Essentials for Improving Service Quality in Cancer Care

March 2016 | Berry, Leonard L.


Some 1.6 million Americans were diagnosed with cancer in 2015, according to American Cancer Society estimates, at an annual cost exceeding $125 billion.1,2 Despite breathtaking scientific achievements in diagnosis and treatment, cancer still exacts a heavy toll physically, emotionally, and financially on patients and their families. Service shortcomings, such as appointment delays and poor communication among providers, compound the medical and financial burdens of cancer. Advances in the service quality of cancer care are imperative.

Services can be categorized as those that customers want (eating out, getting a stylish haircut) and those, like cancer care, that people need.3 Research shows that “need” services can heighten service expectations and emotional responses to poor service.4,5 The more important the service, the more there is at stake, and the more alert and sensitive the customer is to service performance.4 When customers become cancer patients, they typically reach the highest state of service sensitivity.

High-emotion, need-based services like cancer care demand continuous improvement. The American College of Surgeons now designates as “standards,” service enhancements that cancer patients regularly request, such as a formal care-navigation process and a survivorship-care plan for ongoing treatment and follow-up.6 Nevertheless, since 1999, when the Institute of Medicine issued ten recommendations to improve overall cancer care, actual progress has been limited on the key service issues of care coordination, psychosocial care, clinical-quality variation, timely access to palliative and hospice care, and access to services for un- and underinsured patients.7,8

Informed by clinical experience (KM), career-long work in quality improvement (KM, LB), and a study of how to improve the service experience of adult cancer patients and their families (LB), we propose 6 “essentials” for improving service quality in cancer care. The research was conducted in 3 phases and covered the service experience of patients and families from diagnosis through treatment, post-treatment, and, in some cases, end-of-life care. Phase 1 involved “pilot” field visits and interviews at 2 cancer centers to become better oriented in the domain of cancer care. Phase 2 involved “key informant” interviews with more than 60 respondents (patients, family members, oncologists, surgeons, palliative care specialists, nurses, and health system leaders). The goal was to identify the most salient service shortfalls in cancer care. Phase 3 consisted of 3-day site visits and interviews at 8 cancer centers in the U.S. ranging from a private oncology practice, Marin Cancer Care, to cancer centers in large, integrated health systems, such as Intermountain Healthcare and Kaiser Permanente. Site visits also were made to a large hospice and to a community health center primarily serving low-income, uninsured, or underinsured patients. The focus of phase 3 was identifying potential solutions to the service shortfalls documented in phase 2. The site visits enabled interviews with non-clinical staff, such as social workers, chaplains, and financial counselors, in addition to patients, families, clinicians, and administrators. In all, more than 350 people were interviewed in the study.

The voices from this research speak clearly in guiding service improvement. Although some important service initiatives fall outside of our 6 target areas, our framework offers a practical foundation for clinicians, leaders of health systems and professional societies, and government agencies as they work, with urgency, to improve service to cancer patients and their families.



  • Kedar Mate