Reducing the Burden of Cancer

Oncology patients and their caregivers face a wide array of challenges, both large and small. Lauren Gjolaj, MBA, BSN, RN, direc­tor of clinical operations at Sylvester Comprehensive Cancer Center at the University of Miami Miller School of Medicine, sees those difficulties firsthand.

A self-described proud third-generation nurse with a desire to serve the oncology patient population, Gjolaj’s commitment to helping patients and advancing her education allowed her to move ahead quickly in her career. She strives to improve the lives of patients and quality of care at the center—and share what she has learned with other centers across the country.

Gjolaj credits much of her interest in process improvement to Six Sigma training, which she says changed her life. Six Sigma is a statistical methodol­ogy that Gjolaj, along with her team, has employed to problem solve many of her award-winning proj­ects. The program, developed by Bill Smith in 1986, takes a dual approach, incorporating both technical and management components.¹ The training can be completed in steps, represented by different col­ored belts. Gjolaj possesses a green belt but hopes to obtain a black one in the future.

“The most important part of the process improve­ment to me is not just ‘fixing’ the issue for today but creating long-term, sustainable solutions,” she says. “If you don’t set up the process so that it’s a sustain­able win, people get tired and suffer from change fatigue. Creating collaborative solutions that make it better for everyone are the keys to success.”

CREATING SOLUTIONS

Gjolaj describes her leadership style as “transparent and predictable,” with a strong focus on teamwork and recognition for a job well done. “I see interact­ing and teaching as a way to build other nurses and myself into the best caregivers we can be, which, in turn, makes our patients’ lives and experiences bet­ter,” she says. Some ways in which Gjolaj and her team have accomplished this at Sylvester is by creating a neutropenic fever task force and decreasing wait times in the outpatient setting.

Due to their immunocompromised status, patients with cancer face potential life-threatening events, all of which require prompt intervention to circumvent poor outcomes. Although many healthcare providers know that prompt medical intervention is impera­tive when a patient presents with a serious symptom such as neutropenic fever, many settings struggle with workflow issues, creating a potential lapse of precious time. “It’s critical to recognize neutropenic fever early and to initiate empiric systemic antibac­terial therapy promptly in order to avoid progression to a sepsis syndrome and possibly death,” according to investigators.²

By implementing a few inventive strat­egies to quickly identify this at-risk pop­ulation, the Sylvester team significantly reduced the time between patient arrival to the emergency department (ED) and administration of intravenous antibiotics. First, they gave patients a neutropenic fever alert card to present to healthcare practitioners and added a correspond­ing question to the ED patient sign-in form. Then they created a neutropenic fever alert system within the hospital, which quickly brings a trained team to a patient’s bedside.

“It was innovative and challenging and, no doubt, has saved hundreds of lives,” Gjolaj says. “I would like to continue to spread awareness and share our best practices with the other cancer centers and hospitals to expand the lives saved.”

The implemented changes took sev­eral attempts to perfect, Gjolaj admits. The project involved members of many departments and required an interdis­ciplinary approach to problem solving, but it ultimately benefited patients and improved outcomes.

The hard work paid off: The task force won 2 awards, Overall Showcase and Greatest Customer Impact, at the 2017 Florida Sterling Conference Team Showcase competition. “None of this is just me. These [changes] could not have been created and implemented without a team. I’m just the conductor,” Gjolaj says.

In 2014, the competition honored Sylvester’s Comprehensive Treatment Unit (CTU) team for their work surrounding an issue that plagues outpatient oncology clinics nationwide. The team received first place for “Systematically Decreasing Wait Time in an Outpatient Oncology Treatment Unit.”

The project began by collecting data on outpatient workflow processes and exam­ining potential areas for improvement. A new process was created using existing staff and resources, redistributing them to improve efficiency. The result: a major reduction in patient wait times—an esti­mated 53% less for laboratory results and a 26% decrease in overall wait time. The CTU team took 14 minutes off arrival-to-chair time and reduced laboratory turn­around time from 52 to 24 minutes.

The team’s efforts were well received, and patient satisfaction increased greatly. Oncology patients spend so much time waiting at outpatient infusion centers, and the team gave them back a little bit of what they desire most—time away from the hospital. “Performance improvement efforts are a great motivator, because the outcomes are tangible; [for example] what used to take 20 steps now takes 5, [or a] wait time that used to be 100 minutes is now 10,” Gjolaj says. The CTU team also was honored in 2014 with the “Innovation of the Year in Patient Care Award” by the Florida Hospital Association.

In a 2015 blog post, “The Bottom Line: Break the Silo or Perish,” Gjolaj highlights the importance of collaboration and sharing of information within corporate structures for best possible outcomes and more efficient solutions to com­pany issues. “The worst part about silos is the impact they have on the everyday man—the frontline employee who can become very frustrated with their organization when they have identified problems but can’t do anything about them—it’s demoralizing and can lead to decreased engage­ment and higher turnover,” she wrote. “When breaking the silos, start with small, manageable projects, remembering that practice makes perfect. Be patient with the process; remember that learning a new skill takes time. Build on small wins, and before you know it, collaboration will be the norm.”³

IMPLEMENTING IMPROVEMENTS IN OTHER CENTERS

Cancer centers that face similar challenges can learn from the team’s success. “Don’t try to fix everything at once. Start small and build from there,” Gjolaj says. She encourages oncology teams to drill down the root of the cause and look to frontline staff for solutions.

Gathering data doesn’t have to be so time-consuming that it backs up the cause, she says, adding that any type of data collected can prove useful. “Go back and tweak your inter­vention. It’s OK,” she says.

Gjolaj shares these additional tips for providers at any level:

• Pick a topic that makes an impact, with a call to action, then map the baseline process.
• Obtain the voice of the customer—interview key stakeholders.
• Form a team with different backgrounds and perspectives.
• Obtain data.
• Define what you want to improve.
• Define steps you need to take.
• Complete the steps.
• Track the outcome.
• Share your success!

Gjolaj has her sights set on the next area of focus: apply­ing her hospital experience to clinical research. She plans to tackle the issue by attempting to improve process efficiencies that support patients and families who participate in clinical research studies, further helping oncology patients navigate the often-foreign world of healthcare.

Everyone brings something to the table, a mentor once told her. “Going into teamwork scenarios with this perspective has allowed me to learn from others’ perspectives and become a better nurse and leader,” Gjolaj says.

REFERENCES

1. Lean Six Sigma. Six Sigma Online website. sixsigmaonline.org/ six-sigma-training-certification-information/category/lean-six-sigma-cat/. Accessed December 7, 2017.

2. Bow E, Wingard JR. Overview of neutropenic fever syndromes. Wolt­ers Kluwer website. uptodate.com/contents/overview-of-neutropenic-fe­ver-syndromes. Updated October 9, 2017. Accessed December 5, 2017.

3. Gjolaj L. The bottom line: break the silo or perish. Florida Sterling Coun­cil website. floridasterling.com/blog/entry/break-the-silo-or-perish-thats-the-bottom-line. Published June 30, 2015. Accessed December 7, 2017.