In Sixty Cancer Action
Initially, Honest was contracted by the Regional Health Authorities of Manitoba (RHAM) to develop a series of tools to support the internal rollout that was underway. A Provincial Cancer Patient Journey Steering Committee had been established two years prior, co-chaired by the CEOs of RHAM and Cancer Care Manitoba, with representation from all related actors in health care and government and across the Province, and patient and family representatives. Great investment had been made in identifying the gaps and barriers in the existing systems and subcommittees had completed the first care pathways.
Based on our experience, we understood that there was one barrier to the successful implementation of the program – care provider engagement – and that this barrier has multiple influencing factors.
The modern American hospital has been called “the most complex organization in the history of man.” Canada, Australia, Great Britain and others would argue that a regional health authority, or a population based program delivery model like Cancer Care Ontario easily takes this title.
Any single goal that proposes to be overlaid on a system with this degree of complexity requires a multi-faceted approach that accepts some facts of health care life:
Care providers have diffuse accountabilities, to their professional associations; their unions; their employers; their practices; their coworkers and their patients. They can be cynical of systems approaches. They face incessant demand, and they are expected to be able to offer the best of the latest, and most want the best outcomes for their patients.
Patients and their families are afraid. They come from every culture, background and education level. They have different perceptions of health care providers. They have different expectations of the system. They absorb information through these filters. System administrators are squeezed between funders and care providers. They are challenged from both sides to deliver measurable evidence of return on investment.
Our approach, in the case of In Sixty, was to begin the communication planning process by surveying care providers across the system to determine their impressions of the program, their perceived barriers, the types of information they were most likely to deem credible and useful and the most credible sources of information. We also interviewed patients and families with similar questions, and held focus groups with them, because we wanted them to know they were heard, and we wanted to capture the stories they were willing to share to further the progress of the initiative.
Examples of questions we asked of patients:
In your experience, as we are creating information for patients and families who have a suspicion or diagnosis of cancer, what is most important in tone or approach? Are there specific words or terms that should not be used? Based on your experience with cancer, or family and friends who have had cancer, what information tools are missing at the start of the cancer patient journey?
Examples of Questions we asked family physicians:
What type of information would compel you (and your colleagues) to take part in improvements that target the quality and timeframe of your patients’ journey? What communication obstacles or process obstacles do you face in ensuring patients with a suspicion or diagnosis of cancer receive timely results and care based on their circumstance?
Questions we asked Care Providers:
Based on your experience with patients, or family and friends who have had cancer, what information tools are missing during the cancer patient journey?
How do you prefer to receive updates and information on changes in health care?
We used these results and others to form a series of recommendations on the process, tone and tools required to address the challenges at hand. Based on timing and budget, we proceeded to develop the items listed in the tools section above and the client used our information and plan recommendations to manage the communication rollout. We have developed proprietary tools and approaches to ensure that communication is relevant, clear, credible and creates accountability.
We ensure that the communication is relevant by undertaking the following steps:
1) research and situational assessment, as described above.
2) articulating the purpose of the initiative in the most meaningful, yet credible way possible.
3) identifying the most relevant aspects of the initiative to each audience, based on the research.
4) delivering information where, when and how people want it.
We ensure that the communication is clear by:
1) challenging clients to define priorities.
2) aligning related action items with SMART objectives.
3) using plain language, augmented with photography, graphic
elements, icons, video, etc. as required.
4) seeking feedback.
We ensure that communication is credible by:
1) communicating change management in a reality-based style, rather than trying to ‘sell’ people on it.
2) challenging our clients to resource their priorities appropriately, or redefine their expectations.
3) establishing the expectation that the project plan is not set, and will evolve as circumstances change.
4) when it requires front-line staff buy-in, introducing change in ways that engage the most credible people in the process (this is not the system administrators or the physicians).
5) tracking and reporting on meaningful indictors.
We build accountability into our processes by:
1) accepting that in health care, it is rare that systems can hold people directly accountable to achieve desired results. This becomes more pronounced the further removed the initiative is from the front line.
2) understanding who people are actually accountable to; and who they perceive they are accountable to.
3) aligning our communication and tools with those accountabilities.
The tools developed for the program included: the survey tools and approaches for initial research; the initiative name, the logo, the brand, the templates, legends and guidelines for the breast cancer and lung cancer pathways, which have subsequently been used as the standard for other pathways. Support materials included powerpoint presentation templates, banners, e-newsletters, signage, brochures, door decals, brochures, staff pins and tent cards. We also provided them with a detailed brand manual and an organizational policy template to imbed protection of the brand into the program policies.
These were the priority items as defined by the client based on their available budget. As a result, we provided the tools that would support their ongoing communication in the most cost-effective ways. There were other recommendations made for tools and communication approaches, which we feel could support CCOs work as well.