 2017

DK

SE

NO

Differences and similarities in the context and its consequences - 1

Similarity: Type of health care system

A public expectation to the welfare state to deliverHealth care a political issue

OUS Kreftsenter CCC

Differences and similarities in the context and its consequences - 2

Difference: The institutional structuring of health care

The ability to implement all the way down – the role of negotiation and governance

OUS Kreftsenter CCC

OUS Kreftsenter CCC

Helse-departement

Helse-departement

Helse-departement

Sundhets-styrelsen

DanskeRegionere eksMidt Jylland

Helse-direktoratet

Helseregioner eksSør-Øst Region

HospitalHospital Hospital

Social-styrelsen

LänenEks

SkåneRCC

Differences and similarities in the context and its consequences - 3

Difference: The overall motive

The espoused challenge and over all aims- Relative survival- Social and/or geographical inequality- Increased patient satisfaction- Cost efficiency - Delivering the best cancer care

OUS Kreftsenter CCC

Differences and similarities in the context and its consequences - 4

Similarity: Identical interventions

The same ideas, immediate motivation and content of the reformAmbitious and long way downDiffusion or learning?

OUS Kreftsenter CCC

1. Staging the need for a reform

• The investment crises hitting cancer diagnostics and treatment• Building national clinical programs and guidelines for cancer

diagnosis• The acknowledgement and focus on the needs to accomplish far

better coordination across the silos Pathway and some crises• The establishment of special positions and institutions cancer

care on national and/or regional level• The establishment of special positions and institutions cancer

care on national and/or regional level• The appearance of examples of delivering practical solutions to

the perceived challenges

OUS Kreftsenter CCC

2. Constituting a situation of urgency • The role of media, interest groups and some specialists• Defining the dominant way of conceptualize the

problem and the solution• National political commitment on a very high level• Short way from political embracement to politically

demand for action

OUS Kreftsenter CCC

3. Enabling dynamics and building capacity for change• Extraordinary organizational structures – some

previously established and some created as part of implementation

• A room for institutional entrepreneurship created and filled by experienced actors - mainly insidersExtraordinary organizational structures – utilized by

institutional entrepreneurs

• Activating specialists – bottom up meets top down• Existing models actively integrated in the change

process

Enabling dynamics and building capacity for changeDifferences and their impact?

• Differences in rules framing the implementation processes– Governance vs facilitating vs consultancy– Mandatory vs voluntary

• The role of funding facilitating implementation?• The role of monitoring pathway data in changing

behavior and outcome

OUS Kreftsenter CCC

How did it work?

• Huge energy, an extraordinary experience and perceived success

• However: Right and only answer to the challenge? How should we measure a success of the SPP reform? When is the mission completed?

OUS Kreftsenter CCC

CPP - The right answer to the challenges?

• What about other quality measurements?• What about those cancer patients not being included

into SPPs? • What about integration of primary care?• What about patient pathway after the start of first

treatment?

OUS Kreftsenter CCC

How did it work? - 2

• There is several possible scales to measure:– Monitoring waiting time a part of governance– Standardized patient pathway as a part of governance– Improved waiting time– Continuous improvement processes organized along pathway– More satisfied patients– Decreased inequalities– More cost efficient health care– Improved planning system and logistics – Patient perspective penetrating the systems and behavior– And at least: a lesson to learn from

OUS Kreftsenter CCC

Invitation to a further dialogue

• Since this project want to be a part of a learning process I will be happy to present and discuss our findings in other fora and organizations that have some connection to these stories

• Contact informationPer Magnus Mæhle Email: pemm@ous-hf.noTlf: +47 91356340

OUS Kreftsenter CCC

Oslo universitetssykehus er sertifisert somComprehensive Cancer Centre

OUS Kreftsenter CCC