Cancer Care Quality Management System
Do we need one?
By Michael Sidra
Let’s be honest — working in health care can feel like trying to juggle a dozen balls while running a marathon.
No matter how organized we try to be, most days are just a blur of urgent requests, shifting priorities, and a never-ending to-do list.
In all this chaos, it’s hard to carve out time to reflect on what we could be doing better.
But here’s the thing: if we want to provide safer care, prevent burnout, and actually make improvements that last, we need more than good intentions.
We need to embed systems and processes into our operational and support structures that keep us focused on continuous improvement.
This is where a quality management system (QMS) can help. A QMS embeds quality improvement into the fabric of our work.
I will explain how, but first, let’s define a quality management system.
Quality Management Systems
While there are many definitions of a Quality Management System (QMS), they are all essentially describing a purposefully designed system that minimizes patient harm and enhances outcomes. The Institute of Medicine defines a QMS as a structured approach including processes, and structures that are designed to systematically minimize harm and enhance patient outcomes [1].
For me, a QMS has three essential components; say how we do what we do, do what we say we are going to do, and continually get better.
Deciding on how – this is the ongoing process of examining evidence and developing clinical and non-clinical best practices such as the development of clinical guidelines, and workflows. It involves the continual refining and updating of processes, procedures, and workflows so we are always providing the best evidence-based care.
Doing what we say – beyond documenting what we do and do it – consistently. This may seem like a “no brainer” but practically, this speaks to sharing of information, implementation of practice changes, and change management. Which can be a challenge in a complex adaptive system like healthcare.
Continually improving – we measure, evaluate and continually improve. To do this, we need to have access to data and evidence.
To me, a QMS is the “how” of imbedding quality into our structure. Quality Dimensions help to define the “what” of quality improvement.
Dimensions of Quality Improvement
A Quality Management System has several dimensions that address various areas of improvement. For example, the Health Quality Alberta (previously Health Quality Council of Alberta) recently released an update to their quality dimension. They added two dimensions (Equitable and Integrated) noting seven dimensions for quality as follows,
- People-centred,
- Accessible and timely,
- Effective,
- Efficient and sustainable,
- Safe,
- Equitable,
- Integrated.
The Alberta Quality Dimensions for Health | Health Quality Alberta accessed July, 2025The Institute of Medicine (IOM) outlines similar type of quality dimensions:
- safety,
- effectiveness,
- patient-centeredness,
- timeliness,
- efficiency,
- equity.
While these frameworks use slightly different words, they are describing similar foundational aspects of quality improvement.
Quality dimensions serve as guideposts in a quality management system. Efficiency, safety, patient centered care, etc. are all things that a high performing healthcare system does well and continually improves.
The quality management system outlines structures, processes and accountabilities that drive safe, high-quality care. For example, in Cancer Care AB, we have clinical experts in treatments for specific malignant tumor types e.g., Lung cancer treatment, that come together regularly to review evidence and update clinical guidelines. In this example, the function, process and responsibilities of the Tumour Teams would be a component of a high performing quality management system.
Do Quality Management Systems Actually Work?
Evidence in peer reviewed articles, show that a structured Quality Management System improves safety, quality, and team engagement.
Here are a couple of quick examples.
Mayo Clinic Cancer Center: Clinical Research Quality Management System
The Mayo Clinic Cancer Center introduced a Quality Management System (QMS) in its Clinical Research Office, drawing on ISO 9000/9001 principles [7].
Key elements of the program included:
- Establishing governance and oversight
- Assigning a Quality Management Coordinator
- Completing comprehensive staff training
- Creating dashboards for key performance indicators
Benefits included establishing a culture of quality improvement, engaged staff, and improved processes.
Another example is from MD Anderson Cancer Network in Texas. They implemented a comprehensive Quality Management System (QMS) for their radiation oncology program [8]. It included:
- Utilizing standardized protocols and checklists to ensure uniformity across multiple sites and teams.
- Employing real-time data collection and centralized monitoring to track compliance and performance metrics.
- Conducting regular audits, peer reviews, and multidisciplinary meetings to identify gaps and drive process improvements.
- Integrating feedback processes for clinicians and staff to report issues and suggest enhancements.
- Emphasizing education and training to maintain high competency among all personnel.
The program demonstrated high efficacy in maintaining treatment quality, reducing errors, and fostering a culture of safety and accountability. The large-scale, prospective approach allowed the center to manage quality across a geographically dispersed network, ensuring that all patients received consistent, evidence-based care.
A robust QMS in any health system enhances care delivery by standardizing excellence, engaging stakeholders, and adapting to evolving needs.
A Quality Management System for Cancer Care AB
We (CCA) currently have useful structures and processes that form the foundations of a comprehensive quality management system (QMS).
However, we need to bring it together, clarify roles and responsibilities, decide on quality metrics and co-design a way to continually share learnings.
A QMS will help us identify how our structures interact with each other, how we share learning, clarify measurement and co-design a process for ongoing improvement.
Stay tuned for more on CCA’s Quality Management System…
-Michael
Michael is the Senior Program Lead of the Provincial Systems, Programs & Performance team in Cancer Care Alberta. He dedicates his career to improving patient outcomes and enhancing health system performance by optimizing processes and delivering innovative solutions to complex issues.
References:
[1] https://www.ncbi.nlm.nih.gov/books/NBK557505/
[2] https://hci.care/how-to-implement-a-quality-management-system/
[3] https://pmc.ncbi.nlm.nih.gov/articles/PMC6502556/
