We hear the remarkable story of how a partnership between a private oncology centre and a government hospital saved lives and proved the value of working together.
The need and solution
The East London CancerCare Oncology Centre planned to replace their linear accelerator. An alternative was needed for their patients to receive radiation therapy from February 2018 to June 2018. Frere Hospital was approached to provide a care management platform for the private patients during this time.
Eighty-four East London CancerCare patients were treated through 1523 treatment encounters at the Frere Hospital Oncology Unit, and were spared having to travel 300km to the nearest private sector oncology unit.
This was done without compromising the radiotherapy care provided to approximately 1520 uninsured patients treated monthly at Frere Hospital.
Successful implementation of this project relied on effective and efficient patient flow, between two independent units in two independent hospital facilities belonging to two different sectors. Quality assurance by both parties was rigorous to ensure a consistent quality of care, appropriate patient safety, without compromising access to specialised resources.
The patients and the community affirmed that the overall patient experience at Frere Hospital was a pleasant surprise.
The results demonstrated that a public sector facility is able to provide excellent quality oncology services in a seamless manner to all patients.
It also affirms that healthcare professionals share an innate desire to care for their patients and, therefore, are driven to find workable solutions to complex problems to deliver that care.
This innovative partnership proves what can be achieved when public and private sectors collaborate with a common purpose to deliver efficient and effective cancer treatment for our citizens.
The bonus was this project generated much-needed revenue for Frere Hospital. It also resulted in further improvement of billing processes at the hospital beyond the project.
Background of Frere Hospital
Frere Hospital is a 900-bedded academic tertiary hospital located, in East London, in the Eastern Cape. It provides specialist services to 44% of the EC population (2,8million people) living in the central region of the Eastern Cape Province. However, for oncology it drains two thirds of the 6,5 million people living in the central and eastern parts of the province.
Following a process of extensive consultation with community stakeholders about the design and delivery of services at Frere Hospital, upgrading of the Frere Hospital critical units, medical wards and oncology units began, in earnest, in 2011. The R203million investment in infrastructure upgrades culminated in the first patients being moved into the modernised oncology facilities in November 2014.
Mapping the way forward
• With the increasing demand for cancer care, the Frere staff would not be able to provide services to any additional patients during normal working hours.
• With respect to treatment planning capability of both partners the following was noted:
a) Frere and Border Oncology (CancerCare) used the same treatment planning system (Xio) and the same record and verify system (Mosaiq).
b) However, because the 3D-planning may be done in two different units, the images would not associate automatically.
c) The versions deployed at the two units were also different.
After this review, the project team agreed that the preferred option was to leverage the capabilities of both partners – Border Oncology team and MSH (CancerCare) would do the CT scanning and 3D-planning part of the process and Frere would provide the radiation therapy component. This would be done after hours from Mondays to Fridays using both Frere LINACs, so as not to compromise the service being provided to the Frere public sector patients.
Standard operating procedure
The standard operating procedures (SOPs) were developed and agreed between the involved parties. It confirmed the roles and responsibilities for each of the processes within the partnership to ensure:
- Medical aid authorisation.
- Pre-planning and 3D-planning.
- Registration of private patients and data transfer to Frere Hospital.
- Radiotherapy treatment at Frere.
- Contingency measures for medical emergencies and side effect management.
- Correct billing of patients.
There were two major challenges encountered: administrative burden and ensuring safety of public commuting patients after hoursas they travelled in for care.
The administrative burden came about from the referred patients in the project having to be registered four times. Firstly, as patients of two different facilities. Then, secondly, on the patient record and verification systems. Not all of the information was made available for pre-booking at Frere.
Until Frere received a dedicated registration clerk at the radiotherapy unit, the full-time clerks viewed the additional patients from the project as additional work on an already overloaded system.
Inconsistencies in numbers of patients captured and treated were corrected by the Frere case manager reconciling the Equra Health billing sheets with the Frere Mosaiq information. This extra work made the process more cumbersome.
Patients reliant on public transport were preferentially offered the earlier of the after-hours appointments to mitigate against any potential physical danger to these patients after hours when they travelled in for care
Patients, who were receiving concurrent chemotherapy treatment and weekly radiotherapy, and were admitted for symptom control at St Dominic’s, arrangements were made for them to be transported to Frere Hospital via private ambulance.
All parties agree that this case study is evidence of what can be accomplished when we have a common purpose to serve our patients.
There was a display of dogged determination and grit to find workable solutions as logistical and process issues arose during the proposal development and project implementation phases. The critical success factors included:
- Effective communication between the two site teams for proper coordination of the various processes involved in the patient journey.
- Necessary information for effective clinical decision-making had to be available.
- Each team member had to have a clear understanding of the systems and workflows of two units.
What started out as a need to provide radiation care to patients for a specified period culminated in ‘top-class treatment’. It contributed to changing the perceptions the private patients and their relatives had had of the quality of care provided in a public hospital.
The Border Oncology patients admitted to being initially apprehensive about having to receive treatment at Frere. Some had never been to a public hospital before. However, they were pleasantly surprised by the facilities. Many positive comments were regarding cleanliness, spaciousness and the updated equipment at Frere Oncology department.
Staff members from both the private and public sectors have gleaned a better understanding of the challenges faced in each of these sectors, in delivering efficient and effective cancer treatment. They have acknowledged that they learnt a great deal from each other in terms of treatment technique, workflow and general inter-sector collaboration.
The successful implementation of this project also emphasised the importance of case management in ensuring effective and efficient quality care that optimally deploys all the available resources of both the public and private health sectors.
MEET OUR EXPERT – Dr Rolene Wagner
Dr Rolene Wagner is the CEO of Frere Hospital. Together with her team, she has spearheaded the turnaround strategy at Frere. As a result, the services are measurably more patient-centred: safer with better patient outcomes and of a standard that has improved overall patient satisfaction with the experience of care at Frere.