Wilmot’s newly appointed director of regional operations talks about quality in cancer care. ‘There’s a lot of reason to be optimistic in terms of progress,’ he says
By Chris Motola
A: I’ve been on the faculty for about six years. I’ve served as the chief quality and safety officer. In that capacity, I was able to oversee our efforts to ensure high quality of care. As part of our regional strategy, we’ve expanded over the last four or five years to try to elevate the quality of care systemically throughout Upstate New York. In doing that, we now operate 14 different locations in Upstate New York. We’re now the busiest cancer center in the state outside of New York City. So, with that we recognized the need for dedicated leadership, and I was asked to take that on last year. I had a fair amount of experience from working on safety and quality, that it was kind of a natural fit for me to be doing this.
Q: How do you measure quality in terms of cancer care?
A: The idea is that in order to have good quality care, you have to have good structure. For a cancer institute, we’re asking things like “do you have a bone marrow transplant program? Do you have adequate staffing?” Good structure leads to good process, which leads to good outcomes. So are we providing the right type of care to the right patient at the right time? So, outcomes are things like survival, quality of life and other things that are important to the patient. In healthcare in general, the majority of outcomes are related to either structure or process. We’ve been very fortunate that our national professional organization, American Society of Clinical Oncology (ASCO), has set up a number of quality improvement metrics. It’s an oncologist-generated program called the Quality Oncology Practice Initiative (QOPI) that helps us determine what quality metrics we should be following for cancer care. We’ve been participating in that program for seven years now and [we are] one of the first academic centers to be involved. As part of the QOPI program we do a systematic review of our processes twice per year. Then the certification program is the next level, where we have to attest that we’re meeting standards for chemotherapy administration. It’s similar to what hospitals go through with the Joint Commission.
Q: What does your financial role entail?
A: I guess what I was referring to there was overseeing the financial aspects of running the practice. When we’re evaluated these situations, we want to have a good business plan, a good financial plan, to make sure we’re able to provide the right kind of care for folks. Drug costs are a big issue today and cancer drugs are some of the most expensive, but it also subsidizes a lot of revenue for health care organizations.
Q: Timing is a big deal with cancer, right? Early detection tends to mean better outcomes?
A: In general, yes.
Q: Given how big and ongoing an issue coverage is in America, how do you deliver the preventive care necessary to improve outcomes?
A: I think screening and prevention is one area we’ve made a lot of strides, but as you point out, it can be very challenging. So the idea there is to understand what testing is appropriate for increasing survivability. Mammography and colonoscopies are, for example, proven to reduce mortality from breast and colon cancers. I think our primary care physicians are educating their patients very well, but it’s also up to patients to partner with their physicians and to undergo appropriate screening. Another area that’s seen great strides is lung cancer screening. We look at high-risk populations — patients aged 55 through 70 who have a history of 30 pack-years (one pack a day for 30 years) — and the recommendation is for them to undergo yearly CT scans to identify early lung cancer. About two-thirds to three-quarters of the time, before now, lung cancer was detected at Stage-III or later, after it had already spread to other places in the body. So, identifying appropriate patients for the screenings and then making sure you have systems in place to accommodate them makes a big difference.
Q: Your clinical practice is focused on lung cancer, correct?
A: I’m an oncologist focused on lung cancer and other thoracic malignancies.
Q: And you’re splitting time between administration and practice?
A: Yeah, I still see patients at Wilmot. I’ve had to scale back some of my clinical activities, but I think it’s still important that I see patients so that I really understand the latest technologies and care processes for patients with cancer.
Q: Do you see cancer treatment moving forward at a rate comparable to treatments of other major killers like heart disease?
A: Clearly we’ve seen tremendous advances in cancer treatments and subsets of patients who are living a lot longer with their cancer or even being cured of it when that used to not be the case. But I think a big issue is that people tend to think of cancer as being one underlying problem, or one diagnosis. In 2017, we understand the biology enough to say it’s not really appropriate to just say someone has “lung cancer” in our specialty. We need to know the cell types the cancer started in, the changes in the DNA that are driving the growth of the cancer. Because of all the mutations that can occur, the idea of finding a cure for this big umbrella of diseases called “cancer” is really challenging. We need to focus efforts on finding treatments for specific mechanisms of cancer. Lung cancer and melanoma are two areas in which tremendous advances have been made in understanding the biology and treatment of these cancers. We understand the mechanisms and have drugs that can specifically target those mechanisms. So the targeted medications are not only more effective, but have fewer side effects. We’re also making some strides in immunotherapy, using the body’s own immune system to attack cancer cells. There’s a lot of reason to be optimistic in terms of progress.
Name: David W. Dougherty, M.D.
Position: Chief quality and safety officer of the Wilmot Cancer Center
Hometown: Forty Fort, Pa
Education: Jefferson Medical College; Pennsylvania State
Affiliations: Strong Memorial Hospital; Highland Hospital
Organizations: American Society of Clinical Oncology; Simon School of Business Executive Alumni Board; Penn State College of Medicine Alumni Board
Family: Married; two sons
Hobbies: Coaching baseball, sports, music, running, exercising