In fiscal 2024, Greenville, S.C.-based Prisma Health made an enterprisewide commitment to reduce the time breast cancer patients were waiting for surgery after diagnosis.
Currently, the American College of Surgeons’ Commission on Cancer recommends breast cancer patients undergo surgery within 60 days of diagnosis. In 2023, Prisma Health leaders set a goal to shorten the time between biopsy and surgery from 60 days to 45 days or fewer.
The health system achieved its goal by the end of fiscal 2024, with 64% of eligible patients undergoing surgery within 45 days. Three of the leaders behind the initiative — Julian Kim, MD, Ashley Cothran, BSN, RN, and Nathalia Cojanu — spoke to Becker’s about the operational changes required to reach the goal and the lessons other health systems can take from their experience.
Dr. Kim and Ms. Cothran are president and administrator of the Prisma Health Cancer Institute, respectively, and Ms. Cojanu is administrator of Prisma Health’s Pulse Clinical Advancement Program.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What operational changes were most critical to Prisma Health achieving breast cancer diagnosis to surgery in 45 days or fewer?
Dr. Julian Kim: This project was selected as the number one goal for the entire healthcare system but was not geared toward a certain financial metric. We called it operationalizing empathy, because it was about letting patients know we really care about them.
The goal was actually part of our enterprise scorecard and part of our incentive compensation for Prisma leaders in the first year that it started. The number one driver of success was engagement. Engagement across all individual sites of not only our surgeons, but our schedulers, the operating rooms, all the things that are part of that time to surgery. We had transparency in performance data, performance of not only the whole enterprise but also each individual site.
Another thing we need to mention is our IT team. The ability to look on our desktop and pull up data across the system was really built by the IT team, and it’s all derived and downloaded monthly from Epic, so no small feat. It took a lot of hours of folks working together to try to come up with that.
Nathalia Cojanu: As a part of our overall Pulse Clinical Advancement Program, we utilize a methodology called ADTP: assess, diagnose, treat and prevent.
During the “assess” phase, we conducted an in-depth analysis of our current state, identifying all the stakeholders involved throughout the patient journey, keeping in mind anyone who’s touching the patient or even behind the scenes from the EMR perspective. We convened these stakeholders to collaboratively map the process out in each market and truly drive this initiative forward together.
Q: Where did you initially see the greatest delays in the pathway?
NC: What our findings yielded from the start was that many steps were being completed sequentially and causing a delay in the process.
We started to promote workflows that allowed for parallel processing where feasible. For example, we created a timer in Epic after we identified people were manually tracking the patient’s journey in Excel. We also identified the opportunity that a breast MRI could be scheduled prior to the patient’s surgical consultation. We really collaborated as a team to prioritize breast cancer surgeries, even over other elective, nonurgent procedures when necessary.
Genetics counseling was one of the biggest ones we unearthed that was actually more market-specific toward the Midlands. We requested that they hold time slots specifically for breast cancer patients and they were more than willing to do that.
Ashley Cothran: We have large academic hospitals, large community hospitals and smaller facilities who could manage to get patients in a lot faster. The differences between the markets really showed up when they started to figure out and assess what the problems were.
For example, in one area we realized we were bringing patients in to see the surgeon first who was then placing an MRI order. Then we had to wait for that appointment, wait for potentially additional biopsies and the results. So we moved that process. If we knew a patient needed an MRI, we said “Let’s go ahead and order it. Let’s get it done before they ever see the surgeon so we’re not slowing down step in the process.”
Q: What advice can you give other hospital and health system leaders when it comes to addressing variation across facilities?
NC: In my opinion, it is worthwhile to truly establish a platform that fulfills this purpose. We have Clinical Specialty Councils, and they operate as a component of the overall Prisma Health Pulse Clinical Advancement Program.
Within this program, we support the expert clinicians that live and breathe in these spaces and the ongoing efforts to enhance quality, safety, patient experience, value, health disparities and population health across our continuum of care.
JK: We’re very fortunate to be in a system that is structured to have a very defined way of operating and improving. Even in the absence of that, the message is: It’s important to try to do this enterprisewide, to have teams that are dedicated to a specific project, and that it’s going to take institutional commitment.
Q: You’ve begun extending this work into screening mammography access. What lessons from the surgery-timeline initiative are informing that expansion?
AC: We didn’t just do something to check the box, we found value in this. It did not disappear just because we met our goal, we’re still measured on it. I can go to the website right now and see where we are up to this point.
NC: All the team members that touch the patient throughout this journey were phenomenal in coming up with the solutions. They were the ones that, on a whim, asked for a timer and now we have a real-life timer in Epic. We didn’t leave anyone’s opinion unheard. The process was lengthy but it was well worth it. Because look at what we’ve accomplished and what we continue to accomplish.
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