Penn Center: Implementing Innovation in Cancer Care

In cancer care, the initial innovation can sometimes be the easy part – while encouraging the adoption of proven solutions at any scale or pace is often fraught with difficulty.

In contrast to medicines, where bodies such as NICE lay a clear framework for testing and adoption of new treatments, the road to implementing a new service, pathway, or technology can often be unclear, plagued with ‘pilot-itis’, not adoption at scale.

Penn Centre

The Penn Centre for Cancer Care Innovation (PC3I) is an organization with a novel approach to improvement. It is a community of researchers and healthcare professionals who work across 3 states, 6 hospitals, 12 oncology clinics and more, representing 19,000 new cancer patients per year. PC3I aims to interconnect all these settings, producing a huge ‘real-world laboratory’. It boasts an impressive portfolio of service innovation projects, such as:

• Integrating optimal cancer pathways and trial opportunities into EHRs
• Automated nudges from EHRs to screen young people at risk of early-onset bowel cancer
• An authoritative body of work on whether financial incentives increase bowel screening, and crucially, why.

These innovations are set within a create-test-scale framework, which has a track record of d innovation from pilot to wider practice (to be discussed below).

Implementation Science

This backdrop made PC3I the ideal contenders for a grant given as part of the?‘Cancer Moonshot’ programme – establishing the Penn Implementation Science Center in Cancer Control (ISC3) in 2020.

These centres provide a team integrated into a healthcare setting, with implementation expertise, such as logistics, demonstrating value, and monitoring and adjusting a phased implementation. They aim both to generate new implementation research (for example, how connected are cancer clinicians, and why do they collaborate), but also, crucially, to increase institutional confidence to innovate and adopt.

This institutional confidence to innovate is already evident at the Penn Center, where, for example, a project looking at new strategies for smoking cessation in cancer patients has been designed with implementation success metrics, iterative cycles of adaption, and mixed-method consultation, plus a clear path to rollout upon success.?

Such experience also cross-pollinates other innovation projects – for example at Penn Medicine, there’s the parallel Acceleration Lab, with a detailed vision for scale-up of innovation, currently running a program to increase bowel screening adherence to 80%.

What success looks like: cancer care at home

For a striking example, we can look at PC3I’s cancer care at home programme. The programme was already underway when, in early 2020, PC3I were able to rapidly and pre-emptively scale the project in response to the COVID pandemic and subsequent lockdown.

They had already begun to demonstrate benefits relating to patient-centred care and quality of life of ‘cancer care at home’, but also had the institutional resources, knowledge, and confidence to act quickly:

Reflections

We are facing a wave of innovations in cancer care today, especially given the explosion of new digital platforms. The US National Cancer Institute (NCI) alone currently lists over 200 research-proven service innovations. In Wales too, from LHCs to RDCs, this is clearly a crucial time for implementing and scaling solutions for cancer care.

As with most subjects in Global Scan, this approach might not directly translate – to take one example, Wales has a very different relationship with primary care to contend with, which is crucial for cancer outcomes. However, a number of transferable ideas jump out:

• Capacity, available across the network, available specifically to provide expert support in implementing and scaling solutions.?
• Innovative project design, with attention paid to asking how implementation will occur, building in iterative improvement cycles, and with a clear vision to scaling.
• An interoperable digital EHR infrastructure, enabling roadblock-free access to intelligence and research for PC3I members across institutions and states.
• A culture encouraging improvement and experimentation – asking where and how to deliver innovations, not whether to do them.

If anything here sparks any thoughts are ideas, please feel free to reach out for a chat.