We must do better for our patients: Tackling the anxiety that comes with Cancer
By Dominique Bird, Acting National Director for Quality Safety and Improvement, NHS Wales Performance and Improvement and Chair of the Faculty Members for the All-Wales Cancer Cellular Pathology Collaborative.
We’re two months into the All-Wales Cancer Cellular Pathology Collaborative officially starting and work has progressed since we had the first learning session.
For those who aren’t familiar, cellular pathology is the study of cells, tissues, and organs to diagnose diseases. It involves examining tissue samples and cell samples to identify abnormalities and determine the cause and effects of diseases, particularly cancer.
Cellular pathology is just one part of the cancer pathway, which is the journey a patient takes from initial suspicion of cancer to diagnosis and treatment.
We recently had our first shared learning session where teams in cellular pathology labs from six health boards across Wales met to share updates. Discussion was fruitful and it’s safe to say that teams showed psychological safety, being candid with their progress. This feeling of openness fostered a collaborative environment; so much so that some health board teams have joined forces to collectively work on their ‘Takt time’, a term that is used for identifying processing time required to match demand.
“An extensive wealth of knowledge in Cellular Pathology teams”
Shared learning sessions are typical of the Institute for Healthcare Improvement (IHI)’s Breakthrough Series (BTS) Collaborative model, which is what we’re using for the Cellular Pathology Collaborative.
A Collaborative model is based on a series of in-person and virtual learning sessions with action periods in between, where teams look to trial the improvements and report back if they’ve been successful. Effective improvements can then be spread and scaled to other teams, settings, organisations or even internationally, so improvements can be made on a larger scale.
The proven approach allows organisations to share and learn from each other and other experts in the field. After working with cellular pathology teams in health boards and trusts since 2022, we recognised their extensive wealth of knowledge and expertise in the field and seen firsthand the improvements they’ve made using lean methodology in their areas. You can read more about this work on our website.
A voice for the many
The collaborative is just one element of the overall work being done to improve pathology services across Wales. To ensure a joined-up approach across the different programmes, we have experts in pathology and cancer established in the collaborative as faculty members.
Faculty members range from clinical leads in their fields including from the Strategic Programme for Planned Care, National Pathology Programme and Suspected Cancer Pathway to Consultant Pathologists and Clinical Psychologists. As Chair of the faculty members, I’m pleased to see the breadth of proficiency we have feeding directly into the collaborative and helping shape the priorities.
The first time that teams met together was at our in-person learning session in April. During the session, teams heard from our faculty members on the purpose of the collaborative, the use of AI in the work and creating the culture for improvement work to thrive, among other topics. Our meeting space was also turned into a lab simulation where teams had to increase the number of ‘paper’ samples effectively going through the lab stages (see pictures below).
But arguably, the standout part of the day was hearing from our public contributor, David Edwards, who gave a voice to the many people who undergo tests for a suspected cancer.
David shared his story on how he went to his GP about a hernia and mentioned about a lump he had found on the off chance, not suspecting it may be cancer. It was only when he had been referred to Velindre NHS Trust and the possibility of cancer set in, that his mindset had changed.
“My GP referred me to the Ear, Nose, Throat (ENT) department in Cardiff for the lump so I didn’t think anything of it. I was still going to work, and it didn’t really affect me. When they then said I was going to be referred to Velindre that’s when I thought the worst – this could be cancer.”
In between his first appointment with his first GP to his final appointment, months went past, and, on some occasions, he attended appointments where teams didn’t have his results to share, further increasing David’s anxiety.
“If you think of people waiting for their results, even to be told if it’s not cancer, it doesn’t just affect that person – it can affect up to 20-30 people. For example, loved ones, family members, friends, work colleagues, neighbours are all waiting to hear with you. It causes a ripple effect and varying levels of anxiety. And trust me, that anxiety never goes for someone who thinks they may have cancer.”
During the session, David personally thanked the cellular pathology teams for doing their bit and playing a huge part in his cancer journey. Typically, patients like David only meet medical and nursing staff and don’t get the opportunity to encounter staff from the diagnostic part of the cancer pathway. Diagnostics can often be seen as the unsung part of the cancer pathway, but it plays a vital role; these are the staff in laboratories examining biopsy samples to help determine if patients have cancer.
Hearing from David brought home the reason why we’re doing the work in the first place – to give our patients a timely diagnosis and reduce this anxiety for our service users. We must do better by them.
Using a co-design approach
The only way to create conditions for these improvements to spread is for teams to engage from the start. This is why we we’re taking a co-design approach to the collaborative. Even the overall aim of the work has been recently amended thanks to direct feedback from teams.
By working with staff on how we can overcome hurdles, make improvements, and spread and scale these changes to other areas and teams, we’re making positive progress in our efforts to achieve the Suspected Cancer Pathway target and make the wait a little less anxious for our patients.