CASE STUDY

A client developed a new oncology treatment that required a companion diagnostic (CDx). The specific diagnostic test was currently funded for screening and prevention purposes. Before a positive decision to increase funding of the test to include a CDx role it was expected that laboratories had to show that they optimized current service levels.

Initial discussions with clinicians and stakeholders revealed that the current test (operating primarily for screening and prevention), was already experiencing strain from the existing volume of tests.

The investigation also determined that testing processes across Canada were complicated and varied considerably in terms of efficiency and funding. As well, the assessment indicated that the majority of ‘bottlenecks’ in the system were associated with access to testing. Wait times varied from weeks to months, based on patient priority and the site-specific efficiencies. The incremental volume of testing for the CDx was anticipated to add more stress the system. It was also recognized that it was important to collaborate with the clinical, laboratory and administrative communities to address challenges and develop enhancements to accommodate the potential increase in testing volume.

An interdisciplinary pilot program was recommended to identify potential process changes and enhancements at a pilot site. The model and process could then be applied to other sites.

A pilot hospital was recruited and key stakeholders were interviewed about the current process, what was working well, and what could be improved. The data were develop into a process map and opportunities for enhancement were identified.

A workshop on the process led to the development of short and long-term targets for improvement. The short terms opportunities were prioritized and preliminary action plans were outlined for the top priorities.