Using breakthrough series collaborative methodology to improve safe delivery of chemotherapy in Ontario.
OBJECTIVE
Chemotherapy delivery is complex, involving multiple providers across settings to deliver safe, effective care. Cancer Care Ontario initiated a provincial breakthrough series collaborative, based on methodology from the Institute for Healthcare Improvement (IHI), to improve the safe delivery of chemotherapy, from ordering through preparation and administration.


METHODS
Over the 1-year period of the collaborative, three in-person sessions educated participants on improvement methodology. Twenty teams tested and implemented elements of a predefined change package in their local systems. Monthly teleconferences supplemented the education while encouraging a culture of knowledge sharing. Teams completed monthly self-assessment surveys that evaluated their progress using a 6-point scale, where 1 indicated no evidence of improvement and 5 indicated achievement of all goals and improvement objectives.


RESULTS
Monthly self-assessment surveys revealed that over time, scores improved from 1 to 4, indicating significant progress. Moreover, 100% of participants reported in an exit survey that the collaborative had improved the culture of safety in their organizations. The gains of the collaborative have been sustained through development of a practice community and provision of ongoing coaching through the IHI Open School.


CONCLUSIONS
Participation in the collaborative enabled local interdisciplinary teams to develop processes and structures to support ongoing quality improvement, including formation of a sustainable structure for knowledge translation and exchange. However, lack of a shared provincial target limited overall evaluation. Other lessons learned included providing adequate time for planning and clearly defining roles and responsibilities of involved teams and project sponsors.
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada vicky.simanovski@cancercare.on.ca.
Vicky
V
Simanovski
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Esther
E
Green
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Elaine
E
Meertens
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Leonard
L
Kaizer
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Noor
N
Ahmad
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Sherrie
S
Hertz
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Roger
R
Cheng
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Judy
J
Burns
Cancer Care Ontario; Institute for Safe Medication Practices Canada; Princess Margaret Cancer Centre, Toronto; Credit Valley Hospital, Mississauga; and Grand River Hospital, Kitchener, Ontario, Canada.
Monika K
MK
Krzyzanowska
D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003299:Cooperative Behavior; D016503:Drug Delivery Systems / Q000379:methods*; D004358:Drug Therapy / Q000379:methods / Q000592:standards; D006801:Humans; D008495:Medical Oncology / Q000193:education / Q000379:methods; D009369:Neoplasms / Q000188:drug therapy*; D009864:Ontario; D010043:Outcome and Process Assessment, Health Care / Q000379:methods*; D058996:Quality Improvement
D000970:Antineoplastic Agents