Cancer Care Closer to Home

Overview

Initiative type

Service Improvement

Status

Deliver

Published

June 2025

Summary

This project identifies and addresses barriers to accessing cancer treatment for patients in the rural communities of the West Moreton Health Services (WMHS) region.

Implementation sites: Ipswich Hospital

Partnerships:  N/A

This project was presented as a Poster at CEQ Showcase 2025 (PDF 504KB).

Aim

The primary goal is to improve both patient and staff satisfaction by facilitating greater access to cancer treatments closer to home, in line with WMHS’s commitment to providing more accessible treatment for those living in rural areas.

Outcomes

  • Increased patient satisfaction with access to cancer care in rural settings, targeting a rise from 50% to 75% by 2026.
  • Enhanced staff satisfaction through improved support and access to resources in rural facilities, increasing from 40% to 70% by the end of 2026.
  • Reduced medication-related adverse events in rural hospitals within West Moreton from 5% to 1-2% by 2026.
  • Decreased failed-to-attend (FTA) rate for rural oncology patients attending the Ipswich Hospital outpatient clinic, aiming to lower the rate from 25% to 10% by 2026.

Background

The West Moreton Health Service (WMHS) catchment is undergoing significant population growth and is identified as one of the fastest growing populations in Queensland with expectations that the population will double to 588,00 by the year 2036. WMHS has the fastest projected population growth (in relative terms) of any Health Service in Queensland with a projected compound annual growth rate of 3.58% from 2016 to 2041. This results in a doubling of the population in less than 20 years.

WMHS plan (2020-2035) outlines chemotherapy as one of the top public specialties (by admissions) accessed by WMH residents and the oncology service provides the largest ambulatory care patient presentation cohort of any of the medical disciplines at WMHS. Medical Oncology is the only cancer service currently provided at WMHS, predominantly at Ipswich hospital. The previously outlined growth of the West Moreton region has impacts on access to outpatient cancer care services, resulting in demand which surpasses capacity. Growth and increase in demand for outpatient services impacts on patient seen in triaged time frames. Introducing cancer care into the rural satellite hospitals within WMHS provides an opportunity to expand our existing Outpatient services, improving access to care and increasing outpatient capabilities across identified services.

Clinical services proposed to operate from the rural satellite hospitals have demonstrated demand/capacity mismatch due to the growth of the local West Moreton population and will benefit from additional resources to support care provision and patient outcomes. This assessment will determine their overall benefit, their suitability for the physical space and geographical location, and their ability to generate activity to meet annual performance targets based on the diagnostic findings.

Methods

To capture the perspectives of patients, staff, and the organisation, the project team employed various diagnostic tools. A Root Cause Analysis (RCA) using the fishbone technique was conducted to identify underlying causes of problems and barriers. This process was led by the project lead and involved key stakeholders, including the Nurse Unit Manager and Clinical Nurse Consultant (CNC) of the Oncology Day Unit at Ipswich Hospital, the project sponsor, and other team members from West Moreton Health Services (WMHS).

Data was gathered through surveys of nurses and pharmacists at rural sites, and patient satisfaction surveys. These responses, along with RCA findings, helped identify core issues and challenges. A meeting with the Director of Nursing and Executive Director was held to assess project feasibility based on initial RCA results. System data from CHARM (Pharmacy Oncology Information Management System) and the integrated electronic medical record (ieMR) was used to create a Big Picture Mapping (BPM). Based on the RCA, BPM, system data, and survey results, decisions were made regarding which rural hospital sites within WMHS could implement the "Care Closer to Home" initiative, following the QRECS guidelines.

A gap analysis was conducted by the Senior Oncology Pharmacist and CNC to evaluate infrastructure limitations for treatment delivery and oral anti-cancer medication supply at rural sites. It was found that Ipswich Hospital's land constraints prevent establishing an on-site aseptic production unit, although future development is possible under the WMHS strategic plan. Slade Health, an external compounding facility supplying intravenous anti-cancer drugs to Ipswich Hospital, was identified as a key partner for the next project phase, critical for delivering chemotherapy and immunotherapy (including cytotoxic and hazardous drugs) to rural sites.

The project applied Six Sigma and Lean Thinking methodologies, along with the Theory of Constraints, to guide the clinical re-design process. These frameworks helped identify and analyse core issues, informing the solutions design phase. The focus was on creating value for rural patients by maintaining care flow, developing supporting systems, and eliminating waste, such as unnecessary travel, fuel costs, and time away from families and work. This clinical re-design was part of an ongoing quality improvement initiative. Barriers to providing care closer to home were identified, including staff educational needs, confidence levels, and challenges in treatment delivery and supply at rural sites. Other concerns included transport issues for patients undergoing treatment, rescheduled appointments,  and the lack of digital health systems in rural hospitals, many still relying on paper-based documentation. These limitations, along with the need to align services with QRECS guidelines, were key planning considerations.

To manage change, the ADKAR model was utilised, incorporating lessons learned from Ipswich Hospital where change is often met with initial resistance. The SCARF Tool was also used as a communication strategy to foster engagement and motivation throughout the project's lifecycle.

Discussion

The Oncology Project, led by the Nursing Director and Strategic Planning Team, aligned with WMH’s strategic direction focused on clinical delivery and service redesign. The newly appointed Executive Director of Innovation and Healthcare (EDIH) consulted at its inception, determining the project's focus on efficiency opportunities in workforce management, clinic processes, scheduling, external supplier interdependencies, and future service provisions. COVID-19 significantly impacted the project’s approach. Initially planned as a collaborative review with key stakeholders, the project faced disruptions due to pandemic priorities. The relocation of services and adjustments to address COVID-19’s impact on Oncology Services led to a shift in focus to meet evolving service needs.

A diagnostic approach gathered insights through semi-structured interviews and focus groups, identifying limitations and areas for improvement. Stakeholders participated in process mapping of the patient journey from referral to treatment, providing a clear understanding of existing workflows and challenges. Benchmarking against other Oncology Services and data analysis, supported by the Digital Health Team, informed the review. This data-driven approach identified inefficiencies and shaped recommendations aligned with short- and long-term goals. Despite COVID-19 challenges, the project identified opportunities for efficiency and adaptability.

Proposed solutions included:

  1. Telehealth for Cancer Services: Delivering cancer care at rural sites, improving access to specialised services closer to home.
  2. Direct Treatment Delivery: Compounding  treatment from an external facility to rural sites, including PBS Mapping to enhance sustainability and address medication costs.
  3. Staff Education and Training: Upskilling rural nurses and pharmacy staff for effective succession planning in chemotherapy
    administration. These solutions aimed to improve rural cancer care access in West Moreton.

Solution 1 allowed fast implementation, Solution 2 involved negotiation with an external facility, and Solution 3 focused on staff empowerment for sustainability.

Progress:

Launched in May 2024, WMH's Tele-Oncology Service has enabled low-risk cancer patients to receive treatment closer to home. By April 2025, 20 patients saved over 9,500 km in travel, with more than 200 service occasions at Ipswich Hospital. Seven rural nurses were trained to administer anti-cancer treatments.

Next Steps:

Three of WMH's four rural facilities now offer Tele-Oncology, with the fourth set for completion by 2026. The service is temporarily funded, with permanent funding being pursued. A formal service evaluation in late 2025 will guide future service expansion, including allied health disciplines and broader treatment options for rural patients.

References

  1. West Moreton Health Strategic Plan 2021–2025, 2022, viewed on-line 2nd October 2023,
    https://www.westmoreton.health.qld.gov.au/sites/default/files/inline-files/strategic-plan.pdf
  2. https://www.health.qld.gov.au/__data/assets/pdf_file/0029/818246/QReCS-Guide-2019-Compressed.pdf, last assessed on 02.10.23
  3. Ō¯no Taiichi (2019) Toyota production system: Beyond large-scale production. New York: Productivity Press.
  4. Victorian cancer patient experience survey tool project (health.vic.gov.au) accessed on 24th March 2023.
  5. Mazzocato  P, Savage C, Brommels M, et al, Lean thinking in healthcare:  a realist review of the literature, BMJ Quality & Safety 2010;19:376-382.
  6. Nave D, 2002, ‘How to compare Six Sigma, Lean, and the Theory of Constraints: a framework for choosing what’s best for your organisation’, Quality Progress, March 2002, pp.73-78.
  7. www.cosa.org.au accessed on 1st December 2022
  8. Wong Q, Lacombe M, Keller R, Joyce T, O'Malley K. Leading change with ADKAR. Nursing Management. 2019;50(4):28-35
  9. Rock D. SCARF: A brain-based model for collaborating with and influencing others. NeuroLeadership  journal. 2008;1(1):1-9
  10. Australian Commission on Safety & Quality in Healthcare, National Safety in Quality Healthcare Services Standards (2019) National Safety and Quality Health Service Standards
  11. Enhancing Chemotherapy Capabilities in Rural Hospitals:  Implementation of a Telechemotherapy Model (QReCS) in North Queensland, Australia, Sabe Sabesan et al, Journal of Oncology Practice 2018 14:7, e429-e437
  12. Health Canada. Workplace hazardous materials information system–official national site. Ottawa (ON): Available from: www.hc-sc.gc.ca/ewh-semt/occup-travail/whmis-simdut/index-eng.php
  13. Preventing occupational exposure to antineoplastic and other hazardous drugs in health care settings. Atlanta (GA): US Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health;2004. Available from: www.cdc.gov/niosh/docs/2004-165c.
  14. National Institute for Occupational safety and Health. NIOSH alert: preventing occupational exposures to antineoplastic and other hazardous drugs in health care settings.2004:1-4. https://www.worksafe.qld.gov.au/__data/assets/pdf_file/0006/88710/guide-handling-cytoxic-drugs- related-waste.pdf, accessed on 01.10.23

Key contact

Gurunath Sule

Senior Pharmacist

West Moreton Hospital and Health Service

Email: gurunath.sule@health.qld.gov.au

Last updated:   June 2025

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