The Questions We Should Be Able to Answer

An Introduction to Performance Measurement

By Michael Sidra

Since joining CCA about three years ago, I’ve been inspired by how, every day, you help cancer patients get the care they need.

You make treatment decisions, manage symptoms and complications, and deliver treatment with remarkable precision. You also listen, comfort, provide tools and equipment and drugs and hope. You analyze data, manage projects, coordinate and juggle many moving parts.

You keep the system moving.

But that’s not all.

I’ve also been inspired by the conversations I’ve had, with so many of you, about how we can do even better.

The questions that keeps popping up is; how do we know whether the system is truly delivering the best care possible?

AND

How do we make it better?

Most healthcare teams can answer questions about the performance of their own area. They can often describe wait-times, volumes, staffing pressures, and quality indicators within their area.

While individual clinic areas track their metrics effectively, connecting those data points across the full patient journey is our next major opportunity. Performance excellence depends on knowing where patients experience delays, where care breaks down, what outcomes are achieved, and how those outcomes can be improved across the entire patient’s journey.

A System for Patients

Yes, cancer care is complex, but the needs of patients are, for the most part, well known and consistent.

Patients need to be diagnosed quickly and receive effective treatment in a timely way. Each patient’s needs are unique, but at the end of the day, all patients need equitable access to support from the time they are diagnosed through to survivorship care, or palliative care.

A high-performing cancer system delivers those things reliably.

Our blind spots

Cancer care is one of the most data-rich areas in healthcare.

Still …

Many health systems (including ours) struggle to answer critical questions.

How long does it take a patient to move from first suspicion of cancer to treatment?

Where are delays occurring?

What are patients experiencing while they move through the health system?

Answering those questions can be challenging because the information needed to answer them sits in different systems, owned by different organizations, and reported through different governance structures.

Limits of current approaches to system performance measurement

Most healthcare organizations use a combination of quality improvement methods and performance reporting.

Both are essential.

Quality improvement methods such as Lean and Plan-Do-Study-Act cycles help teams identify problems and test solutions, locally. These methods can improve clinic flow, reduce delays, strengthen communication, and improve safety.

Performance scorecards provide leaders with a broader view of how programs are performing, especially when they look at trends over time.

Each approach serves an important purpose

But neither approach consistently provides a complete picture of patients’ trajectory.

Most measurement systems are designed around organizational structures. Patients experience care across those structures.

The seam between organizations

Many of the biggest risks to quality, safety, and timeliness occur during transitions.

For example, a patient with symptoms suggestive of cancer may begin in primary care. Then they move through diagnostic imaging, laboratory testing, specialist referral, and finally oncology consultation, and treatment.

Each step can function well on its own.

The overall trajectory can still be slow.

Because care spans multiple specialized teams and settings, building shared responsibility across these transitions helps us support patients more seamlessly. The same pattern appears elsewhere.

A patient receiving systemic therapy may develop serious treatment-related complications and present to an emergency department. Acute care clinicians manage the complication. Oncology teams adjust the treatment plan. The two events are directly connected from the patient's perspective. But these parts of the system are measured and governed separately.