Improving an acute oncology service (AOS) through collaborative leadership
Authors: Buyan Rowena Catipay , Aylott Jill , Carratt Duncan 
Published: May 2020

Purpose
Over half of adults under the age of 65 years will be diagnosed with cancer at some point in their lives (Ahmad et al., 2015). Demand for services is outstripping the capacity in the NHS, as 77% of NHS Trusts are unable to start treatment within 62 days (Baker, 2019; NHS England, 2019). Side effects of treatment can be life threatening (Tsai et al., 2010) with many patients attending ED; however, these can be managed through a hospital’s Acute Oncology Service (AOS). This paper aims to explore a collaborative leadership approach to improve services for patients [Rubin et al., 2015; Department of Health (DOH), 2012].

Design/methodology/approach
A case study of an AOS in an NHS Trust was the focus for the development of a strategy of ‘Collaborative’ leadership, with the aim to increase the engagement of a wide network of clinical and non-clinical stakeholders in a review of the AOS. The case study identified the level of effectiveness of the service since its inception in 2012. Using a quality improvement methodology (Deming 2000; Health Foundation, 2011; Aylott, 2019) resulted in learning and increased collaboration between clinical and non-clinical staff.

Findings
Action learning processes revealed that AOS staff had been frustrated for some time about the dysfunction of the current process to manage the increased demand for the service. They reported their perceptions and frustrations with the current process of referral and patient discharge. Data revealed alerts from the Emergency Department (ED) to AOS resulted in 72% of patients inappropriately referred, with an over representation of patients who had a previous existing cancer condition. Clinical engagement with the data informatics manager (DC) revealed a need to improve data quality through improvements made to the database.

Research limitations/implications
Increasing demand for cancer services requires a continuous need for improvement to meet patient needs. Cancer waits for diagnostic tests are at their highest level since 2008, with 4% of patients waiting over 6 weeks to be tested compared to the tested target of 1% (Baker, 2019). This paper draws on data collected from 2017 to 2018, but a continuous review of data is required to measure the performance of the AOS against its service specification. Every AOS team across the NHS could benefit from a collaborative learning approach.

Practical implications
Clinical services need collaborative support from informatics to implement a Quality Improvement methodology such as the IHI Model for Improvement (IHI, 2003). Without collaboration the implementation of a quality improvement strategy for all NHS Trusts will not come to fruition (Kings Fund, 2016). Quality Improvement Strategies must be developed with a collaborative leadership implementation plan that includes patient collaboration strategies (Okpala, 2018), as this is the only way that services will be improved while also becoming cost effective (Okpala, 2018).

Social implications
In the UK, 20-25% of new cancer diagnoses are made following an initial presentation to the ED (Young et al., 2016). Cancer-related attendances at ED had a higher level of acuity, requiring longer management time and length of stay in ED. With cancer care contributing to 12% of all hospital admissions, an increase of 25% over the past two decades (Kuo et al., 2017) the AOS will need continued collaboration between clinical staff, informatic managers, patients and all stakeholder organisations to continuously improve its services to be “fit for purpose”.

Originality/value
This case study reports the innovative collaborative work between a Medical Oncologist, an NHS Trust Informatics manager and a QI academic facilitator. The Health Foundation and Kings Fund have identified the continued challenges presented to the NHS in the transformation of its services, with the Health Foundation (2011) reporting the need for more collaborative working between clinicians and non-clinicians to drive improvement. This model of collaboration creates a new way of working to drive improvement initiatives and sets out a rationale to develop this model further to involve patients. However, this will call for a new way of working for all.