How to cut time out of cancer pathways

Meeting cancer performance targets is a challenge for many trusts with waiting times for diagnosis and treatment growing since the pandemic. But this is a worrying time for patients as well, and they would welcome quicker turnaround of results and diagnosis.

Cutting time out of this pathway would benefit everyone but are there ways to do this which do not compromise patient safety? An HSJ webinar, in association with SS&C Blue Prism, addressed this important question and tried to find ways trusts could reduce waiting times.

The newly introduced 28 day faster diagnosis standard has targeted minds, efforts and energies on what can be done to get patients to the point of a definite diagnosis or having cancer ruled out, said Ian Vousden, programme director of Kent and Medway Cancer Alliance. “There is variation in terms of how organisations meet that standard and meet that target. But every day counts, particularly when you’re looking at that 28 day diagnosis target,” he said.

The role of digital workers

The pandemic had exposed the biggest challenge the NHS faced – workforce capacity, added Sheron Robson, programme manager for early diagnosis at the Northern Cancer Alliance. She wanted to move some of the capacity spent tracking patients through the system into more patient-facing tasks such as navigating them through the cancer pathway.

“We talk a lot about days in the pathway, but I try and keep in my mind that these are sleepless nights for these patients,” she added.

And the early part of the cancer pathway can be very complex indeed. Amanda Sparkes, chief clinical officer at Inicio Health, highlighted how computer systems, even within the same organisation, did not talk to each other, and pathways needed considerable numbers of staff just to administer them. This was often repetitive work whereas staff had come into the NHS to help people.

But, when she worked at the Royal Free, she found there was an opportunity to automate some of this work and concentrate on aspects such as ensuring the patient got the right appointment first time.

Using “digital workers” can release staff from mundane high volume tasks, said Karen Gorman, account director for healthcare at SS&C Blue Prism.

These can log into all the systems used across the pathway just like a human, doing tasks such as checking if a patient has attended, whether results have been issued or need updating and updating cancer registries.

“We’ve got that live in probably eight or nine different trusts, including trusts like Frimley, where they’ve got 700 referrals a day coming in; at least 150 of those are two week wait referrals,” she said.

“So the digital workers are replacing that menial task that the staff would have done, and uploading that directly into the Epic patient record for the clinicians to then triage.”

These digital workers were software robots, which could be trained to copy and emulate the work the administrative teams were doing, she explained.

“They’re trained in exactly following the process the workforce do currently and logging into all those different systems, navigating through, capturing the data, uploading it into wherever it needs to go to,” she said.

“Of course, these software digital workers work 24 hours a day, seven days a week. They’re not off for Christmas Day or Christmas Eve. They don’t need to go through mandatory training. They are just working constantly all day, every day. So actually, when you look at the throughput and the activity of being able to work through backlogs,[they] improve those pathways and release another day on that pathway.”

Empowering staff to identify and resolve system blockages

The same approach of using digital workers had been utilised to upload information needed for multidisciplinary meetings to discuss patients and then ensuring the patient’s GP got the information they needed from that meeting, she said. It could also free up capacity to improve data quality in organisations, looking at things like duplicate pathways and “clock stops”.

Releasing staff to become patient navigators can bring many benefits such as helping to highlight some of the inefficiencies in a pathway. Mr Vousden said: “They’re close enough to be able to identify where they can see some of those blockages and then escalate and talk to their teams about that. That’s really important that they feel empowered to be able to identify those issues to colleagues within their teams.”

What they are able to do may differ between trusts, pointed out Ms Robson. For example, in a small team a patient navigator might have the relationships to talk to the people who can change things but it might be different in a tertiary centre.

“I see those navigators being that single point of contact for a patient to be able to ring them up and make sure that they don’t DNA any of their investigations, and they know which bit of the hospital they go into, for which thing, and they can support them if it’s a question of bus fare at a particular time of the month, or if it’s needing to provide the wording that will get the carer off work,” she said.

However, what about capacity to diagnose and treat patients once the administrative processes have been optimised? Ms Robson agreed capacity would continue to be a challenge but said that, for example, reducing do not attends would ensure that capacity was used to the fullest extent. 

Embracing industry partnerships in healthcare

NHS organisations can sometimes be reluctant to invite in private companies to help them – but Ms Gorman said they could lead to quicker outcomes by rolling out solutions which had already worked in other trusts and enable staff to be freed up to reform the processes.

And sometimes trusts found that the problem is not where they think it is, said Ms Sparkes, “When we go in and look and understand and discover… they might need something else or actually to automate further up the pathway and it releases humans from something completely different,” she said, stressing the importance of a “helicopter” view of the end-to-end pathway in order to find the problem rather than just moving it downstream.

Mr Vousden added: “I think if we had systems and processes and potentially automation in place, there could be capacity released as a result of that. I think the NHS needs to be braver and more open to working with industry in relation to innovations that are proven to be successful.”

For more information visit SS&C Blue Prism