Latest / Becker’s Healthcare Podcast / Redesigning Oncology Care to Improve Access, Throughput and Patient Experience

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Redesigning Oncology Care to Improve Access, Throughput and Patient Experience · Becker’s Healthcare Podcast

0:00
- This is Scott Becker with the Beckers HealthCare
0:03
- podcast.
0:04
- I am thrilled today to be joined by
0:05
- a brilliant leader. We're joined today by Donna
0:08
- Rizzi.
0:09
- Donna is the executive director of oncology at
0:11
- Johns Hopkins Hospital.
0:13
- She's also the associate chief nursing officer of
0:16
- the cancer service line at the Sydney Kimmel
0:19
- Comprehensive Cancer Center, part of Johns Hopkins Medicine.
0:22
- Of course, Johns Hopkins, one of the best
0:24
- respected systems in the the world.
0:27
- Donna, we are so thrilled to have you
0:29
- with us today.
0:31
- Before we get started
0:32
- no. Thank you. Tell us a little bit
0:34
- about your background and your career.
0:37
- Just give us an introduction.
0:39
- Sure. Absolutely.
0:41
- Well, thank you for that introduction. Thank you
0:43
- for inviting me today.
0:44
- And I've been a nurse for almost thirty
0:48
- eight years.
0:49
- Been very fortunate in my career. I've had
0:52
- wonderful
0:53
- professional opportunities.
0:55
- I have background in,
0:57
- critical care,
0:58
- oncology,
1:00
- clinical care, and then, of course, I've been
1:02
- in a leadership role for
1:04
- many, many years.
1:06
- Originally from New York City, born and raised
1:09
- in the Bronx,
1:10
- and made my way to Hopkins about six
1:13
- years ago.
1:14
- And it's really been a it's been a
1:16
- wonderful experience, and oncology
1:18
- is
1:19
- the
1:20
- part of my heart that I cannot ever
1:23
- let go of. Yeah. Just just
1:26
- fascinating. You spent a long time at Mount
1:28
- Sinai as well. I did. A couple of
1:31
- fantastic health systems.
1:33
- And and we'll talk about oncology today. I
1:35
- mean, oncology is is one of these places
1:37
- where there is tremendous
1:40
- burnout, tremendous challenges. I I saw a stat
1:43
- recently
1:44
- about twenty seven thousand oncologists in the country
1:46
- and about two million new cancer diagnoses a
1:49
- year Yeah. Which is a fascinatingly frightening stat.
1:54
- WingToss
1:55
- did their fourth annual state of cancer centers
1:58
- report
1:58
- and found that high patient volume
2:01
- is overtaken staffing shortages
2:03
- as the leading driver of burnout in cancer
2:06
- infusion centers. Just tremendous patient volumes in our
2:09
- nation of 350,000,000
2:10
- people.
2:12
- When you think about this, the high volumes,
2:15
- does that match what you're seeing?
2:17
- And what does that tell us about where
2:18
- the real pressure points are in oncology today?
2:22
- Yeah. That's that's a great question, and it
2:24
- is so on point to what we're seeing
2:27
- in health care.
2:28
- You know, I think part of it is
2:30
- that we want
2:32
- any patient that can be treated in the
2:34
- ambulatory
2:35
- setting to be treated in the ambulatory
2:38
- setting and to be treated as close to
2:40
- their home as possible.
2:42
- So it is
2:44
- incredibly
2:45
- important
2:46
- as volume grows,
2:48
- as more and more regimens
2:50
- are moved to the outpatient setting,
2:53
- as patients live longer lives, that we have
2:56
- to be at the ready
2:58
- for our patients
3:00
- to think about what their oncology care looks
3:03
- like. I think it does represent an important
3:06
- shift in how we think about operational
3:09
- excellence in oncology.
3:10
- If you think about that lean toss report,
3:13
- Scott,
3:14
- it really reinforces
3:16
- that
3:17
- 62%
3:18
- of organizations
3:19
- now cite patient flow and scheduling
3:22
- as their top operational
3:24
- challenge
3:25
- compared with 19%
3:27
- citing staffing shortages. And, again,
3:30
- it is
3:32
- really because
3:33
- our patient volume is growing.
3:36
- Our patients are living long and happier lives,
3:39
- and so we really have to be at
3:41
- the ready to respond.
3:44
- Patients are receiving much more complex therapies.
3:47
- They have multiple steps in that therapy,
3:50
- which means that it is not a single
3:53
- visit.
3:54
- We can't just find an available chair for
3:56
- a visit. Our patients come back week after
3:59
- week after week
4:01
- for long regimens,
4:03
- and
4:04
- it is really important that we have that
4:08
- coordination between their provider,
4:11
- the lab tests they have to take,
4:13
- any of the pharmacy preparation,
4:15
- nursing availability.
4:17
- They have to be financially cleared, and that's
4:20
- a whole another topic.
4:22
- Their transportation
4:23
- has to be arranged. Often, they bring somebody
4:26
- with them, and
4:28
- everything has to happen in lockstep coordination.
4:32
- So it's really important that we think about
4:35
- this. One delay early in the day can
4:38
- create a cascade of delays throughout the entire
4:41
- afternoon.
4:43
- So as a
4:44
- large academic medical center and
4:47
- an organization
4:48
- that is always thinking about
4:50
- the best way to deliver patient care, we
4:53
- really needed to think about our big approach,
4:57
- and not just one piece of it. So
4:59
- that's why we look beyond the infusion chair.
5:03
- We think about how we can eliminate unnecessary
5:06
- variation
5:06
- before the patients ever walk through the door,
5:09
- and one of the ways we've done this
5:11
- is to develop what we've called an ACE
5:14
- program or advanced
5:16
- clinical
5:17
- evaluation.
5:18
- And it's really
5:19
- most people will know it as
5:22
- nurse verification.
5:23
- We've taken it one step further
5:26
- so that when the patients arrive
5:29
- for their appointment,
5:31
- we are as ready and proactive
5:34
- as we possibly can be.
5:36
- So it really combines
5:39
- predictive scheduling,
5:41
- balancing our templates.
5:43
- We do do advanced drug preparation,
5:47
- and so therefore, the entire day becomes much
5:50
- more predictable
5:51
- for the patients. And, of course, if it's
5:53
- predictable for our patients, it's going to be
5:56
- more predictable
5:58
- for our care team.
6:00
- Thank you. And and and take a moment
6:03
- on this concept.
6:05
- The lean toss report also shows
6:08
- that
6:09
- 65%
6:10
- of cancer centers are looking to expand
6:13
- services
6:14
- in 2026
6:16
- with more organizations spending
6:18
- investing in technology and process improvements
6:22
- rather than simply hiring more staff.
6:25
- Why is that conversation shifting from adding capacity
6:30
- to making sort of better use of existing
6:32
- capacity?
6:33
- Is that part of just so much staff
6:35
- shortages
6:37
- challenges in the country?
6:38
- I I think that, you know, if you
6:41
- if you talk to
6:42
- health care leaders and particularly oncology health care
6:46
- leaders,
6:47
- I think we all agree that a workforce
6:50
- shortage is not going to
6:52
- all of a sudden, resolve.
6:55
- And then from a cancer center perspective,
6:57
- I think we're all competing for the same
7:01
- specialized oncology workforce.
7:03
- So I think we've all decided that hiring
7:05
- more people cannot be the only strategy.
7:08
- We really need to make better use of
7:10
- our clinicians. You you had a great,
7:13
- statistic at the beginning with the number of
7:16
- oncologists versus the number of patients. So we
7:19
- have to think about what our clinical team
7:21
- consists of, making sure we have appropriate advanced
7:24
- practice providers, making sure they're practicing at top
7:27
- of their scope,
7:29
- making sure that we have nurses that are
7:31
- specialty trained in oncology
7:34
- that are either
7:36
- in infusion
7:37
- or in office practice or in radiation oncology,
7:41
- but we've really gotta look at the whole
7:43
- picture. At Hopkins,
7:45
- we approach this by redesigning
7:47
- workflows
7:48
- around the patient
7:50
- rather than just around a historical process because
7:53
- we don't know that that historical process has
7:56
- always worked, or we know it has not
7:58
- always worked.
8:00
- So the goal is to improve access
8:03
- while reducing unnecessary
8:04
- work for our clinical teams.
8:06
- Technology has been very important for this, but
8:10
- it can't be our only strategy.
8:13
- Leontas IQ
8:15
- has been
8:16
- a
8:17
- absolute incredible partner
8:20
- looking at historical
8:21
- patterns
8:23
- in treatment duration,
8:24
- appointment variability,
8:27
- and demand,
8:28
- and they have helped us by looking at
8:30
- all of these pieces of a patient's
8:33
- appointment
8:34
- and said, okay.
8:36
- If a patient is coming in for this
8:38
- treatment, they need this much duration
8:41
- built into their appointment,
8:43
- and that's why we decouple a lot of
8:46
- our lab appointments with their
8:49
- actual infusion appointments
8:52
- because we want to try to anticipate
8:55
- that we're going to have bumps in the
8:57
- day,
8:58
- and we wanna try to plan future schedules
9:02
- instead of simply reacting to a bottleneck that
9:05
- comes up. I also think ongoing collaboration is
9:09
- really important.
9:10
- This hasn't been a traditional vendor relationship where
9:13
- software is implemented and then left alone.
9:17
- We just had last month, maybe even the
9:19
- month before,
9:21
- we had our lean task partners on-site with
9:23
- us at Hopkins for an entire week, Scott.
9:27
- And they came with a group of leaders
9:30
- to every one of our sites
9:32
- that utilizes
9:33
- the IQ platform
9:35
- and really delved into the good, the bad,
9:39
- what's working, what's not. And then we
9:42
- came back with them,
9:44
- several weeks later,
9:45
- and each institution
9:47
- that we have our
9:50
- IQ, Leontas,
9:52
- at, we were able and are still meeting
9:55
- with our leaders with Leontas to go over
9:58
- all of the things that they have compiled,
10:00
- and they're really helping us look at,
10:03
- even now that we have an incredibly
10:06
- tight, strong
10:07
- relationship and use of the LeanTos platform, there
10:11
- are still
10:13
- optimization
10:14
- changes
10:15
- that are being made to make it even
10:17
- better for our patient experience.
10:21
- Thank you. I I I love that, and
10:23
- and I think the points on this,
10:25
- there's only so much you could solve problems
10:28
- through
10:29
- labor and staffing just because it's so hard
10:32
- to find that specialized workforce, and there's so
10:34
- many more
10:36
- complex diagnoses
10:38
- as well. Yeah. And just taking care of
10:40
- those is really challenging with the amount of
10:43
- screening technologies and tools that we have, the
10:45
- population we have, just just the sheer volumes
10:49
- going against the amount of people
10:51
- serving it make it so important
10:54
- that we do a better job of using
10:55
- technology and capacity well. Let let me ask
10:58
- you this question, Donna. Yeah. As you look
11:00
- at implementing new technology workflows
11:03
- and trying to do it differently or trying
11:05
- to improve
11:07
- throughput and how you take care of people,
11:09
- what were the biggest operational bottlenecks
11:12
- in your infusion centers,
11:14
- and and how were they affecting patient access
11:16
- to your workload and overall patient experience?
11:19
- Yeah. That's it it's another really important question,
11:23
- and you sort of already alluded to my
11:26
- answer
11:27
- in that one of our greatest challenges
11:31
- was determining that there wasn't just one single
11:34
- issue that we needed to fix. And so
11:36
- when we broke it down,
11:38
- it was really a cumulative effect
11:41
- throughout that patient journey. So it starts from
11:44
- access all the way through
11:46
- till they go on and live a long
11:49
- and happy life.
11:50
- I think with our patient population,
11:53
- they
11:55
- they enjoy
11:57
- some consistency in their life. So patients frequently
12:00
- arrived at similar times.
12:02
- Provider visit length vary. Treatment plans change during
12:07
- the day. Lab results could be delayed.
12:10
- Pharmacy prep was challenging.
12:12
- Medications
12:13
- often couldn't be compounded till we knew the
12:16
- patient was absolutely going to be treated
12:19
- for a cost or insurance issue.
12:22
- And none of these delays were caused by
12:25
- one department. It wasn't a nursing issue. It
12:27
- wasn't a physician issue. And so
12:30
- it really showed us how important that multi
12:33
- d team is and how interconnected
12:36
- oncology care has become.
12:39
- So a delay in one area affected every
12:42
- team that followed. So our infusion nurses were
12:46
- constantly adapting to unpredictable schedules.
12:49
- One of the biggest lessons we've learned is
12:52
- that improving infusion operations
12:54
- requires looking at the entire patient journey,
12:58
- not just what happens in the infusion center.
13:01
- That's why our redesign included that ACE program
13:04
- that I mentioned earlier,
13:06
- advanced drug prep,
13:07
- a dedicated shot clinic. So we pull out
13:11
- of our daily
13:12
- infusion
13:13
- template
13:14
- everything that's sort of a fast track
13:17
- or a patient
13:19
- just coming in
13:21
- for certain type of, shot chemotherapies.
13:25
- And so what we did was we looked
13:28
- at them
13:30
- singularly
13:31
- and said, if we pull out all these
13:33
- shots,
13:34
- if we pull out a fast track and
13:36
- make that a different pathway,
13:38
- we now remove sometimes almost
13:41
- 30 to 40 patients per day in the
13:44
- large academic medical center that we don't have
13:47
- to include
13:49
- in all of our nurses'
13:51
- assignments.
13:52
- So this way, we staff the fast track
13:54
- differently than we staff our infusion chairs.
13:58
- So it's really being open
14:00
- and working closely with our lean toss partners
14:03
- to figure out
14:05
- different pathways for our patients based on exactly
14:09
- what they're coming in for on that day.
14:12
- Thank you. And and and talk about this.
14:15
- Your team in trying to work through these
14:17
- different challenges of bottlenecks
14:19
- combined
14:20
- AI enabled scheduling
14:22
- with redesigning the workflow,
14:24
- including advanced clinical evaluation, advanced drug preparation,
14:29
- fast track, and curbside care models.
14:32
- How do these changes reinforce
14:34
- each other, and why is it important that
14:36
- it's not simply a technology rollout,
14:39
- but but also a work redesign rollout? That
14:41
- they go hand in hand, the people and
14:43
- the technology.
14:45
- Well, I will tell you one thing, and
14:47
- and maybe it's a nursing situation or maybe
14:50
- it's just the the world we live in
14:52
- right now. But I think it's really important,
14:54
- first of all, that we demystify
14:57
- AI. Right? And so
14:59
- it's not AI, especially for health care delivery,
15:03
- especially for oncology, it is not going to
15:05
- take the place
15:07
- of my decision making, of a critical thinking
15:10
- pathway. So I think you have to show
15:13
- your staff when you're making any big changes
15:16
- like this
15:17
- that their work and their experience
15:21
- will always come before everything else. But with
15:24
- historical data review
15:26
- through LeanTas,
15:27
- we can really
15:29
- make them understand that this piece of technology
15:32
- is not going to improve the care we
15:35
- deliver alone.
15:36
- People redesigning
15:37
- care improve healthcare.
15:40
- Technology
15:40
- simply allows us to do it more intelligently.
15:44
- If we use AI
15:46
- to automate an inefficient workflow,
15:49
- we really haven't made any positive changes.
15:53
- So it's very important that we don't take
15:55
- that human piece
15:57
- out of what we're doing and that we
16:00
- make sure that it's a partnership.
16:02
- We intentionally
16:03
- redesigned our workflows to address the underlying cause
16:06
- of delay
16:07
- so that the ACE work and the verification
16:10
- shifted clinical review upstream. So we start that
16:14
- review
16:15
- sometimes seventy two hours before the patient's appointment,
16:19
- looking at making calls to the patients.
16:22
- And if there are issues that need to
16:24
- be solved before the patient arrives, we wanna
16:27
- make sure we can do that.
16:29
- So the advanced drug prep shortened treatment start
16:32
- times for certain drugs,
16:34
- we are able to mix the night before.
16:38
- Patient receives the phone call, all of the
16:40
- pieces of the puzzle are looking
16:43
- very positively.
16:45
- And remember, as I mentioned earlier, some of
16:47
- this
16:48
- does not happen for really high cost drugs.
16:51
- But for the drugs that we know we
16:54
- can do this with,
16:56
- certainty,
16:57
- We mix
16:58
- these drugs. They're shortened treatment start times. We
17:02
- still have a less than 1%
17:04
- waste, so we do a very good job
17:07
- of making sure that that clinical evaluation is
17:09
- done well.
17:11
- Our shot clinic improved chair utilization
17:14
- by matching the level of care to the
17:16
- patient needs,
17:17
- and any fast track pathways
17:20
- are streamlining care for appropriate patients.
17:24
- IQ then helped us optimize when patients enter
17:27
- the system.
17:28
- They utilize
17:29
- predictive analytics,
17:31
- and this helps us to understand
17:34
- demand,
17:35
- and the redesigned
17:36
- workflows
17:37
- allow our teams to meet that demand more
17:40
- efficiently.
17:41
- Those interventions
17:43
- reinforce one another,
17:44
- but they don't replace one another,
17:47
- and that combination is why we've been able
17:50
- to reduce average drug wait time by forty
17:53
- six percent,
17:54
- increased advanced drug prep from nine percent to
17:58
- sixty five percent,
18:00
- and increased weekday
18:02
- patient volume
18:03
- by 16%
18:06
- across six infusion centers
18:09
- without compromising
18:10
- quality. So we're very proud of the work
18:13
- that we've done and the partnership
18:15
- that we've established
18:17
- with LeanTos IQ.
18:20
- And it really is this combination of great
18:23
- people with great technology. It's really both. It's
18:26
- not one of the two. Correct. It's constantly
18:30
- humans in the loop, humans involved,
18:33
- people taking care of people with great technology.
18:35
- Is is that a fair assessment? Yes. 1000%.
18:39
- And Donna, let me ask you this question.
18:41
- For oncology
18:43
- leaders that are listening,
18:45
- where should they begin if they wanna achieve
18:47
- similar results that you've achieved in terms of
18:50
- throughput, taking care of patients, taking care of
18:53
- staff,
18:54
- limiting some of the burnout, and taking care
18:56
- of this
18:57
- larger than ever patient census?
19:00
- Yeah.
19:01
- I I you know, this is gonna be
19:03
- maybe a controversial
19:05
- comment, but I do think it's really important
19:08
- that oncology leaders
19:10
- don't purchase technology
19:13
- before they really understand their operational
19:16
- challenges.
19:17
- What barriers are they facing? Because if they
19:20
- don't break it down, Scott, and they don't
19:22
- really understand where the bottlenecks
19:25
- are, then technology
19:28
- is not going to fix anything that's already
19:30
- broken.
19:32
- Technology will amplify the good processes,
19:35
- but you've really gotta understand
19:37
- where your
19:39
- challenges and barriers lie.
19:41
- I think you have to start with mapping
19:44
- a patient journey,
19:45
- and that goes from the minute they make
19:48
- a call, who's answering that first call,
19:51
- and everything through. And I love process maps
19:54
- because of that. You have to look at
19:57
- every handoff,
19:58
- every potential
19:59
- delay or real delay,
20:01
- and every unnecessary
20:03
- step.
20:04
- You wanna make sure since our multi d
20:07
- team
20:08
- is crucial
20:10
- to a positive patient experience, you wanna make
20:13
- sure that you have nurses,
20:15
- pharmacists, your schedules, your providers, your advanced practice
20:19
- providers,
20:20
- any operational leaders, and honestly, we utilize
20:24
- patients through our patient family advisory committee
20:28
- to help us to look at the process
20:31
- differently.
20:32
- And then we look at our data.
20:34
- So
20:35
- the report that Leentas did
20:38
- found that 82%
20:39
- of organizations
20:41
- struggle to access actionable operational data.
20:45
- But for us,
20:47
- the goal should be to turn this historical
20:50
- data into meaningful insights
20:52
- so that we can think about what went
20:55
- well,
20:56
- what didn't go well,
20:58
- and that helps us inform decisions,
21:01
- and not just simply for us to keep
21:03
- looking at reports.
21:05
- And I also think it's really important
21:08
- for us to choose partners,
21:10
- not vendors.
21:11
- It's one thing to have a vendor. They
21:14
- set you up. It's
21:16
- you're you're in there and then not to
21:18
- have the support.
21:19
- We have meetings weekly with our
21:22
- partners
21:23
- in Leontas.
21:26
- It's a continuous
21:27
- process of learning,
21:29
- measuring,
21:30
- improving, and adapting.
21:33
- And again, I think the goal isn't to
21:35
- see more patients simply for the sake of
21:37
- volume,
21:38
- it's to improve access to timely high quality
21:41
- cancer care,
21:42
- while creating
21:44
- a more predictable
21:45
- and sustainable
21:46
- environment for our nurses,
21:48
- for the care
21:50
- team, and really for our patients. When those
21:52
- goals align,
21:54
- patients benefit,
21:55
- clinicians
21:56
- benefit, and the organization
21:58
- is better prepared to meet these growing needs.
22:01
- Our patients are very, very intelligent,
22:04
- and I promise you the information we get
22:08
- from our patients regarding what their patient experience
22:11
- is like is worth its weight in gold.
22:15
- Thank you. Your point
22:17
- on that true engagement with your technology partner,
22:21
- whoever you're working with, so that you've got
22:23
- that kind of responsiveness
22:24
- that you're constantly fixing things together,
22:27
- it it is so important. So, like, we
22:29
- always think of this term of
22:31
- is someone a vendor to you or they
22:33
- a partner with you?
22:35
- And whether you're on the side of the
22:37
- technology company or the side of the health
22:39
- system,
22:40
- you need that partnership to make things really
22:42
- evolve correctly, don't you? I mean, that's so
22:44
- important so that you really get that responsiveness.
22:46
- See, it's almost like having four deployed engineers
22:49
- or people that you could really fix things
22:51
- together and and improve them together.
22:53
- Yeah. I mean, it's it's,
22:54
- you know, it's as much
22:56
- a win for us and our patients and
22:59
- our teams.
23:00
- It's gotta feel the same way for
23:03
- our partner and our and our lean task
23:06
- partners because they wanna continually
23:09
- make improvements. So that partnership, the only way
23:12
- they can know is by, again, meeting with
23:15
- us. It's one thing to look at data,
23:16
- but that real time
23:18
- exchange of ideas and feedback
23:21
- is crucial. And our partnership with Leontas
23:25
- is absolutely
23:27
- it there's there's no other partnership that we
23:29
- have that similar.
23:32
- That's really remarkable.
23:34
- Again, we're visiting today with Donna Brici,
23:37
- brilliant leader at Johns Hopkins Hospital in the
23:40
- Sydney Kimmel Comprehensive Cancer Center, Johns Hopkins Medicine.
23:45
- Donna, what a pleasure to visit with you,
23:47
- and what a remarkable career that you're having
23:49
- in the leadership.
23:51
- Thank you so much for taking the time
23:52
- with us today. What a pleasure. Thank you
23:54
- so much for having me, Scott.