Integrated Cancer Service Delivery Virtually There

1
Integrated Cancer Service Delivery Virtually
There ? Authors Dr Christopher Bain,
Information Manager Mrs Jenny Byrne, Manager and
Assoc Prof Michael Green, Acting
Director Western Central Melbourne Integrated
Cancer Service. Level 7 , 372 Albert St, East
Melbourne. Vic Australia. 3001.
Results
Abstract
Discussion (contd)
There is a dearth of quantitative and trial
based literature in the area of virtual
organizations. The terms virtual teams,
virtual communities and communities of
practice all are evident in the literature.
Whilst the subtleties of definitional differences
are beyond the scope of this poster, it was
apparent that the lessons from the literature
using all these definitions were of value to this
project, since they heavily overlap. The
following table highlights some examples of the
key facilitators of, and barriers to, success in
creating these virtual entities, irrespective of
the nature of the articles retrieved, on the
basis that an analysis of both can provide the
answer to the key question at hand - what are the
barriers to the successful provision of
healthcare delivery via a virtual model?
Recently in Victoria there has been a large
amount of work involving clinicians, hospitals
and government, in relation to the establishment
of a Cancer Services Framework (CSF) for the
state. Critical to the CSF is the provision of
co-ordinated, best practice, multi-disciplinary
care for patients with cancer, via the
establishment of 9 Integrated Cancer Services
(ICS). This poster presents the results of a
literature review in relation to virtual
healthcare delivery, in order to extract key
lessons for the ICS to facilitate their ongoing
development, and in turn to deliver better
services for our patients.
Reproduced with permission from Page (Page,
2003)
Equally, failure to achieve the kinds of cultural
changes necessary in traditional organizations,
in order to facilitate their participation on
these collaborative arrangements, is another key
theme. Other themes identified include issues
around governance and privacy, both of
individuals data and of organizational knowledge
and workings. Pages article is especially
insightful (Page, 2003) in relation to how some
of these barriers can be overcome. He emphasises
the role of gentle planned change interspersed
with reflective feedback for stakeholders. (see
quote below and figure above)
Reproduced with permission from Fauske (Fauske,
2002)
Introduction
The context for this research is the development
of ICS in Victoria in recent years. Similar
models have been developed in the UK and Canada,
although there are some key differences in the
models used. There has been no formal evaluation
of the relative success or failure of the ICS
model to date, so this research provides an
opportunity to review the relevant literature in
the area, and to assess progress through the lens
of virtual organizations.
Where there is no common culture or social
capital, weak intermediaries and short term
motivations.iterative processes offer the most
promising path to successful network development
(Page, 2003)
Limitations
Background
Conclusions
There are a range of drivers for models of care
delivery which are not premised on the
traditional institutionally based silos. They
include, amongst others, cost efficiencies and a
truly patient centred view of health care
delivery. This concept ties to our definition of
a virtual organization as a combination of
various parties (persons and/or organizations)
located over a wide geographical area which are
committed to achieving a collective goal by
pooling their core competencies and resources.
(Jansen et al, 1998). The implementation of such
models (in this context, the ICS model) provide
challenges for all parties. For hospitals the
challenges are for organizations to work together
at multiple levels from service planning and
governance to the sharing of IT. For the ICS,
the challenges are of bringing disparate parties
together both within and across organizations,
whilst all the while building a virtual
organization from the ground up. For
government, there is risk attached to such a
venture both in terms of financial risk, and
political risk in the event of failure. All
parties take on these risks and challenges in the
expectation that patient care may be improved.

• The key findings of the review were that there
  are some notable barriers to the delivery of
  healthcare in a virtual model (a virtual
  organization) including
• Insufficient or inappropriate IT support
• Issues around micro politics and organizational
  dynamics
• Governance, legal and privacy issues
• Clinical issues not being adequately addressed or
  clinical benefits not realised
• Financial issues not being adequately addressed
• Failure to identify or address stakeholders needs
  
• This research has highlighted key issues that
  need to be addressed in order to successfully
  establish the ICS model, and achieve the intended
  improvements in cancer care. The findings fit
  with operational experience in establishing the
  model.

Limitations
There was no restriction on the kinds of articles
retrieved be they systematic reviews, RCTs
(unlikely), expert opinions or magazine style
articles because this field of work is still in
an immature state, certainly from a health
perspective. In addition it could be argued that
a more precise definition of a virtual
organization could have been used, thus avoiding
any issues over results relating to virtual
teams or communities of practice as opposed to
virtual organizations.
Discussion
Models of care delivery which are not premised
on the traditional institutionally based silos
are increasingly being explored in healthcare
across the Western world. Notably very few of
the papers retrieved referred specifically to the
cancer care context, but nonetheless we believe
the results to be informative in this context and
representative of a relatively immature
literature base in this subject area (especially
in the health literature) Nonetheless the
literature around virtual organizations (and
similar terms) is such that there are some clear
themes that emerge. These include the theme of
appropriate IT support being self evident as a
necessary precursor to the establishment of such
collaborative arrangements. (see quote below)
References
Methodology
Fauske, J. (2002). "Preparing School Leaders
Understanding, Experiencing, and Implementing
Collaboration." International Electronic Journal
For Leadership in Learning 6(6). Jansen, W
Steenbakkers, G.C.A and Jagers, H. (1998)
Co-ordination and use of ICT in Virtual
Organizations. PrimaVera Working Paper 98-05.
PrimaVera Working Paper Series,University Van
Amsterdam. McKeon Stosuy, M. and Manning, B
(2005). Joining Up e-Health e-Care Services
Meeting the Demographic Challenge." Stud Health
Technol Inform(114) 65-81. Page, S. (2003).
Virtual Health Care Organizations and the
Challenges of Improving Quality." Health Care
Manage Rev 28(1) 79-92.
The question being asked was what are the
barriers to the successful provision of
healthcare delivery via a virtual model? A
literature search was conducted of the PubMed
medical, science and health services literature
database for publications in the last 5 years,
using the terms virtual and health or
healthcare. The search returned 755 results.
These were narrowed down to relevant articles
related to service delivery and care models and
then analysed
Incentives that promote IT adoption without
emphasis on interoperability have the potential
to fail to enable (the) full clinical quality
and economic efficiency gains (McKeon Stosuy and
Manning, 2005)
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