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Cancer Solutions: Integrating e-learning and Quality

South Eastern Sydney Illawarra Area Health Service

Abstract

Education of staff is key to delivering quality care and managing change. Existing systems for delivering education are fragmented and inefficient. E-learning addresses some of these issues but significant challenges exist to ensure that any system meets institutional needs and is driven by a quality agenda.

An online platform for education within the South Eastern Sydney Illawarra Area Health Service (SESIAHS) Central Hospital Network, Cancer Services has been developed. This includes an online learning and information manual and courses for specific disciplines. The project was based on priorities derived from staff workshops and quality priorities. Utilisation of e-learning has been integrated with face to face teaching and orientation activities. Overall levels of satisfaction with the program are high and error rates have been reduced in targeted areas.

Aims

  • To develop an e-learning system for staff in a Comprehensive Cancer Centre
  • To integrate learning with quality objectives
  • To enable sharing of resources within Cancer Services

Nature of the Problem

Education of staff is key to the quality of care. The previous educational processes were inefficient. Educational resources were poorly utilised, often duplicated and difficult to access.

New medical and nursing staff rotate into Cancer Services every 3 months. The amount of information required continues to increase dramatically and had become difficult to prioritise with limited time allocated to orientation. Pre-existing orientation strategies were based on a paper manual and brief group sessions, which was not conducive to individualised learning.

An overall strategy addressing educational needs and professional development of our longer-term staff was also lacking.

Extent of the Problem

The key problems identified include:

  1. No coherent strategy regarding education across Cancer Services.
  2. No knowledge of what educational resources were available within Cancer Services.
  3. No data available on utilisation of existing educational resources.
  4. Poor access to existing paper resources at point of care.
  5. Poor utilisation of paper resources at point of care.
  6. Minimal sharing of existing educational resources.
  7. No mechanism for collecting or incorporating feedback about educational activities.

Strategic Importance

Education is a paramount strategy to ensure quality of care and implementation of change. The Cancer Solutions e-learning platform aligns primarily with Strategic Direction (6) “building a sustainable health workforce” by addressing the educational needs of the workforce, encouraging job satisfaction and retention; Strategic Direction (2) “creating better experiences for users of health services” through addressing issues in the quality of care; and Strategic Direction (7) “being ready for new risk and opportunities”. Any approach to new risks and opportunities is going to require a flexible and efficient framework for education and training about the response to these challenges.

Planning and Implementing Solutions

A piloted e-learning program identified potential solutions to many of the above problems. Subsequently, a plan to expand and integrate the system with organisational priorities was developed. These priorities included:

  1. Setup a project executive to determine priorities with representatives from medical staff, nursing education and the Quality Committee.
  2. A project grant was obtained from Cancer Institute NSW to fund the project development.
  3. Utilise network of computers recently installed for electronic medical record.
  4. Facilitate workshops with each discipline group to identify educational priorities based on need for quality improvements..
  5. Develop and peer review e-learning and other online content.
  6. Provide training to staff using the system.
  7. Consult with the Area Organisational Learning Unit regarding development and integration of resources.
  8. Integrate and seek partnerships with existing educational resources and stakeholders (Cancer Australia, Royal Australian College of Physicians).

There is now a comprehensive online resource that deals with essential issues for training such as how to: manage our patients; use the electronic oncology record (VARiS); organise procedures; break bad news; and deal with emotional stress.

There are courses designed for medical undergraduates, junior medical staff; oncology advanced trainees, new graduate nurses and oncology clinical nurse specialists.

This resource is used to drive orientation of new staff as well as facilitate professional development of existing staff.

Issues identified by the quality committee requiring educational input are now incorporated into Cancer Solutions, which include the design of specific activities to address the issue.

Other features include utilisation of existing online resources; automatic feedback on participation and course utilisation; integration of self-assessment tasks with educational content; centralised library of resources (images case studies etc.) to facilitate efficient development of new content and sharing amongst disciplines; and built in course assessment and feedback for further improvements.

Outcomes and Evaluation

The existence of a comprehensive online resource is the main outcome.   We have 252 registered users. 53 have completed the medical orientation program. In the last orientation the proportion of users rating 5/5 was (83%) for effectiveness and (100%) for  relevance.  There has been 100% compliance with successful completion of the orientation program for residents and new graduate registered nurses.

60% of New graduate nurses completed the optional learning modules. All staff indicated the program supported their clinical practice.

As an example of improving quality of care, in one specific program, we have reduced intrathecal chemotherapy policy non-compliance to 0% (previously one incidents monthly).

Without improved education strategies, it is not possible to achieve key NSW State Health targets. Priority Number 3 of the NSW Cancer Plan 2007 –2010 is improving cancer services and professional education. 

Key targets of this priority include integration of infrastructure across Cancer Services; improved access to educational resources for rural areas; a multidisciplinary approach to care, education and professional development; and better coordination of Specialised Cancer Care Programs such as The NSW Oncology Group. As the Cancer Solutions site matures the above key targets can be addressed.

Sustaining Change

Sustaining Cancer Solutions is critical to our responsibility to develop and support our clinical staff and ensure we are able to meet the future demand for cancer services expected with an increase in the numbers of cancer patients. Significant effort has gone into making these changes sustainable. These include:

  1. Building participant buy in through initial workshops and attempting to meet suggestions for improvement.
  2. Broadening the skill base by training a broad range of staff in contributing to system development.
  3. Diffusion of content responsibilities throughout Cancer Services.
  4. Incorporating content development into existing educational tasks.

Future Scope

The future scope of Cancer Solutions has State and National appeal and relevance.  The lessons learnt from this project are fundamental and applicable across other cancer centres and health services. National programs currently under development as a result of this project include: Accreditation for prescribing chemotherapy (National Prescribing Service); and  pharmacology for oncology trainees (Medical Oncology Group Australia).

It is intrinsic to the project that the system can be adapted and modified easily and tailored to address individual facility considerations.

The development skills obtained are transferable through the development of standard operating procedures and through mentoring staff in other services.

Project Team

Matthew Links, Winston Liauw, Chris Sargeant, Patrice Thomas

Contact

 

Date created: 4th Nov 2008 | Date reviewed: 4th Nov 2008