[Suzanne Beuker, National Clinical Lead – Cancer Services, Ministry of Health] So the work of the National Bowel Cancer Working Group has been quite ground-breaking and it’s provided a lot of insight into how we can gather information in New Zealand.
This report is giving us information about the quality of our bowel cancer care provided throughout New Zealand and it’s showing us some quite considerable variation both throughout the country and variation within ethnic groups in New Zealand.
We have to think both as clinicians, as organisations and as the public whether we think that that’s fair and reasonable and if it’s not then we’re going to have to look at ways to provide quality improvement in those organisations that’s going to benefit the patients and reduce that variation.
[Professor Ian Bissett] Well the quality indicators are a way of comparing DHBs but they have to be looked at with the understanding that there are some differences across the country. For instance some centres have particularly complex cases sent to them and so the actual population may be slightly different. The differences we’re finding though are in some cases wider than we’d expect even with that reality.
[Rami Rahil, Executive Director, Cancer Control, Canadian Partnership Against Cancer] The data is important. It’s necessary, but it’s not sufficient. There needs to be that engagement to get the changes that you need in clinical practice decisions.
[Professor Ian Bissett] The best thing is for the DHBs to engage with the reason why their indicator might not be as good as elsewhere, perhaps having some help from other DHBs that are doing better and then putting up an action plan in place to deal with that.
[Suzanne Beuker] Organisations need to understand their own data because there might be considerable differences between patient populations in Auckland versus Tairawhiti and so those organisations have to understand their own data. And then we need to look at ways that we’re going to provide quality improvement in places whose outcomes aren’t looking so good, whether that be local investment in quality improvement programmes within those DHBs or whether it’s actually buddying up similar sized DHBs. So not just saying that only big places do great work but perhaps there’s smaller DHBs whose outcomes look great … what are these places doing?... and link them up with organisations that need to provide some improvement.
I think that the main thing is, is that this information has to be viewed in the light of quality improvement. It’s absolutely not about punishing DHBs or clinicians whose data might not look that great. It’s actually about improving things for patients.
[Professor Ian Bissett] With an understanding about the quality of treatment across the country we can ensure there is an improvement in quality at all sites so wherever a patient is diagnosed they can be happy they will end up with good treatment.
[Suzanne Beuker] And the next step really is to roll that out, use the Bowel Cancer Working Group as a model for the other large volume tumour streams. So we want to look at tumour streams where there’s a lot of patients experiencing that cancer but also tumour streams where there’s a big equity gap. So the next tumour stream in that indicator work that’s progressing is prostate cancer. There’s significant work going on in the lung cancer space as well.
[Rami Rahil] It takes a lot of effort. It takes a lot of patience. And there are some bumps and stumbles along the way but persistence produces results and it took us a number of years but we definitely now see the full value in having good, meaningful, compelling information on quality and outcomes in Canada.
New measures being introduced are expected to ultimately improve care and outcomes for New Zealanders with bowel cancer.
The just released Bowel Cancer Quality Improvement Report includes a number of quality performance indicators which have been identified and accepted as a measure for good care by clinicians and others who are suitably qualified. These can be used to identify good practice as well as opportunities for improvement.
“The report shows that while overall New Zealand is performing well in comparison with England and Scotland for example, there is some regional variation in quality of care and treatment that we have a responsibility to address,” says Suzanne Beuker, National Clinical Lead for Cancer Services at the Ministry of Health. “The Ministry of Health and district health boards will work together to ensure recommendations made in the report are incorporated into quality improvement programmes.
“This variation may be because people are not diagnosed soon enough for us to treat their disease at an early stage or we may not be providing accessible treatment services for people diagnosed with cancer and their whānau in a way that is timely, easy to access and limits time away from their family and work. Bowel cancer is a significant issue for our Māori population who overall have worse outcomes than non-Maori. So equitable access with suitable referral pathways in place are very important, in addition to treatment options.
“By looking harder at the data in this report district health boards can investigate the reasons for any variations and gain a better understanding of their patient populations. Where disparities exist we can support them to make any necessary changes. This will involve working together, sharing ideas and learnings.”
The bowel cancer quality improvement indicators are the first to be developed and released in New Zealand. Work is underway to develop similar indicators for other common cancers, such as prostate and lung cancer.
“This is ground-breaking work. Along with the national roll-out of the bowel screening programme, which aims to save lives by detecting bowel cancer at an early stage when it can often be successfully treated, there is the potential to make a big difference to patients with bowel cancer no matter where they live in New Zealand,” says Suzanne.
Quality improvement starts with getting good data, developing standards and introducing positive changes. This is an important step down this path.