NCG Key Initiatives

Quality Improvement Program

QI Videos

Cohort 2022

Sir No. Quality Theme of the QI projects Quality Goals achieved Key outcomes achieved Link to A3 sheet and the Graduation Presentation
1. Improving nutrition in patients of head and neck cancer undergoing treatment. (efficiency, safety, patient experience) Improved the percentage of patients experiencing weight loss of ≥10% of body weight from 70% to <10%.
  • Developed a system of dietician consults in radiation oncology outpatient clinic and diet plan for every patient.
  • Implemented nutritional counselling and diet education pamphlets
 https://vimeo.com/831162109
2. To decrease the average number of days taken for optimal pain control. (efficacy, efficiency, timeliness, patient experience) Reduced the average number of days taken to reduce palliative cancer patients’ self-reported pain score from more than 6/10 to less than 4/10 from 8 days to 3 days
  • Developed institutional pain management protocol and implemented pain charts, pain diaries.
  • Improved awareness on opioid use among health care workers, patients and caregivers through educational programs and information leaflets.
 https://vimeo.com/831172546
3. Improving the Breast Imaging and reporting time of priority breast scans for suspected breast cancer patients. (efficacy, efficiency, timeliness) Increased the percentage of patients reverting back to surgical oncology OPD with breast imaging reports within one working day from 0% to 30%.
  • Collaborated with radiology to create priority slots for surgical oncology.
  • Tagging priority scans for improve communication to get priority slots.
 https://vimeo.com/831167438
4. Quality improvement project to mitigate delay in the discharge process of oncology patients admitted to private ward (Efficiency, timeliness, patient experience and satisfaction) Reduced the average time of discharge of private oncology patients from 6 to 4.5 hours.
  • Efficient discharge summary process through checklists and automation.
  • System alert for faster clearance in billing sections.
 https://vimeo.com/831178242
5. Patient feedback (patient experience and satisfaction) Incorporation of patient feedback registration from 0-30% within completion of treatment.
  • Creation of a documentation process to get patient feedback.
  • Creating awareness among patients for feedback during consults and using banners.
 https://vimeo.com/831143162
6. Communication of bad news to advanced cancer patients in gynaec-oncology. (Experience and satisfaction) Improved the physician satisfaction of communication from 30-60%
  • Standardized the communication protocol like SPIKES for routine clinical use.
  • Physician training for improved communication.
 https://vimeo.com/831152020
7. Patient priority and needs guiding palliative care delivery (Equity, Patient Experience and satisfaction) Patient priority and needs guiding palliative care delivery (Equity, Patient Experience and satisfaction)
  • Created a standard template for documentation of patient needs.
  • Created and tested a repository of patients need in different languages.
 https://vimeo.com/831126259
8. “QUICK PAC- Single check Pre anaesthesia clearance. (safety, efficacy, efficiency, timeliness) The Pre anaesthesia clearance - first time - improved from 60-80%
  • Implemented and tested electronic Pre anaesthesia clearance checklist.
  • Manage referral for comorbidities in house and improved coordination with surgical team.
 https://vimeo.com/831175721
9. Reduction of treatment initiation time for lung and colorectal cancer patients. (Efficiency, timeliness) Reduced the treatment initiation time from 31 days to 17 days.
  • Implemented smooth navigation of patients through electronic retrieval of medical records, segregation of new and follow up patients and providing counselling.
 https://vimeo.com/831124028
10. Early discharge- Better service (Efficiency, timeliness, patient experience and satisfaction) Reduced the discharge turnaround time of surgical patients from 180 to 110 minutes.
  • Test and implement SOP for the discharge process.
  • Simplified the billing process.
 https://vimeo.com/831173522
11. Ensuring compliance to treatment in advanced head and neck cancer patients undergoing chemoradiation. (Safety, Efficacy, Timeliness) Improved compliance to weekly chemotherapy from 66-90%.
  • Implemented telephonic reminder call for chemotherapy.
  • Counselling and Education of patient about plan of management.
 https://vimeo.com/831388486
12. Reducing delays for radiation treatment initiation. (Efficiency, timeliness, patient experience and satisfaction) Reduced the average time from CT simulation to radiation initiation in curative planed patient from 20 to around 12 days.
  • Implemented SOP for radiation planning process and use of radiation treatment scheduler.
  • Utilized the KEVAT services for coordination of radiation care plan.
 https://vimeo.com/831124629
13. Timely completion of planned surgery in gastrointestinal surgical oncology team. (Efficiency, timeliness) Improved the rate of planned surgeries within 30 days of registration from 25-40%
  • Improved turnaround time for pathology reporting through checklists, training sessions.
  • Streamlined the appointment process.
 https://vimeo.com/831393046
14. Adherence of patients to outpatient OPD visits (Efficacy, Efficiency) Improved the adherence of OPD appointments from 60 to 70%.
  • Incorporated the follow up planning at the time of discharge.
  • Implemented telephonic follow up calls reminder for visits.
 https://vimeo.com/831161363
15. Reducing wait times for daily radiotherapy treatments- READY RT ((Efficiency, timeliness, patient experience and satisfaction) Reduced the average daily waiting time from 65 minutes to 45 minutes.
  • Implemented dedicated radiotherapy treatment time slots with reporting time.
  • Organized physician review visits.
 https://vimeo.com/831171492
16. Encouraging caregiver for screening (Efficiency, timeliness, patient experience and satisfaction) Increased the caregiver participation in screening from 38% to 50%.
  • Training and process flow for clinicians to encourage caregivers.
  • Encouraging health seeking behaviour of caregivers through audiovisual aids, pamphlets.
 https://vimeo.com/831156900
17. Lack of pain assessment in head and neck cancer patients (timeliness, patient experience and satisfaction) Increased the objective pain assessment in head and neck cancer patients on their initial visit from 18% to 80%.
  • Training of health care workers on pain assessment and scoring.
  • Pain score documentation and availability of pain charts.
 https://vimeo.com/831169768
18. Patient deferral from treatment in head and neck surgical oncology (Equity, Patient Experience and satisfaction) Reduced the default rate in head and neck outpatient clinic from 40 to 20%.
  • Providing financial support through job opportunities while at hospital and awareness of support policy.
  • Tracking of patients through patient navigator and home care teams
 https://vimeo.com/831169224
19. Prolonged waiting time for patient attending surgical oncology clinic. (Efficiency, timeliness, patient experience and satisfaction) Decreased the waiting time of patients in surgical oncology clinic from 157 to 100 minutes.
  • Appointment time scheduling of outpatient patients in clinic.
  • Ensuring start of clinic in time.
 https://vimeo.com/831144031
20. Wait times for starting chemotherapy (Efficiency, timeliness, patient experience and satisfaction) Reduced wait times to start chemotherapy from 10 to 5 hours.
  • Accelerated approval of chemotherapy process.
  • Prioritize blood sample collection and reporting.
 https://vimeo.com/831164334

Cohort 2021

Sir No. Quality Theme of the QI projects Quality Goals achieved Key outcomes achieved Link to A3 sheet and the Graduation Presentation
1. Effective screening of palliative care outpatients for psychosocial distress and needs (efficacy, efficiency, timeliness) Improved psychosocial assessment of palliative care outpatients from the baseline of 11% to more than 45%
  • Developed a SCREENING CHECKLIST with Designated space to identify palliative care outpatients who are likely to be "at risk" for psychosocial distress.
  • Tested feasibility of Distress Thermometer scores for psychosocial assessment in a palliative care setting
  • Tested feasibility of phone-follow-up for those unable to come and needing close follow up.
 https://vimeo.com/697271130
2. Improve the assessment of delirium in patients with advanced cancer at home care settings(efficacy, efficiency, timeliness of care) Improved assessment of delirium in home-bound palliative care patients from 25% to 50%
  • Pre-emptive screening approach led to improved patient comfort and caregiver satisfaction and QoL for ~160 patients and their families.
 https://vimeo.com/697273347
3. Improve cervical screening of women attending the general Gynecology clinic(safety, efficacy, efficiency, timeliness) The number of pap smears amongst women in the age group of 25-60 years, visiting the general Gynecology clinic, increased from the current 34% to 70%
  • The awareness on cervical cancer prevention by vaccination and screening amongst patient/family visiting general gynecology clinic from increased from 50% to 80%
  • The awareness on cervical cancer vaccination and prevention among healthcare workers in the general gynecology clinic improved from 77% to 100% .
 https://vimeo.com/697273797
4. Early integration of Palliative care in Oncology – to reduce serious health related suffering (safety, efficacy, efficiency, timeliness) Increased referral of Stage IV cancer patients from oncology to the specialist palliative care team from current 7.5% to 25%
  • Developed institution-specific “Referral criteria” through a Delphi consensus process.
 https://vimeo.com/697274979
5. Improve bed utilization in chemotherapy day care services (efficacy, efficiency, timeliness, patient experience, staff satisfaction) Increased the chemotherapy day care unit bed utilization from the existing 61 % to 75 %
  • This resulted in;
    i) Reduced waiting time for patients;
    ii) Timely administration of chemotherapy services;
    iii) Improved patient satisfaction.
  • Developed and regularized the protocol for pain assessment within the outpatient and in-patient patients records..
 https://vimeo.com/697275795
6. Improve objective pain assessment in Oncology outpatient and In-patient settings(efficacy, efficiency, safety, patient experience, staff satisfaction) Improved objective pain assessment in oncology outpatient and In-patient settings from 0% to more than 80%
  • This improvement reduced the overall hospital revisits of oncology patients from faraway locations
  • Physician training for improved communication.
 https://vimeo.com/700758539
7. Improve follow up among head and neck cancer patients post definitive treatment with Radiation The 6th month follow up of post-radiation head and neck cancer patients improved from 41% to more than 60%
  • Established a unit dedicated to teleconsultatio.
 https://vimeo.com/697285557
8. To ensure that enrolled children receive adequate and timely phone follow-up by the palliative care team.(patient experience, staff satisfaction, efficacy of care) Achieved the goal of adequate and timely phone follow-up for enrolled Children, from baseline 20% to 99%
  • This helped parents with self-management of care of their child, reduced their hospital visits, and cut down both costs as well as saved time that took to travel and see a physician.
 https://vimeo.com/700762220
9. To reduce the weight loss of head and neck cancer patients on curative radiation therapy (efficiency, safety, patient experience, staff satisfaction) Weight loss of cancer patients on curative radiation therapy decreased from a baseline average of 50% before the QI project to 20% after completion of the project.
  • Of these patients, only 22% of all patients studied had weight loss, more than 5%.
 https://vimeo.com/700761179
10. To identify and address the waiting time before chemotherapy in day care setting(Timeliness, efficacy, efficiency) The waiting time of > 90% of patients with scheduled appointments, reduced to < 2hrs.
  • The percentage of scheduled appointments increased from 21% to 42 %
 https://vimeo.com/697274496

Cohort 2019

Sir No. Quality Theme of the QI projects Quality Goals achieved Key outcomes achieved Link to A3 sheet and the Graduation Presentation
1. Improving Colposcopy coverage of camp-screened positive women (efficacy, efficiency of Preventive Oncology care) Improved colposcopy coverage in camp-screened women from the community, from 12.5% to 95%
  • Developed an App to visualize all abnormal results at once with colour triage and contact number
  • Report generation time improved with modification of staff roles and processes e.g. fixed day follow-up up visits.
  • Devised App to visualize & review the camp screen results quickly by colour coding of abnormal results.
  • Gained some ground towards WHO 2030 cervical cancer elimination strategies.
 https://vimeo.com/696043247
2. Improve identification and effective management of acute mucositis related pain to prevent drop-out from curative intent Radiotherapy for head and neck cancer patients (safety, efficacy, efficiency through treatment adherence) Reduced the prevalence of Mucositis related pain in patients on curative intent Radiotherapy for head and neck cancer, from the baseline 70% to 20%
  • 100% of patients’ pain score is documented as the care-processes changed.
  • The burden experienced by residents, technologists, & nurses were measured and found insignificant.
  • Interventions improved the patient compliance to treatment, and the overall treatment duration adhered to.
  • Reduced secondary morbidities e.g. improved the nutritional intake
  • Systematized the access of patients to Palliative care during curative phase of their treatment.
  • Better patient rapport, trust, and confidence.
 https://vimeo.com/696043956
3. Improve the initial work - up time of patients coming to the breast cancer clinic (Time efficiency, efficacy, efficiency) Reduced the work up time of breast cancer patients visiting onco-surgical unit, by 2 hours in at least 50% of patients
  • The number of mammography /weeks increased by 52% with better utilisation of the machine and operation theatre
  • The inter-team interactions became more cohesive and satisfaction of the patient improved.
  • Improved the hospital revenue; and positive influence on OP scheduling
 https://vimeo.com/696044969
4. Improving the initial work - up time of patients and reduce the time to 1st Radiation Therapy in a tertiary cancer centre : (Time efficiency efficacy, efficiency of care) The waiting time to 1st Radiation Therapy was reduced successfully from 8 hours to 6.6 hours
  • 40-man hours of working day and 80-man hours of waiting time /day
  • The satisfaction scores (VAS score) of patients, caregivers, and RT technicians and Drs improved
  • The altered processes improved the audit possibilities of electronic documents pre-Radiotherapy
 https://vimeo.com/696041000
5. Improving in-patient referrals from Oncology to Palliative Medicine (Early Integration of Palliative care in oncology) Improved the percentage of referrals from oncology to palliative care from 12% to 50 %
  • Developed a structured referral form with a built-in feedback form.
 https://vimeo.com/696042518
6. Implementation of Palliative Care for critically ill cancer patients in the ICU (Efficacy, efficiency, equity by Integration of Palliative Care in oncology Critical Care) Improved the reference rate of critically ill cancer patients in the ICU to access palliative care, from zero to 50 %
  • Developed the institution-specific trigger tool for Palliative-care referral
  • Achieved major practice change: patients began to get admitted directly for supportive care, without entering ICU.
  • Policy change achieved- mandatory use of the tool for all ICU patients
 https://vimeo.com/696042028
7. Improve Patient satisfaction by reducing waiting Time in PC OPD (Time efficiency) Reduced the waiting time at the Palliative care OPD from 35 minutes to 20 minutes
  • Improved patient – staff relationship
  • Efficient functioning of OPD processes.
 https://vimeo.com/696045489
8. Setting culture appropriate standards for a comfortable dying of terminally ill cancer patients at home (efficacy, efficiency through care continuum, timeliness) Incorporated advance care directives into EOL care policy where none existed
  • Ensured satisfactory end of life care within the community settings.
  • Improved staff satisfaction in the care of the dying patients with advanced cancer from current 6 to 8 by the end of the project.
  • Developed a bereavement policy
  • Cultural change in the organisation towards death and dying
  • Improved the satisfaction of families, with care provided
  • Increased donations to support activities of the organisation
 https://vimeo.com/696044514

Cohort 2018

Sir No. Quality Theme of the QI projects Quality Goals achieved Key outcomes achieved Link to A3 sheet and the Graduation Presentation
1. Assess death and dying experience of patients who died in IPM (Quality of Death). The team achieved a rate of assessment of death and dying experience of in-patients from the family caregivers perspective from 0% to 100% during the project period
  • Developed a Tool to assess death and dying experience.
2. Improve documentation and data recording in the palliative clinic of a tertiary cancer care centre(Safety, efficacy of care, efficiency, staff satisfaction) Improved the percentage of complete documentation of PC Home Visits from zero to 90%.
  • Care coordination and triaging of patients improved.
3. To improve turnaround time in decision -making for patient support – at a community based cancer support organisation(Time-efficiency) The team was able to reduce the turn-around time from the patient's 1st visit with application for economic support, to activating medical support from a baseline of 46 days in Dec 2018 to 15 days by June 2019
  • Tool developed for patient/families to provide feedback regarding delays in patient support
 https://vimeo.com/696044969
4. Improving nursing staff satisfaction in the in-patient Palliative care unit at a tertiary cancer care centre (Safety, timeliness, efficacy of care) The team improved the satisfaction score of IP nursing staff on the clarity of doctor’s orders and care-plan, from the baseline of 4/10 to 9/10 (0= not satisfied at all & 10= completely satisfied)
  • Developed Questionnaire tool - used during admission, during daily rounds and during discharg.
 https://vimeo.com/696041000
5. Quality initiative to improve daytime discharge process at the in-patient palliative care unit at a Tertiary Cancer Care Centre(Timeliness, staff satisfaction, patient experience The average discharge time was reduced from baseline 3.5 hours to average 45 minutes across the project time
  • Improved the patient experienc.
  • Improved staff satisfaction
  • Improved turn over as it released in-patient beds for others in need
6. Lack of a structured screening program to identify patients to be prioritized for home care and insufficient number of home visits. (Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) The number of home care for identified patients increased from 5 home visits per week to 10 per week by June 10th, 2019.
  • ESAS based triage for patients for Screening and identifying needs of patients actually requiring Home based Palliative care services - achieved by 28th February 2019.
7. The comprehensive assessment of patients attending out-patient palliative care clinic was not standardized -Tertiary Cancer Care Centre ((Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) The percentage of patients attending out-patient palliative care clinic receiving a comprehensive patient assessment, increased from 29% to 55%
  • Utilised the 4S form, to document the somatic, social , spiritual, and psychological domains (and consent) as comprehensive assessment of a patient in outpatient palliative care

Cohort 2017

Sir No. Quality Theme of the QI projects Quality Goals achieved Key outcomes achieved Link to A3 sheet and the Graduation Presentation
1. Activate early palliative care referral for patients with advanced Oral Cancer by a tertiary cancer centre The delays for referring patients with oral cancer to the palliative medicine clinic decreased from a baseline average of 48.02 days to 12.94 days by the end of the project period
  • Documentation of symptom burden became a routine process during oncologist consultations, which is a marked change in practice, after the referral protocol was implemented was implemented.
 https://vimeo.com/698960757
2. Improve satisfaction of the home-care unit with the quality care delivered to registered patients by a community-based palliative care organisation. (Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) The satisfaction of home-care unit staff during the project period progressively increased from baseline of 5.82 –7.6 by the end of the project period
  • An algorithm-based triaging process based on the intensity of care needs was developed.
  • A field support team was established to respond to the logistical concerns and to manage unplanned homecare
  • An additional homecare team got activated to respond to unplanned urgent home visits
  • The homecare brochure developed during the project continues to clarify the non-emergency nature of homecare service and what may or may not be expected
  • The project activated a grant for an Integrated Hospital Based Continuity of Care project which supports patients in all settings and the triage is done using the tool.
 https://vimeo.com/698959466
3. Initiate documentation of prognostic discussions of patients seen by the community-based palliative care organisation. (Efficiency, timeliness, efficacy of care, staff satisfaction, patient experience) Increase in the documentation of discussion on prognostication with patients and families, from baseline zero to 75 %
  • The newly developed form was found to serve also as a conversation guide, and improved confidence levels of team members in engaging with patients
  • It further simplified and streamlined the discussion on prognostication as a routine sustained process.
 https://vimeo.com/698962734
4. Identify and improve referral of patients by the community for homecare services provided by the community-based palliative care organisation.(Timeliness, efficiency of care) Outcome was a document with details on homecare for the public to understand about its nature of care, what services are provided etc
  • Another document to decide the frequency of homecare as per the symptoms was also made.
 https://vimeo.com/698961979
5. Identify patients who need palliative home care the most, and address their needs through homecare service -study at a tertiary cancer care centre: (Timeliness, efficiency of care) Improved the number of weekly Home-based care visits from two at baseline to over 6/week.
  • The team created an electronic medical record system to register and triage patients, with mapping of their location and follow-up using unique codes.
 https://vimeo.com/698960228
6. Improve the rates of early palliative care referrals for outpatients with lung cancer in a tertiary cancer centre .(Timeliness, efficiency of care) Increase in referrals of needy patients to palliative care from an average of 50% to 75%
  • The learning from this project triggered other studies employing A3 methodology-based QI project in other domains.
 https://vimeo.com/698961452
7. Facilitate appropriate medical decisions at the hospice by improving the access to the required information (safety, .(efficacy, efficiency of care) The confidence score of the hospice doctor regarding the goals of care of patients transferred from hospital to hospice improved from baseline of 1.5/10 to 6.5/10
  • The coordination and communications between the involved teams at the hospital, and hospice accentuated the care provided
 https://vimeo.com/698958434