When time matters: a qualitative study on hospital staff’s strategies for meeting the target times in cancer patient pathways

Abstract

Background Cancer patient pathways (CPPs) were introduced in Norway in 2015. CPPs are time-bound standardised care pathways that describe the organisation of and responsibilities for diagnostics and treatment, as well as communication with the patient and next of kin. The aim is to ensure that cancer patients experience a well-organised, coherent and predictable pathway without any delays in assessment and diagnostics caused by non-medical reasons. Preventing delays in diagnostics by meeting specific target times is central to the successful implementation of CPPs. The aim of this paper is to describe how hospital staff cope with the increased focus on meeting CPP target times and the measures and strategies implemented by hospitals and their staff. Methods Data for this paper were collected in a larger study on implementation and experiences with CPPs among hospital staff, general practitioners, and patients in Norway (2017–2020). The study had a qualitative cross-sectional design, and data were collected through interviews. This article is based on semi-structured interviews with hospital staff (N = 60) in five hospitals. Results Hospital staff are highly aware of the target times, and try to comply with them, in the interest of both the patients and the hospitals. The implementation of CPPs was not accompanied by the allocation of additional resources; therefore, hospitals could not simply increase capacity to meet the target times. Instead, they had to develop other strategies. Four categories of strategies were identified: (i) introducing new roles and more staff, (ii) reorganising the workflow, (iii) gaming the system and (iv) outsourcing services. Conclusions Hospital staff are torn between meeting the target times and a lack of resources and capacity. This is not unusual in the current healthcare context, where staff face organisational reforms and increasing demands on a regular basis. It is important to recognise frontline workers’ efforts towards realising new organisational changes. Therefore, carefully weighing the benefits against the costs and undertaking the necessary planning are important in the design and implementation of future care and treatment pathways for patients.

Exploring wait time variations in a prostate cancer patient pathway—A qualitative study

“…20 Yet another study found connections between wait times and lack of resources and capacity, and stated that hospital staff were torn between meeting the target times and a lack of resources and capacity. 21 This corresponds with our findings. Lastly, we refer to Kreindler, who stated that successful wait reduction entails ensuring that sufficient capacity exists, and applying sustained intervention to ensure that this capacity is well used.…”

“…A common perception among respondents in this study turned out to be that even though professionals made strong efforts to achieve the target times in one part of the system, the lack of resources, competence, or initiative in another part of the system hindered the processes and created bottlenecks in the system 20 . Yet another study found connections between wait times and lack of resources and capacity, and stated that hospital staff were torn between meeting the target times and a lack of resources and capacity 21 . This corresponds with our findings.…”

Merging existing practices with new ones: the adjustment of organizational routines to using cancer patient pathways in primary healthcare

“…As intended, PHC providers used CPPs as a tool to facilitate a faster patient flow within the PHC units by referring to the alarm symptoms associated with specific forms of cancer in each CPP and following the procedures described in the CPP accordingly. Even so, PHC providers observed that using CPPs risked prolonging the waiting time for other patient groups, as previous studies found in secondary care as well [ 32 , 33 ]. Nonetheless, the bulk of our results show that the adoption of CPPs had unintended consequences for the organizational routines in the PHC units.…”

Equitable access to cancer patient pathways in Norway – a national registry-based study

“…Wilkens et al discuss challenges with possible crowding-out effects as a result of implementing CPP [ 5 ]. A Norwegian study, with interviews of physicians and patients, indicated possible crowding-out effects as a result of the standardised target times in CPPs [ 35 , 39 ]. In a qualitative study on CPP in Sweden, implementation of CPPs was accompanied by unintended effects such as longer waiting times for other patients and patient groups in need of the same health care resources [ 40 ].…”