Collaboration with the Christie Cancer Centre Manchester - A Stimulus for Change in Radiation Oncology Services
Oct 16, 2018 -
J. A. McNamara 
The government has decided to invest over €40m in the development of Radiation Oncology services in Cork University Hospital (the Hospital) as a key strategic intervention to enhance the delivery of cancer care in the South of Ireland. This decision presents the Hospital with a unique opportunity to accelerate change in the delivery of Radiation Oncology services commensurate with the provision of additional specialist staff, new equipment that offers capacity to provide innovative treatments and new patient pathways that will be externally accredited.
This is an ambitious goal but one that we must set for ourselves because that is what patients, being cared for in our cancer services, deserve and it is what the National Cancer Control Programme and the National Radiation Oncology Care Programme expect.
However, a key challenge is to oversee the construction, equipping, commissioning and opening of the new Radiation Oncology Department while simultaneously delivering a busy, evolving service in a challenging change programme. This requires the convergence of leadership at executive, clinical and critical specialist support levels in what Prof. Kotter called a “Guiding Coalition” mindful that the literature shows that 75% of change interventions fail!
What makes this change programme different is the engagement of The Christie Cancer Centre in Manchester – one of the leading cancer centres in the National Health Service (NHS). In 2016, leadership at Cork University Hospital identified an opportunity to accelerate change in the delivery of Radiation Oncology services through this bipartisan collaboration to facilitate the transference of specialist knowledge, the refinement of treatment protocols, the implementation of new work practices and critically the opportunity to collaborate in clinical trials with The Christie.
The Christie is an ambitious Cancer Centre that have as their vision, the goal to be one of the top five Cancer Centres in the world and to that end they are actively engaged in developing their international portfolio. Their decision to collaborate with Cork University Hospital is an important indication of their belief that the Radiation Oncology here will be the best Cancer Centre in Ireland as will be evidenced by the awarding of ISO Accreditation status in commensurate with the opening of the new Department in 2019.
The development of international collaborations can be extremely rewarding but can also be challenging in several respects.
In the first instance, peer to peer comparisons on work performance, adherence to new techniques and adoption of innovation can be a significant stimulant to create resistance to change – a risk that needs careful management.
Further, it is important that the transfer of new protocols and patient pathways is managed in a way that allows for nuancing to reflect local circumstances without losing sight of the need to reflect international best practice. Ultimately the project must be “owned” by the specialist staff in the Hospital who will be challenged to deliver the best quality of care to patients and will be professionally accountable for that care.
In relation to the successful delivery of the project, one of the key learning points has been the need to reconcile the organisation and management of projects in Ireland with a different process that exists in the NHS. In Ireland, the construction of such capital infrastructure is the responsibility of the Estates function which works hand in glove with the host hospital as distinct from the model in the NHS in which the host hospital manages construction, equipping and commissioning of new capital developments.
These challenges have been overcome by the active participation of key leaders from The Christie on the Project Team at Cork University Hospital which meets on a monthly basis. The Team has established five streams to manage various aspects of the project:
- Project construction
- Equipment programme
- Human resource planning
- Technical and patient pathway
- Quality / Accreditation
The lead for each group has access to the expertise of The Christie and reports to the Project Team against a pre-determined list of priority actions at its monthly meeting. This orderly structure ensures that risks to the full implementation of the project are identified and pro-actively managed between meetings of the Team.
What then are the lessons to be taken from the engagement of external expertise such as in the case of The Christie?
There is no doubt but the credibility that external expertise can bring, can be a significant motivation for staff in the service(s) to reflect on their individual and collective practice. Such reflection ought to be part of the culture of service delivery in the pursuit of the highest quality of service for patients. Furthermore, external engagement can act as a stimulus for validation of the Department or indeed of the Project Team and can add significant high-end value to the quality of services delivered to patients. Ultimately, as a teaching hospital we should always be open to innovation and to implementing change that has demonstrably proven to be successful in other jurisdictions.
As Cork University Hospital continues to evolve with the potential to become a “great” hospital, collaborations with other hospitals internationally, help us to challenge ourselves about our performance but more importantly serve to differentiate Cork University Hospital from other Irish hospitals by benchmarking our performance against the best performers internationally.
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J.A. McNamara
Chief Executive Officer