toh

Dr. Robin Boushey credited Ottawa’s innovative Community of Practice model for enabling system changes that have improved outcomes for patients. “It’s all about the patient at the end of the day,” he said.

Imagine facing rectal cancer surgery and not knowing if you’ll end up with a permanent colostomy bag or not. And that’s if you had a chance for surgery at all.

Until eight years ago, most surgeons across the region did just a few rectal cancer surgeries a year, so they didn’t develop an expertise, explained Dr. Robin Boushey, Medical Director of the Colorectal Cancer Assessment Centre at The Ottawa Hospital. In many cases, patients with larger tumours invading surrounding pelvic organs received palliative chemotherapy and radiation, with no chance to have their tumour removed surgically.

“There’s a strong correlation between volume of surgeries and better results, with respect to your ability to have your rectum reconstructed with no permanent colostomy and to be cured of your cancer,” Dr. Boushey said.

In 2007, the Champlain region’s colorectal experts got together, as part of the Regional Surgical Oncology Program’s Community of Practice, to make improvements. The colorectal Community of Practice was formed – a group of about 75 physicians, nurses, health administrators and senior management from eight regional hospitals. They meet every three months to analyse regional performance data, define challenges, find and fix gaps and bottlenecks, and develop and share best practices. They standardized the entire clinical-care pathway that colon and rectal cancer patients follow throughout the region.

For example, they decided to centralize rectal surgeries at The Ottawa Hospital, Montfort Hospital and Queensway Carleton Hospital. That way, the multi-disciplinary surgical teams develop high expertise; from 90 rectal surgeries per year in 2007, The Ottawa Hospital now does 185 a year. In that time, the 90-day survival rate has improved significantly despite performing more complex surgeries.

“We’ve been extremely successful in transforming care in the region,” said Dr. Boushey, who leads the colorectal Community of Practice. Even within The Ottawa Hospital, high-performance multi-disciplinary surgical teams handle the complicated cases where multiple organs are affected.

He and his colleagues have shared these best practices across Canada and around the world, since they can be used in any type of health-care system. Dr. Boushey attributed this success to Ottawa’s unique Community of Practice model.

“How would you do it otherwise? The team is too large and changes happen too quickly to do this by phone or through grand rounds,” he said. “We can harness information from the entire region and learn from each other.”

You might also like…