Patients who come to Memorial Sloan-Kettering Cancer Center for the diagnosis and treatment of cancer receive outstanding care. However, in keeping with a long tradition at Memorial Sloan-Kettering of constantly looking for ways to improve performance, Robert E. Wittes, Memorial Hospital's Physician-in-Chief, has launched the Quality of Care Program. The program's goal is continuous quality improvement across a full spectrum of services -- from direct cancer care to general medicine to psychosocial support. This will occur by setting care standards, measuring actual performance, and providing feedback to physicians and nurses.
"Through this program we will establish care standards where necessary, improve patient flow processes, address patient safety issues, and enhance information flow among the medical teams," said Dr. Wittes. The Memorial Sloan-Kettering program will use nationally accepted measures as well as metrics developed by the Center's own care teams.
Care standards are "best practices" -- based on evidence whenever possible -- that clinicians are expected to follow. The Memorial Sloan-Kettering program will focus on areas where problems have emerged, or where there is significant practice variation and reducing that variation by implementing standards is likely to make a difference in outcome. "We don't want a large proliferation of standards and will implement them only where they are likely to be really useful," Dr. Wittes pointed out. "If there is evidence that doing things a certain way is actually better, then even if we haven't seen any problems emerge at Memorial Sloan-Kettering, if our practice here isn't conforming to best practice standards, we should make the necessary changes," he said.
At present, these areas include venous thrombosis prophylaxis (venous thromboembolism is a blocked blood vessel due to a blood clot, usually in a leg, which can occur after surgery); perioperative use of beta blockers for surgical patients to reduce postoperative myocardial infarctions; the treatment of pain; and glucose control in diabetic inpatients.
Seven committees are working together to identify improvements in the delivery of care. The Clinical Council, led by Robert C. Kurtz, Chief of the Gastroenterology and Nutrition Service, will identify areas in which care standards are necessary and coordinate their development or adopt standards if they already exist. Metrics, led by David G. Pfister, Chief of the Head and Neck Medical Oncology Service, will recommend measures to assess care quality. Patient Flow, led by Gianna Zuccotti, Associate Chairman for Clinical Affairs, Department of Medicine, will work to ensure timely patient movement through points of care at multiple locations. Clinical Informatics, led by David R. Artz, Medical Director, Information Systems, will provide staff with user-friendly tools to access information and will further develop Memorial Sloan-Kettering's point-of-care informatics applications to enhance the Quality of Care effort. Patient Safety, led by David P. Jaques, Vice Chairman of the Department of Surgery, will identify mechanisms and implement systems to minimize the risks of care delivery. Quality Assessment, led by Bruce D. Minsky, Vice Chairman of the Department of Radiation Oncology, will monitor the quality of care and initiate projects to improve or redesign certain processes by which patient care is delivered. Training and Education, with a leader to be named, will oversee efforts to educate the staff on care process innovations and develop conferences, training seminars, and computer-based training that emphasize care quality. The committees will provide feedback to staff of their own outcomes data and that of their peers.
"One of our goals is to be able to present our record for the edification of various audiences, especially our own staff," said Dr. Wittes. "And most important, for people who are either receiving their care at Memorial Sloan-Kettering Cancer Center or thinking of it, so they will be more educated consumers."
