Arecent Kurt Salmon survey of best practices among the nation’s leading oncology networks suggests that ownership can have significant influence on a network’s ability to implement best practices, and provides a road map for each ownership type to enhance its level of development.
The study included more than 132 inpatient oncology sites within regional oncology networks across the United States. The participants, who requested confidentiality as a condition for participation, represent some of the largest and most respected oncology centers in the country.
The study found that the most advanced oncology networks are governed through a central oncology network leadership council, have developed highly coordinated centralized systems and resources, and have implemented common clinical care protocol sets across sites and instantaneous access to patient records at any point of care. The ownership model of an oncology network can influence its ability to implement best practices.
System networks are perhaps best organized to achieve an advanced level of development. Because these networks have a single common owner over all sites, they are better positioned to develop a centralized governing council with clear ac - countability for goals and direction. Primary control over the network allows systems to define administrative and physician leadership roles and hire appropriate staff to support network planning and coordination. The system can mediate the different interests of individual sites and ensure leadership incentives support the network, rather than encourage competition be tween network participants.
One key benefit of common ownership is that the system can allocate funding to support the oncology network. Within the system networks interviewed, most were funded in this way. As part of the system, the oncology network competes for resources with other initiatives, such as other service line development and capital investments. To ensure it receives adequate resources, the oncology network is encouraged to conduct robust planning, define clear priorities, and articulate required investments and benefits.
System networks also have control over all sites of care, operations, and resources, and thus greater ability to mandate care processes, monitor compliance in a highly coordinated fashion, and develop a strong central group of oncology physicians. System networks can adopt common clinical care protocols and processes more rapidly than in other ownership models, a key to improving quality and consistency of care.
Collaborator networks are driven by the need to balance various ownership interests, because they are comprised of separate owners who come together to advance oncology care. As such, these networks require stronger central governance models to coordinate collective direction and initiatives.
Within the most advanced of these networks, a dedicated, centralized governing oncology leadership council (OLC) exists to ensure that network goals are achieved. The OLC is responsible for defining administrative and physician leadership roles and hiring appropriate staff to support network planning and coordination. This is typically an independent function of the OLC, with minimal influence from participating members.
Collaborator networks require additional effort and attention to balance competition among sites and ensure network strength.
Collaborator networks rely on funding contributions from each site to support network operations. The level of funding can be highly variable among sites and typically is determined by the leadership committee on an annual basis within the provisions of the affiliation agreement. The budget is based on the agreed-upon set of initiatives and resources required to support development and may be limited by the willingness of members to fund major initiatives.
Typically, these networks require more advanced levels of systems (functional staff, information technology [IT]) as is necessary to support the higher complexity of the operations within different hospitals and sites, although actual levels vary greatly.
Collaborator networks are challenged to mandate the adoption of standard treatment protocols and care processes across sites. To address this area, some affiliation agreements define the level of required participation from each member.
However, because each site still operates within its broader organizational context, adopting common protocols requires complex, timeconsuming processes. These are facilitated by a central guiding body comprised of both network leadership and site clinicians. Adding complexity to coordinating clinical care, collaborator networks typically have a greater diversity of IT systems, because each site has adopted the electronic health record of its organization.
These networks face significant challenge and expense in developing systems (either IT interfaces or staff resources) that can facilitate information flow within the network, and will need to dedicate additional leadership time and network re sources to mitigate these barriers.
Hybrid networks have wider variability in their governance models, with success driven by a highly developed, central decision-making council. These collaborator networks are a combination of a system network and non-owned or joint venture affiliate sites. Similar to collaborator networks, hybrid networks benefit from strong administrative and physician leadership directed by an OLC. These leaders invest greater effort to balance competition within the network and ensure overall success.
Hybrid networks typically have a “lead system” plus collaborator sites that rely on the lead system to develop and sustain re sources while contributing financially to ensure resources are available.
Hybrid networks share the same challenges as collaborator networks when adopting standard treatment protocols and care processes across sites. Both rely on the need to build consensus and protocol adoption over time, and initially achieve agreement on an overarching quality platform as a basis for developing protocols that become more consistent over time. Most hybrid networks also have multiple IT systems, requiring time, staffing resources, technology, and expense to facilitate information flow.