Health Care Delivery
Perspective
Transforming Cancer Care: Are Transdisciplinary Approaches Using Design-Thinking, Engineering, and Business Methodologies Needed to Improve Value in Cancer Care Delivery?
Stanford University, Stanford, CA Rising costs of cancer care illustrate the need to make care more cost effective. The application of population screening, technical advancements in imaging and surgery, and development of effective chemotherapy drugs including targeted therapies that provide personalized treatment have resulted in survival improvements.1-7 However, rising costs of cancer care relative to incremental benefit are creating considerable pressure to improve the value of the methods by which these advances are developed and delivered. These cost concerns have prompted the redesign of health delivery systems to incorporate improvement methodologies used in other fields, such as product and medical device development, that focus on unmet needs and promise critical insight into improving care while saving resources.3,7-10 Unique methodologies are well known in service industries where innovations are consistently incorporated into products to curb cost and increase competitiveness.11 West and Farr define innovation as “the intentional introduction and application within a role, group, or organization, of ideas, processes, products or procedures, new to the relevant unit of adoption, designed to significantly benefit the individual, the group or wider society.”12(p9) Innovation is widely used in product development to create new opportunities, goods, and services and enhance process production to increase revenue.13 In some consumer settings, so-called design thinking has informed the innovation process.14-17 Design thinking refers to methods and processes for investigating ill-defined problems, acquiring information, analyzing knowledge, and positing solutions through creation of consumer products that match identified needs with what is feasible to create market opportunities.14,17,18 The goal is to focus on the end user (ie, user of the product), termed user-centered design (UCD), to enhance consumers’ experiences and interaction, improve product design, and ultimately improve revenue.17 UCD engages end users in every phase of the design to combine empathy for the context of a problem, creativity in the generation of solutions, and rationality to analyze and fit solutions to the context.17,18 Use of design thinking and UCD does not require extensive financial resources, but it requires time and commitment on the part of Copyright © 2013 by American Society of Clinical Oncology
the organization to include stakeholders’ voices in the improvement process. Although design thinking has fueled cost-effective biomedical device development, there is a paucity of these methodologies in health care service redesign.15,19-23 Only recently have design-thinking and UCD methodologies been incorporated into the medical setting to create costeffective transformations that also improve patient and provider satisfaction.14,24-27 Design-thinking approaches at the Mayo Clinic, for example, changed the layout of clinical facilities based on concerns identified by patients, caregivers, and providers. So-called Jack and Jill rooms —in which the setting for the physical examination is separated from the setting for conversation—led to improved patient and provider experiences and enhanced efficiency and clinical capacity.25 Kaiser Permanente used design thinking to improve quality of health care delivery to reduce medication errors through its MedRite effort.26,27 Nurses and patients codesigned an optimized process to reduce medication errors and created physical spaces and processes to help nurses pull medications easier and safely alert others when medications were administered. In 3 years, the project yielded a total of $1 million in cost avoidance, greater employee satisfaction, and patient experience.26,28 These transformations in care delivery shaped by design thinking led to achievement of the triple aim: improved experiences, clinical outcomes, and reduced health care spending.24,25,28 Through incorporation of design-thinking approaches to inform care delivery, transformations in health care can be better positioned to achieve improved value for patients, providers, payers, health care delivery systems, and society—the end users of health care. In this piece, we conducted our own design-thinking effort to better understand diversely defined stakeholders’ knowledge of and attitudes toward improvement efforts originated by transdisciplinary and user-centered design methods in cancer care. Additionally, we sought to identify opportunities to involve design-thinking and engineering methodologies to improve cancer care delivery.16,29-31 The design-thinking method we used in this article was not meant to represent scientifically valid sampling but rather to reveal how widely divergent sources
M A R C H 2014
•
jop.ascopubs.org
e51
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
By Manali I. Patel, MD, MSPH, David Moore, PhD, Douglas W. Blayney, MD, and Arnold Milstein, MD, MPH
understand transdisciplinary approaches in cancer care and to form the basis of incorporating these methodologies into our own product designed to optimize care.
Table 1. Participant Demographics (N ⫽ 73) Demographic
No.
Professional participant background
42
Payer executive
Information Gathering
5
7
Health care provider
35
48
Academic center
20
57
Community based
15
43
Health care delivery system executive
2
3
Patient participant disease
31
42
Hematologic malignancy
2
6
Breast
9
29
10
33
Lung GI
5
16
Prostate
3
10
Head and neck
2
6
71
97
54
76
6
8
Region United States West Midwest Northeast
5
7
Southeast
6
8
International
2
3
Canada
1
1
United Kingdom
1
1
Male
38
52
Female
35
48
Sex
Issues Raised
e52
JOURNAL
OF
ONCOLOGY PRACTICE
•
Knowledge of transdisciplinary approaches Knowledge of design thinking Agree with transdisciplinary approaches
100 80 60 40 20
ex Pa ec ye ut r iv es de He liv al er th y ca sy re st em
Pa
tie
nt
s
0 A ca pr dem ov ic id er s Co m m pr un ov ity id er s
Percentage of Participants
Transdisciplinary approaches to improve clinical processes and care delivery are novel and have not been commonly used in quality improvement efforts in cancer care. Of the 73 participants (Table 1), a majority were familiar with transdisciplinary approaches to improve care, but only a few had familiarity with design thinking (Fig 1). No participants had used design-thinking or engineering methodologies. We found that although there was an overall lack of familiarity with these approaches, after a definition was provided, there was a positive attitude toward the incorporation of these methodologies into cancer care delivery improvement efforts (Fig 1). Not surprisingly, executives from payer groups and health care delivery systems had the most familiarity with transdisciplinary and design-thinking approaches in health care redesign efforts and highly encouraged these innovations in the cancer care delivery space. Practitioners varied in their attitudes toward these approaches. Many community-based oncology providers were unfamiliar with design thinking and did not think that this approach would help improve particular needs of their practices and patients. Academic providers, however, expressed the need for unique methodologies to improve efficiency in cancer care delivery. Finally, patients had little knowledge regarding these types of methodologies in health care but were aware of systems issues in their individual care and were overwhelmingly sup-
Figure 1. Participant responses.
portive of improvement efforts incorporating user-centered design. Transdisciplinary and design-thinking approaches are a departure from traditional health care improvement efforts in that they focus on understanding unmet needs of diverse stakeholders and incorporate improvement methods from professionals outside of the medical field.32 The unfamiliar-
V O L . 10, I S S U E 2
Copyright © 2013 by American Society of Clinical Oncology
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
We identified a convenience sample composed of executives from payer groups and health care delivery systems, health care providers, and adult patients who had experience with cancer care. Our sample was specifically designed to generate hypotheses important to stakeholders to develop a novel cancer care delivery model. Executives from payer groups and health care delivery systems were identified from within the United States based on their previous experiences in improving cancer care delivery. Health care providers were chosen based on their delivery of cancer services as well as from select cancer centers and clinics that were recognized in the literature as providing quality cancer care. We asked three simple questions to inform our effort: (1) What do you think when you hear the phrase transdisciplinary approaches in improving cancer care? (2) Have you heard of design-thinking methodologies? (3) How do you think these could be used in cancer care redesign efforts? All participants were provided with a definition of design thinking as the “methods and processes for investigating ill-defined problems to match identified needs with solutions with a particular focus on the individuals who would use the solutions” before the third question. The Stanford University Institutional Review Board deemed the current project minimally harmful and waived requirement for full review.
%
Acknowledgment The ideas and opinions expressed herein are those of the authors. Authors’ Disclosures of Potential Conflicts of Interest Although all authors completed the disclosure declaration, the following author(s) and/or an author’s immediate family member(s) indicated a
financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a “U” are those for which no compensation was received; those relationships marked with a “C” were compensated. For a detailed description of the disclosure categories, or for more information about ASCO’s conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors. Employment or Leadership Position: Douglas W. Blayney, Stanford University (C) Consultant or Advisory Role: Douglas W. Blayney, Physician Resource Management (C), United HealthCare (C); Arnold Milstein, Mercer, Mercer Health and Benefits (U), Castlight Health (U) Stock Ownership: None Honoraria: Douglas W. Blayney, American Society of Clinical Oncology, Saudi Cancer Foundation, Cancer Centers of Excellence, University of Michigan Research Funding: Douglas W. Blayney, Blue Cross Blue Shield of Michigan Expert Testimony: None Patents, Licenses or Royalties: None Other Remuneration: None Author Contributions Conception and design: Manali I. Patel, Douglas W. Blayney, Arnold Milstein Administrative support: Manali I. Patel Collection and assembly of data: Manali I. Patel Data analysis and interpretation: Manali I. Patel, Douglas W. Blayney Manuscript writing: All authors Final approval of manuscript: All authors Corresponding author: Manali I. Patel, MD, MSPH, Department of Medicine, Division of Oncology, Stanford University, School of Medicine, 875 Blake Wilbur Dr, Stanford, CA 94305; e-mail: [email protected].
DOI: 10.1200/JOP.2013.000928; published online ahead of print at jop.ascopubs.org on December 26, 2013.
References 1. Hillner BE, Smith TJ: Efficacy does not necessarily translate to cost effectiveness: A case study in the challenges associated with 21st-century cancer drug pricing. J Clin Oncol 27:2111-2113, 2009 2. Meropol NJ, Schulman KA: Cost of cancer care: Issues and implications. J Clin Oncol 25:180-186, 2007 3. Turning the tide against cancer through sustained medical innovation: Sustaining progress against cancer in an era of cost containment. http:// turningthetideagainstcancer.org 4. Caraceni A, Martini C, Zecca E, et al: Breakthrough pain characteristics and syndromes in patients with cancer pain: An international survey. Palliat Med 18: 177-183, 2004 5. Earle CC, Neville BA, Landrum MB, et al: Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315-321, 2004
12. West M, Farr JL: Innovation and Creativity at Work: Psychological and Organizational Strategies. Chichester, United Kingdom, John Wiley, 1990 13. 6 P: Innovation by nonprofit organizations: Policy and research issues. Nonprofit Manag Leadersh 3:397-414, 1993 14. IDEO. www.ideo.com 15. Lerner AL, Kenknight BH, Rosenthal A, et al: Design in BME: Challenges, issues, and opportunities. Ann Biomed Eng 34:200-208, 2006 16. Zenios S, Makower J, Yock P, et al: Biodesign: The Process of Innovating Medical Technologies. Boston, MA, Cambridge University Press, 2009 17. Norman DA: The Design of Everyday Things. New York, NY, Doubleday, 1988 18. Rowe GP: Design Thinking. Cambridge, MA, MIT Press, 1987
6. Given BA, Given CW, Stommel M: Family and out-of-pocket costs for women with breast cancer. Cancer Pract 2:187-193, 1994
19. Krummel TM, Gertner M, Makower J, et al: Inventing our future: Training the next generation of surgeon innovators. Semin Pediatr Surg 15:309-318, 2006
7. Newcomer LN: Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly drugs. Health Aff (Millwood) 31:780-785, 2012
20. Makower J, Nayak A: Principles of innovation: Section 2—Transforming clinical needs into visible inventions, in King S, Yeung A (eds): Interventional Cardiology. New York, NY, McGraw-Hill, 2006
8. Schnipper LE, Meropol N: ASCO addresses the rising cost of cancer care. J Oncol Pract 5:214-215, 2009
21. Milstein A, Shortell S: Innovations in care delivery to slow growth of US health spending. JAMA 308:1439-1440, 2012
9. Meropol NJ, Schrag D, Smith TJ, et al: American Society of Clinical Oncology guidance statement: The cost of cancer care. J Clin Oncol 27:38683874, 2009
22. Moulton G: IOM report on quality of cancer care highlights need for research, data expansion: Institute of Medicine. J Natl Cancer Inst 91:761-762, 1999
10. Gustafson DH, Taylor JO, Thompson S, et al: Assessing the needs of breast cancer patients and their families. Qual Manag Health Care 2:6-17, 1993 11. Zaltman G, Duncan R, Holbek J: Innovation and Organizations. New York, NY, Wiley, 1973
Copyright © 2013 by American Society of Clinical Oncology
23. Fuchs VR, Milstein A: The $640 billion question: Why does cost-effective care diffuse so slowly? N Engl J Med 364:1985-1987, 2011 24. Healthcare Innovation by Design. www.healthcareinnovationbydesign.com 25. Center for Innovation: Design thinking. www.mayo.edu/center-for-innovation/ what-we-do/design-thinking
M A R C H 2014
•
jop.ascopubs.org
e53
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
ity with but generally positive attitudes toward these approaches represent an opportunity to incorporate these methodologies into cancer care improvement efforts. The application of these approaches in cancer care improvement, as seen in medical device development, could result in the rapid acceleration of innovations that have the potential to improve cancer care and decrease costs. We acknowledge that these findings are limited to a convenience sample. Although the results may not be generalizable, the insights gained from this effort led our group to create an optimized care delivery model that uses transdisciplinary and design-thinking methodologies. The current model of care is being tested in more than 17 sites nationally. These insights should lead to future studies to test the use of transdisciplinary and design-thinking approaches to inform cancer care delivery innovations. In conclusion, transdisciplinary engineering and design thinking are methodologies used to improve products with the end users in mind. New reimbursement systems that will focus on quality and value, in contrast to our current fee-for-service system, will require that we transform our processes in a more distinctly end user– centered or patient-centered way. In light of these changes in health care, clinicians and administrators in oncology care would benefit by familiarizing themselves with design-thinking and engineering methodologies that have been proven successful in other fields and using them to transform cancer care.
26. Kaiser Permanente: Innovation consultancy. http://xnet.kp.org/innovation consultancy/index.html
29. Yock PG, Brinton TJ, Zenios SA: Teaching biomedical technology innovation as a discipline. Sci Transl Med 3:92cm18, 2011
27. Cain CH, Neuwirth E, Bellows J, et al: Patient experiences of transitioning from hospital to home: An ethnographic quality improvement project. J Hosp Med 7:382-387, 2012
30. Stanford University: Biodesign School. http://biodesign.stanford.edu
28. McCreary L: Kaiser Permanente’s innovation on the front lines. Harv Bus Rev 88:92, 94-97, 126, 2010
31. Stanford University: D-School. http://dschool.stanford.edu 32. Luce JM, Bindman AB, Lee PR: A brief history of health care quality assessment and improvement in the United States. West J Med 160:263-268, 1994
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
e54
JOURNAL
OF
ONCOLOGY PRACTICE
•
V O L . 10, I S S U E 2
Copyright © 2013 by American Society of Clinical Oncology
Perspective
Transforming Cancer Care: Are Transdisciplinary Approaches Using Design-Thinking, Engineering, and Business Methodologies Needed to Improve Value in Cancer Care Delivery?
Stanford University, Stanford, CA Rising costs of cancer care illustrate the need to make care more cost effective. The application of population screening, technical advancements in imaging and surgery, and development of effective chemotherapy drugs including targeted therapies that provide personalized treatment have resulted in survival improvements.1-7 However, rising costs of cancer care relative to incremental benefit are creating considerable pressure to improve the value of the methods by which these advances are developed and delivered. These cost concerns have prompted the redesign of health delivery systems to incorporate improvement methodologies used in other fields, such as product and medical device development, that focus on unmet needs and promise critical insight into improving care while saving resources.3,7-10 Unique methodologies are well known in service industries where innovations are consistently incorporated into products to curb cost and increase competitiveness.11 West and Farr define innovation as “the intentional introduction and application within a role, group, or organization, of ideas, processes, products or procedures, new to the relevant unit of adoption, designed to significantly benefit the individual, the group or wider society.”12(p9) Innovation is widely used in product development to create new opportunities, goods, and services and enhance process production to increase revenue.13 In some consumer settings, so-called design thinking has informed the innovation process.14-17 Design thinking refers to methods and processes for investigating ill-defined problems, acquiring information, analyzing knowledge, and positing solutions through creation of consumer products that match identified needs with what is feasible to create market opportunities.14,17,18 The goal is to focus on the end user (ie, user of the product), termed user-centered design (UCD), to enhance consumers’ experiences and interaction, improve product design, and ultimately improve revenue.17 UCD engages end users in every phase of the design to combine empathy for the context of a problem, creativity in the generation of solutions, and rationality to analyze and fit solutions to the context.17,18 Use of design thinking and UCD does not require extensive financial resources, but it requires time and commitment on the part of Copyright © 2013 by American Society of Clinical Oncology
the organization to include stakeholders’ voices in the improvement process. Although design thinking has fueled cost-effective biomedical device development, there is a paucity of these methodologies in health care service redesign.15,19-23 Only recently have design-thinking and UCD methodologies been incorporated into the medical setting to create costeffective transformations that also improve patient and provider satisfaction.14,24-27 Design-thinking approaches at the Mayo Clinic, for example, changed the layout of clinical facilities based on concerns identified by patients, caregivers, and providers. So-called Jack and Jill rooms —in which the setting for the physical examination is separated from the setting for conversation—led to improved patient and provider experiences and enhanced efficiency and clinical capacity.25 Kaiser Permanente used design thinking to improve quality of health care delivery to reduce medication errors through its MedRite effort.26,27 Nurses and patients codesigned an optimized process to reduce medication errors and created physical spaces and processes to help nurses pull medications easier and safely alert others when medications were administered. In 3 years, the project yielded a total of $1 million in cost avoidance, greater employee satisfaction, and patient experience.26,28 These transformations in care delivery shaped by design thinking led to achievement of the triple aim: improved experiences, clinical outcomes, and reduced health care spending.24,25,28 Through incorporation of design-thinking approaches to inform care delivery, transformations in health care can be better positioned to achieve improved value for patients, providers, payers, health care delivery systems, and society—the end users of health care. In this piece, we conducted our own design-thinking effort to better understand diversely defined stakeholders’ knowledge of and attitudes toward improvement efforts originated by transdisciplinary and user-centered design methods in cancer care. Additionally, we sought to identify opportunities to involve design-thinking and engineering methodologies to improve cancer care delivery.16,29-31 The design-thinking method we used in this article was not meant to represent scientifically valid sampling but rather to reveal how widely divergent sources
M A R C H 2014
•
jop.ascopubs.org
e51
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
By Manali I. Patel, MD, MSPH, David Moore, PhD, Douglas W. Blayney, MD, and Arnold Milstein, MD, MPH
understand transdisciplinary approaches in cancer care and to form the basis of incorporating these methodologies into our own product designed to optimize care.
Table 1. Participant Demographics (N ⫽ 73) Demographic
No.
Professional participant background
42
Payer executive
Information Gathering
5
7
Health care provider
35
48
Academic center
20
57
Community based
15
43
Health care delivery system executive
2
3
Patient participant disease
31
42
Hematologic malignancy
2
6
Breast
9
29
10
33
Lung GI
5
16
Prostate
3
10
Head and neck
2
6
71
97
54
76
6
8
Region United States West Midwest Northeast
5
7
Southeast
6
8
International
2
3
Canada
1
1
United Kingdom
1
1
Male
38
52
Female
35
48
Sex
Issues Raised
e52
JOURNAL
OF
ONCOLOGY PRACTICE
•
Knowledge of transdisciplinary approaches Knowledge of design thinking Agree with transdisciplinary approaches
100 80 60 40 20
ex Pa ec ye ut r iv es de He liv al er th y ca sy re st em
Pa
tie
nt
s
0 A ca pr dem ov ic id er s Co m m pr un ov ity id er s
Percentage of Participants
Transdisciplinary approaches to improve clinical processes and care delivery are novel and have not been commonly used in quality improvement efforts in cancer care. Of the 73 participants (Table 1), a majority were familiar with transdisciplinary approaches to improve care, but only a few had familiarity with design thinking (Fig 1). No participants had used design-thinking or engineering methodologies. We found that although there was an overall lack of familiarity with these approaches, after a definition was provided, there was a positive attitude toward the incorporation of these methodologies into cancer care delivery improvement efforts (Fig 1). Not surprisingly, executives from payer groups and health care delivery systems had the most familiarity with transdisciplinary and design-thinking approaches in health care redesign efforts and highly encouraged these innovations in the cancer care delivery space. Practitioners varied in their attitudes toward these approaches. Many community-based oncology providers were unfamiliar with design thinking and did not think that this approach would help improve particular needs of their practices and patients. Academic providers, however, expressed the need for unique methodologies to improve efficiency in cancer care delivery. Finally, patients had little knowledge regarding these types of methodologies in health care but were aware of systems issues in their individual care and were overwhelmingly sup-
Figure 1. Participant responses.
portive of improvement efforts incorporating user-centered design. Transdisciplinary and design-thinking approaches are a departure from traditional health care improvement efforts in that they focus on understanding unmet needs of diverse stakeholders and incorporate improvement methods from professionals outside of the medical field.32 The unfamiliar-
V O L . 10, I S S U E 2
Copyright © 2013 by American Society of Clinical Oncology
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
We identified a convenience sample composed of executives from payer groups and health care delivery systems, health care providers, and adult patients who had experience with cancer care. Our sample was specifically designed to generate hypotheses important to stakeholders to develop a novel cancer care delivery model. Executives from payer groups and health care delivery systems were identified from within the United States based on their previous experiences in improving cancer care delivery. Health care providers were chosen based on their delivery of cancer services as well as from select cancer centers and clinics that were recognized in the literature as providing quality cancer care. We asked three simple questions to inform our effort: (1) What do you think when you hear the phrase transdisciplinary approaches in improving cancer care? (2) Have you heard of design-thinking methodologies? (3) How do you think these could be used in cancer care redesign efforts? All participants were provided with a definition of design thinking as the “methods and processes for investigating ill-defined problems to match identified needs with solutions with a particular focus on the individuals who would use the solutions” before the third question. The Stanford University Institutional Review Board deemed the current project minimally harmful and waived requirement for full review.
%
Acknowledgment The ideas and opinions expressed herein are those of the authors. Authors’ Disclosures of Potential Conflicts of Interest Although all authors completed the disclosure declaration, the following author(s) and/or an author’s immediate family member(s) indicated a
financial or other interest that is relevant to the subject matter under consideration in this article. Certain relationships marked with a “U” are those for which no compensation was received; those relationships marked with a “C” were compensated. For a detailed description of the disclosure categories, or for more information about ASCO’s conflict of interest policy, please refer to the Author Disclosure Declaration and the Disclosures of Potential Conflicts of Interest section in Information for Contributors. Employment or Leadership Position: Douglas W. Blayney, Stanford University (C) Consultant or Advisory Role: Douglas W. Blayney, Physician Resource Management (C), United HealthCare (C); Arnold Milstein, Mercer, Mercer Health and Benefits (U), Castlight Health (U) Stock Ownership: None Honoraria: Douglas W. Blayney, American Society of Clinical Oncology, Saudi Cancer Foundation, Cancer Centers of Excellence, University of Michigan Research Funding: Douglas W. Blayney, Blue Cross Blue Shield of Michigan Expert Testimony: None Patents, Licenses or Royalties: None Other Remuneration: None Author Contributions Conception and design: Manali I. Patel, Douglas W. Blayney, Arnold Milstein Administrative support: Manali I. Patel Collection and assembly of data: Manali I. Patel Data analysis and interpretation: Manali I. Patel, Douglas W. Blayney Manuscript writing: All authors Final approval of manuscript: All authors Corresponding author: Manali I. Patel, MD, MSPH, Department of Medicine, Division of Oncology, Stanford University, School of Medicine, 875 Blake Wilbur Dr, Stanford, CA 94305; e-mail: [email protected].
DOI: 10.1200/JOP.2013.000928; published online ahead of print at jop.ascopubs.org on December 26, 2013.
References 1. Hillner BE, Smith TJ: Efficacy does not necessarily translate to cost effectiveness: A case study in the challenges associated with 21st-century cancer drug pricing. J Clin Oncol 27:2111-2113, 2009 2. Meropol NJ, Schulman KA: Cost of cancer care: Issues and implications. J Clin Oncol 25:180-186, 2007 3. Turning the tide against cancer through sustained medical innovation: Sustaining progress against cancer in an era of cost containment. http:// turningthetideagainstcancer.org 4. Caraceni A, Martini C, Zecca E, et al: Breakthrough pain characteristics and syndromes in patients with cancer pain: An international survey. Palliat Med 18: 177-183, 2004 5. Earle CC, Neville BA, Landrum MB, et al: Trends in the aggressiveness of cancer care near the end of life. J Clin Oncol 22:315-321, 2004
12. West M, Farr JL: Innovation and Creativity at Work: Psychological and Organizational Strategies. Chichester, United Kingdom, John Wiley, 1990 13. 6 P: Innovation by nonprofit organizations: Policy and research issues. Nonprofit Manag Leadersh 3:397-414, 1993 14. IDEO. www.ideo.com 15. Lerner AL, Kenknight BH, Rosenthal A, et al: Design in BME: Challenges, issues, and opportunities. Ann Biomed Eng 34:200-208, 2006 16. Zenios S, Makower J, Yock P, et al: Biodesign: The Process of Innovating Medical Technologies. Boston, MA, Cambridge University Press, 2009 17. Norman DA: The Design of Everyday Things. New York, NY, Doubleday, 1988 18. Rowe GP: Design Thinking. Cambridge, MA, MIT Press, 1987
6. Given BA, Given CW, Stommel M: Family and out-of-pocket costs for women with breast cancer. Cancer Pract 2:187-193, 1994
19. Krummel TM, Gertner M, Makower J, et al: Inventing our future: Training the next generation of surgeon innovators. Semin Pediatr Surg 15:309-318, 2006
7. Newcomer LN: Changing physician incentives for cancer care to reward better patient outcomes instead of use of more costly drugs. Health Aff (Millwood) 31:780-785, 2012
20. Makower J, Nayak A: Principles of innovation: Section 2—Transforming clinical needs into visible inventions, in King S, Yeung A (eds): Interventional Cardiology. New York, NY, McGraw-Hill, 2006
8. Schnipper LE, Meropol N: ASCO addresses the rising cost of cancer care. J Oncol Pract 5:214-215, 2009
21. Milstein A, Shortell S: Innovations in care delivery to slow growth of US health spending. JAMA 308:1439-1440, 2012
9. Meropol NJ, Schrag D, Smith TJ, et al: American Society of Clinical Oncology guidance statement: The cost of cancer care. J Clin Oncol 27:38683874, 2009
22. Moulton G: IOM report on quality of cancer care highlights need for research, data expansion: Institute of Medicine. J Natl Cancer Inst 91:761-762, 1999
10. Gustafson DH, Taylor JO, Thompson S, et al: Assessing the needs of breast cancer patients and their families. Qual Manag Health Care 2:6-17, 1993 11. Zaltman G, Duncan R, Holbek J: Innovation and Organizations. New York, NY, Wiley, 1973
Copyright © 2013 by American Society of Clinical Oncology
23. Fuchs VR, Milstein A: The $640 billion question: Why does cost-effective care diffuse so slowly? N Engl J Med 364:1985-1987, 2011 24. Healthcare Innovation by Design. www.healthcareinnovationbydesign.com 25. Center for Innovation: Design thinking. www.mayo.edu/center-for-innovation/ what-we-do/design-thinking
M A R C H 2014
•
jop.ascopubs.org
e53
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
ity with but generally positive attitudes toward these approaches represent an opportunity to incorporate these methodologies into cancer care improvement efforts. The application of these approaches in cancer care improvement, as seen in medical device development, could result in the rapid acceleration of innovations that have the potential to improve cancer care and decrease costs. We acknowledge that these findings are limited to a convenience sample. Although the results may not be generalizable, the insights gained from this effort led our group to create an optimized care delivery model that uses transdisciplinary and design-thinking methodologies. The current model of care is being tested in more than 17 sites nationally. These insights should lead to future studies to test the use of transdisciplinary and design-thinking approaches to inform cancer care delivery innovations. In conclusion, transdisciplinary engineering and design thinking are methodologies used to improve products with the end users in mind. New reimbursement systems that will focus on quality and value, in contrast to our current fee-for-service system, will require that we transform our processes in a more distinctly end user– centered or patient-centered way. In light of these changes in health care, clinicians and administrators in oncology care would benefit by familiarizing themselves with design-thinking and engineering methodologies that have been proven successful in other fields and using them to transform cancer care.
26. Kaiser Permanente: Innovation consultancy. http://xnet.kp.org/innovation consultancy/index.html
29. Yock PG, Brinton TJ, Zenios SA: Teaching biomedical technology innovation as a discipline. Sci Transl Med 3:92cm18, 2011
27. Cain CH, Neuwirth E, Bellows J, et al: Patient experiences of transitioning from hospital to home: An ethnographic quality improvement project. J Hosp Med 7:382-387, 2012
30. Stanford University: Biodesign School. http://biodesign.stanford.edu
28. McCreary L: Kaiser Permanente’s innovation on the front lines. Harv Bus Rev 88:92, 94-97, 126, 2010
31. Stanford University: D-School. http://dschool.stanford.edu 32. Luce JM, Bindman AB, Lee PR: A brief history of health care quality assessment and improvement in the United States. West J Med 160:263-268, 1994
Information downloaded from jop.ascopubs.org and provided by at UNIV OF MASSACHUSETTS on April 5, 2015 from 146.189.194.69 Copyright © 2014 American Society of Clinical Oncology. All rights reserved.
e54
JOURNAL
OF
ONCOLOGY PRACTICE
•
V O L . 10, I S S U E 2
Copyright © 2013 by American Society of Clinical Oncology
