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TENNESSEE ONCOLOGY’S Dr. Dickson on patient focused quality

In recent years, there has been focus on improving the quality and patient-centered approach of medical oncology care delivery systems.

Tennessee Oncology put programs to the test in order to improve their response time for patients. These programs have established that timely, appropriate management of symptom related calls is essential to the patient’s experience.

Tennessee Oncology is a community oncology practice with 87 physicians and 35 mid-level providers in 33 locations.

The Saint Thomas West Clinic (a participating clinic in the improvement process) receives 350 to 400 calls per day. This clinic lacked an effective process to appropriately categorize or prioritize incoming telephone calls from patients.

“All Oncologists seek to improve their patient’s treatment experience,” states Tennessee Oncology’s Dr. Dickson. “Improvement isn’t one big thing, but rather addressing the many different day in day out experiences that affect our patients throughout treatment.”

The objectives for these projects were to increase the percentage of symptom management calls that receive a clinical intervention within 2 hours from 54% to 80% by September 2015.

Implementation of the improvement process included: changing the daily call process to assign a telephone operator; combining the roles of the triage nurse and the care coordinator in order for two people to address symptom management calls; and redesigning the automated telephone tree to allow staff to answer calls in lieu of voicemail. Based on time and cost, more difficult changes to implement include: creating evidenced-based triage protocols using Oncology Nursing Society guidelines; expanding the patient portal access; and using client relationship software as a case management system.

In this improvement project, the increase in symptom management response calls went from 54% in April 2015 to 73% in September 2015. The number of nonclinical calls that reached the triage nurse decreased sharply with the new process.

This gives physicians more time to focus on patients in the clinic. Actual costs associated with this project were limited to the purchase of a customer relationship system and the development of the software. Tennessee Oncology fully funded the costs, with no outside assistance.

“Improving our patients’ experience is worth the cost. Tennessee Oncology is one of the largest practices in the country, and we know that comes with many responsibilities,” said Tennessee Oncology’s CEO Jeff Patton. “Developing protocols that benefit our patients are high on our list of priorities.”


Training on the new processes was provided to all of the nurses and front office staff in order to be successful for this new improvement plan. Procedures were updated, and a weekly performance report was created and shared by the management team. The project outcomes were presented to staff at the participating clinic, the Board of Governors, and the larger practice via newsletter and Chief Medical Officer’s Bulletin.

These changes and results were favorably received by clinical staff and administrators. The process changes and implementation of the case management system were rolled out to the rest of the practice and completed by July 1, 2016.