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DF/BWCC’s vision
Aa s part of an ongoing effort to create a model cancer center that integrates the impressive resources of two top institutions, Dana-Farber Cancer Institute (DFCI) and Brigham and Women’s Hospital (BWH) have intensified their vision and commitments and made organizational changes to strengthen their joint program in adult oncology, the Dana-Farber/Brigham and Women’s Cancer Center (DF/BWCC).
The moves, which continue a growing partnership, include articulating a single vision, establishing a single senior leadership, setting joint goals and priorities, advancing the 12 multidisciplinary disease centers, and creating the look, feel, and impact of a program with unified direction and competitive muscle.
DFCI moved its adult inpatient beds to neighboring BWH in 1997, and, at the same time, BWH transferred its hematology and oncology outpatient services to DFCI. The two hospitals have worked to complement and coordinate their medical oncology, surgical oncology, nursing, pharmacy, psychiatry, pain and palliative care, infusion, radiation oncology, transfusion, nutrition and other cancer support services.
“We are using a single set of tools and approaches, establishing single leaders and leadership forums, and devising a single set of best-practice standards to be applied through the whole cancer experience,” said Dana-Farber President Edward J. Benz Jr., MD, who serves as director of the DF/BWCC. Brigham and Women’s Surgeon-in-Chief Michael Zinner, MD, is clinical director.
Executive management for the center also includes Deputy Director of Operations Jim Conway (DFCI’s executive vice president and chief operating officer); Patricia Reid Ponte, RN, DNSc, (DFCI’s senior vice president for Patient Care Services and chief of Nursing, and director of Oncology Nursing and Clinical Services at BWH); and Roger Deshaies (chief financial officer at BWH). Larry Shulman, MD, (DFCI’s senior vice president for medical affairs and chief medical officer) will lead the initiative to establish the center’s regional presence through the development of networking satellite facilities and enhanced relationships with our community colleagues, while Dianne Cerce (BWH’s executive director for oncology services) assumes the role of the center’s key administrator.
Meeting weekly, and reporting to the CEOs of both institutions, this group will set the vision and strategy for the center (see below, left) and coordinate its operations. Representatives from the DF/BWCC’s multidisciplinary disease centers – each focused on a single cancer group – will regularly discuss program and research development. Consistent with the partnership’s commitment to patient- and family-centered care, patients will be represented at appropriate operating meetings.
“Patients who are diagnosed in an outpatient setting and then require inpatient care may, at times, feel as though they are at two separate institutions,” said Zinner, who has watched BWH’s relationship with DFCI grow over the years. “We want to make them feel like they are under the roof of one cancer center devoted to seamless patient- and family-centered care. Institutional identity must be preserved, and both sides must work together to make the whole greater than the sum of its parts.”
Access is key One major improvement will be in the area of patient and referring physician access. The leaders’ short-term vision is that all prospective patients, on their initial phone call, will be directly linked to the appropriate new-patient coordinator through a single call center representing the DF/BWCC. Whereas patients now register separately and receive an identification card for both hospitals, the goal will be to have one check-in card for the center. A fully integrated paging system is currently being implemented. “In addition,” said Conway, “throughout the cancer center, you are going to increasingly see single leaders integrating all activities.”
Another evolving area of partnership is facilities management. In the past, staff from BWH and DFCI made independent plans for physical expansion, then shared their decisions with each other; now, choices are being made together with a cohesive single center in mind. Recent examples include planning for radiation oncology, as well as a new 10-bed inpatient cancer unit on 4C of BWH that supports services delivered by DF/BWCC staff.
“The new inpatient beds are a step, and we’d like to integrate that concept further,” said Zinner. “Not every cancer patient needs to have decisions made with a surgeon, medical oncologist, radiation oncologist, or other specialists present, but some do. If we could have high-volume multidisciplinary clinics next to specialized, discipline-based clinics, then we would all become more efficient.”
Crossing bridges The DF/BWCC will encompass the cancer programs at the two partner hospitals, as well as at Faulkner Hospital, Brigham and Women’s at Chestnut Hill, and other satellite locales. Services will cover the full continuum of care – screening, prevention, diagnosis, treatment, survivorship, palliative care and end-of-life care.
The center’s initial focus is on clinical operations and program development. While the two lead organizations retain individual research programs and operations, they are pursuing joint efforts in translational and clinical research – such as joint recruitments. The DF/BWCC’s value can already be felt; during 2003, some 20,000 patients were seen in the multidisciplinary care centers.
“Our goal is that in the near future, somebody walking across the bridge from BWH into DFCI will pass smoothly from one set of cancer clinics to another and feel they’re in the same place,” said Benz. “That’s where we are headed.”