The essence of tumour streams is:
- focus on one type of cancer at a time. Mostly these are cancers with high incidence and mortality, such as lung, bowel or breast cancer. The expectation is that the level of care can be improved within this type of cancer, for example because recently major changes have taken place or because the care is complex and difficult to co-ordinate.
- find out what the areas of improvement are, for example by speaking with experts, analysing data and reading reports and guidelines. Typical areas of improvement are:
o access to secondary care can be improved
o timeliness of diagnostic work-up can be improved
o access to treatment can be improved
o inequalities can be reduced, for example under treatment of Māori.
o the multidisciplinary approach can be strengthened
o sometimes medical outcomes can be improved
- identify and develop lost cost interventions to improve these areas
- engage senior clinicians and managers to improve the identified areas of improvement and form an improvement group per DHB
- collect data to calculate performance
- organise regular workshops with improvement teams to discuss performance, to select interventions and to exchange experiences with improving care.
Normally a tumour stream project lasts for about a year and a half. After that, it is important to continue to collect performance data and to regularly discuss these within the improvement team. If issues arise, the improvement team has to become active again.
The essence of this method is developed by the Institute of Healthcare Improvement (IHI) in Boston and is called Breakthrough.