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Sunday, August 2, 2009


Mr. Leahy is a seasoned registered nurse currently managing a 4,000-patient-per-year outpatient otolaryngology (ENT) clinic in a major Washington, DC medical center.  He aspires to make a unique contribution to health care by combining his nursing experience with his business experience.  Mr. Leahy has degrees in Business Administration and advanced Accounting.  He also has corporate and small-business experience in budgeting, financial planning, financial management, project management, proposal writing, and administrative management.   Mr. Leahy’s nursing experience includes 10 years in bedside intensive care. 
 While managing his 4,000-patient-per-year, Mr. Leahy was able to manage his schedule to serve as Cancer Treatment Coordinator for the Otolaryngology (ENT) service of a Washington, DC medical center, Feb., 2009-May, 2012.  Mr. Leahy’s results were so dramatic that the Medical Center made a public display about his work in its Inspiration Hallway section from August 2010 until early 2012.  By creating and managing a 7-element cancer care navigation system, he helped reduce the time from initial ENT consultation to the start of treatment from an average 100 days to less than 30 days.  This is important because cancer treatments are most effective when performed early.

Mr. Leahy designed the Plan of Care Exceptions Report (POC) as one element of this 7-element care navigation and management system. The Plan of Care Exception Report (POC) went live in May 2011. It’s purpose is to quickly identify patient non-compliance and similar deviations from cancer treatment plans.  For ENT cancer patients, the report identifies all missed appointment throughout medical center.  It also gives an indicator of why the appointment was missed – patient cancelled, clinic cancelled, no-show, etc.  It calculates a reliability factor to measure how often their appointments are kept, and it also lists when the patient was last seen In the ENT Clinic and when he is scheduled to be seen next.  Deceased patients can be included or excluded, or you can print a report for only deceased patients.  The medical center is now preparing to roll out the program to other services besides ENT and  other medical centers in the region.

The Plan of Care Exceptions Report was not developed in a vacuum.  In February, 2009, the ENT Chief was grappling with serious delays in the treatment of ENT cancer.   She tasked Mr. Leahy to expedite treatment of Head and Neck cancer patients.  In response to this assignment, he created a 7-element care navigation and management system.   It’s purpose is to track, coordinate, instigate, facilitate, and educate.  The graph below shows success in reducing the average time from initial ENT consult (or other “start” event) until commencement of treatment (or negative diagnosis).   This “days-to-begin-ENT-cancer-treatment” has fallen from 100 days at the beginning of 2009 to around 30 days  as of May 31, 2012.  The improvement from 100 days to less than 30 days was dramatic enough that the Medical Center displayed a poster and graph about it in the “Inspiration Hallway” public area for nearly a year and a half, until early this year.
The Seven Elements of Expediting Cancer Treatment Employed by John Leahy for Head and Neck Cancer, February 2009 – May, 2012.
ONE: Early identification of potential cancer patients by frequent review of new consults. Here’s an example of how this benefits veterans:  While reviewing consults in early June, 2012, Mr. Leahy realized that 2 consults sounded like probable head-and neck cancer, and they both had initial ENT Clinic appointments scheduled for June 27.  I phoned both veterans and changed their appointments to June 7.  On June 7, both came to clinic and both were bona-fide ENT cancer cases.  End result: By simply looking at their consults and acting early, Mr. Leahy advanced their cancer treatments by 20 days each before they had even seen an ENT physician!
TWO:  Setting aside a block of appointments every week specifically for patients who should not wait for a “next-available” appointment, but instead should be seen on an expedited basis.
THREE: Establishing an Excel-based work breakdown structure, or plan, for each cancer patient’s prospective diagnosis and care.  Each patient’s treatment is treated as an individual project to be managed and expedited.  Each patient’s WBS-sheet also serves as a place for memos about plans, problems, and face-sheet data.  This is where Mr. Leahy tracks  what is planned and what has happend for each patient.
FOUR: Maintenance of an Outlook based task list to make sure planned elements of cancer treatment do not fall through the cracks.  A perfect example this benefits veterans happened this week.    Mr. B had been diagnosed in September 2011 with buccal SCCA, easily cured if treated early.  Mr. B had had stubbornly refused to come to the hospital for treatment.  ENT physicians had declared that no further effort was needed because the patient had refused care.  But the Mr. Leahy made an entry onto his task list to try again later .  When the “try again” task came due, he crafted and mailed to Mr. B  a special letter designed to be opened,  read carefully, and not thrown in the trash without due consideration.  Two weeks later, Mr. B phoned Mr. Leahy.  Mr. Leahy outlined the long-term danger of the cancer and  encouraged Mr. B to talk about why he was refusing care.  He confided that he was afraid.  He and  Mr. Leahy talked together about fear.  At the end of the conversation, Mr. B accepted an appointment for June 12, and agreed to not miss that appointment no matter WHAT might happen.  On June 12, he came to clinic as promised -- even though he only had one leg and needed to take a taxi with his wheelchair.  His cancer was excised then-and-there in ENT Clinic.  Days-to-Treatment: 303 – which is why that third-quarter-2011 spike in the above graph represents an accomplishment, not a setback.
FIVE: Establishment of a calendar so that we can see important elements of what is happening with all ENT cancer patients on any particular day
SIX:  Identification of non-compliant patients and other deviations from the treatment-plan using the Plan of Care Exceptions Report
SEVEN: Establishment of a repeating list of cancer patients needing post-treatment or during-treatment follow-up, with frequencies that vary from q-month to q-year.  This ensures that post-treatment Clinic follow-up visits do not fall through the cracks.
Mr. Leahy lives in an old farmhouse in the Washington, DC suburbs.  He and his wife have four daughters.  He enjoys reading, hiking, photography, and trap shooting.

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