Collaboration is a key tenet of health care. Considering the countless day-to-day interactions—whether it’s between an intake specialist and a nurse or between physicians as they interact over an electronic health record—health care professionals know how essential it is to work with one another to provide the best possible care for their patients. Pathologists and other laboratory professionals are well aware of the critical role that pathology and the medical laboratory play as a focal point in the health care system to ensure consistently accurate and timely results for patients.
Joseph Khoury, MD, FCAP, and his colleagues at MD Anderson Cancer Network practice this type of collaboration and cooperation between their hospital and MD Anderson’s laboratory in Houston and laboratories at different hospitals and health care systems across the United States and the world.
MD Anderson Builds Network of Quality
Building bonds with like-minded institutions is essential to the fulfillment of The University of Texas MD Anderson Cancer Center’s mission to end cancer. Such relationships allow MD Anderson to expand its impact beyond the institution’s geographic footprint and help disseminate best practices and clinical integration. For the past 10 years, this has been accomplished thanks to the network’s structure of affiliates—designated as certified, associate, or partner members differentiated by their level of clinical integration and collaboration. Dr. Khoury, executive director for pathology and laboratory medicine across the Cancer Network, thinks MD Anderson’s record of providing top-quality, leading-edge cancer care and integration of expertise makes it a model to be emulated.
“When you have collaborative partnerships with a hub institution that is well known for excellence in a high-stakes discipline such as cancer,” Dr. Khoury says, “that creates a very fertile and dynamic platform for ongoing information exchange and knowledge dissemination fueled by constant interactions across a broad collaborative framework.”
MD Anderson operates with three guiding principles when it comes to cancer care, across Houston and across its network of affiliates: 1) disease-focused multidisciplinary care, 2) consistency through evidence-based algorithmic approaches, and 3) a robust, ongoing quality management program.
Disease-Focused Teams Shape Care
As much as possible and depending on the infrastructure and size of a given hospital, Dr. Khoury and his team work to harness the advantages of subspecialty focus as a means toward achieving the most effective and impactful level of cancer care.
“Clinical providers, including pathologists, practice as subspecialists at MD Anderson, and this is among the most important elements in making our institution a world leader in cancer,” says Dr. Khoury. “Accordingly, we work closely with our partner members to help them achieve a level of subspecialty focus that works best for their setting. We invite them to come to Houston and spend time integrated into one of our 12 subspecialty pathology teams to build bridges, build relationships, and see how our model of care works in daily practice.”
And this isn’t an exercise in taking two steps back to the classroom or conducting a brief CME course, Dr. Khoury points out. He is aware of the knowledge and experience of partner member physicians. He puts it another way, “Not that we think we can necessarily teach our colleagues anything new—because many come with a significant number of years of experience—we primarily want to expose them to the way we practice at MD Anderson.”
Dr. Khoury and the network team, along with their counterparts at partner sites and other affiliates, identify areas of need and opportunity on which they want to focus and help their affiliate become a leader in a particular marketplace. So, depending on the institution’s needs, the practice’s pathology structure and volume, and the training background of the pathologists, they might select one, two, or sometimes three disease areas (eg, breast, lung, or gastrointestinal cancers) as declared subspecialty focus areas. Once these areas are identified, the pathologists are encouraged to become second-opinion resources for their team and to spend a sizeable amount of their continuing medical education on their focus area or areas.
Dr. Khoury contends that not only does subspecialization improve the quality of patient care, but it also positions pathologists as experts alongside subspecialized oncologists, surgeons, radiation oncologists, and other members of a disease-focused multidisciplinary team.
“If you’re sitting with a team discussing state-of-the-art biomarker testing in lung cancer, for example, you can come to the team as a general pathologist, and that’s certainly OK, but think how much better it would be if the pathologist, the oncologist, the surgeon, and everyone else at the table focuses on lung cancer and has insight and up-to-date knowledge of that disease,” Dr. Khoury says.
Patients Receive Consistent, Adaptable Care
Secondly, Dr. Khoury and his colleagues focus on pathology and laboratory logistics and processes so that “patients are managed along predictable but appropriately nimble algorithms,” he says, allowing patients to be properly diagnosed and treated, regardless of when they come in or which physician happens to have a hand in their care. Dr. Khoury believes that consistency and a “checklist paradigm” is a highly valuable trait in health care, much like it is an expectation in the aviation industry and other high-stakes fields where errors must be kept to an absolute minimum.
For pathology and the medical laboratory, it requires the pathologist’s oversight and expertise to ensure that patient samples are handled along standardized procedural guidelines that establish testing consistency and accuracy.
Dr. Khoury says, “We have a set of diagnostic approaches, biomarker assessments, and other laboratory tools that help streamline the process and, as much as possible, help avoid the possibility of leaving a stone unturned for each and every patient who seeks care at our institution. We do our best to export our processes in a smart and measured way to our network affiliates depending on their local needs and scope of services.”
Laboratory Leads Quality Management and Improvement
The third main guiding principle for MD Anderson and its affiliates is quality. Quality, safety, and accuracy have long been a priority in the laboratory through regulatory and accreditation measures by organizations such as the CAP and its accreditation and proficiency testing programs. MD Anderson developed standardized processes that start from patient intake and extend throughout their patient’s journey with cancer and into survivorship. Built into each of these processes are quality elements and metrics.
“Compared to other specialties, we are really leaders in terms of quality management and quality improvement; to a large extent due to the nature of our specialty lending itself to quantitative measurements of quality,” says Dr. Khoury.
Investments in quality are oftentimes difficult to measure in fiscal terms. Putting a value on quality-improving activities in tangible revenue terms is often challenging, and this sometimes creates a disconnect between best practices and the need for hospital administrators to keep an eye on the fiscal health of the hospital, practice, institution, etc.
Dr. Khoury says, “Communication and a goal-oriented mindset are the way to balance the two sides of this equation, but quality should always be allowed to tip the balance in its favor, all things being equal.” He contends that the continuous emphasis on quality in laboratory medicine and pathology promotes both patient safety and financial security.
Dr. Khoury is quick to point out that quality should be everyone’s concern. “We learn a lot from our partners. In a large and complex cancer institution, there is always room for improvement,” he says. “We look often at our partners to learn and see how they do things; we do also bring valuable knowledge back to our institution; a two-way knowledge exchange process, that is how we think it should be.”
New Technologies Extend Collaboration
While MD Anderson collaborates with laboratories at other hospitals to identify gaps and focus on specialization, consistency, and quality, Dr. Khoury says he is constantly looking beyond the horizon for ways in which collaboration across the Cancer Network can be augmented further. He sees a lot of potential in digital pathology, which is currently at an inflection point in the United States.
Using its existing infrastructure and electronic health record systems, MD Anderson would potentially be able to become a resource for its network affiliates. Dr. Khoury believes this can be achieved in a variety of ways, “including second opinions, subspecialty support, education, and quality improvement.”
Dr. Khoury sees a big-picture outcome for this type of system. He says, “Through digital pathology, MD Anderson can provide subspecialty expertise in a timely and almost seamless way for our partner sites, thus allowing our fantastic pathology team in Houston in collaboration with colleagues at affiliate sites to improve the care of millions of patient lives through our network partnership and technology.”
Dr. Khoury predicts, “The potential impact of new technologies like digital pathology and clinical-grade artificial intelligence applications will only continue to grow, especially when laboratory professionals work together and with their hospital leadership to develop collaborative communities of care.”