A diagnosis of cancer changes patients and their caregivers. Researching the specifics of an illness, how it will be treated and what it means for the future can be overwhelming. Deciding where to seek treatment will become one of the most important decisions a patient can make.

The University of Texas MD Anderson Cancer Center in Houston seeks to ensure patient engagement and empowerment while focusing on how to support patients new to a cancer diagnosis or recurrence. In late 2010, MD Anderson embarked on an initiative to improve operational efficiency, patient satisfaction and staff satisfaction. The result was PreCare, a new patient portal that places the power of the pre-registration process into the patient's hands.

The Patient's View

While our patient satisfaction scores demonstrated that the patient experience on-site is improving, we surmised that patients' needs begin at the moment patients and their families hear the word cancer and begin the process of becoming a patient at MD Anderson.

We had to shift our thinking from the provider's definition of the care continuum — pre-diagnosis, diagnosis, treatment, discharge — to the patient's definition of the care continuum, which is much more expansive — worried, wellness/prevention, pre-arrival, diagnosis, pre-treatment, treatment, follow-up, survival. We needed to care for patients before they even stepped onto our campus. We acknowledged what other industries have been demonstrating for years: There is an obvious intersection between positive consumer satisfaction and operational efficiencies. It happens when technology creates transparency and places the power of the process into the hands of the consumer.

At MD Anderson, we engaged a long-time partner, Tower Strategies, to help us understand the core issues, conceptualize and lead an initiative that could address needs comprehensively. After viewing processes from patients' perspective, we recognized that many factors contribute to a patient's experience. Cultural shifts needed to occur in our organization, along with process improvements and new technologies; therefore, we engaged the marketing, clinical and information technology departments in these efforts.

Two multidisciplinary clinics were identified for a deep-dive analysis into the challenges and opportunities for change. Gynecologic oncology, a flagship center with quick turnaround times, was chosen for this investigation, given that its patients often were identified as working mothers. In addition, thoracic/orthopedics was chosen for its significant patient capacity and because its population generally comprises older men with caregivers who are in charge of their clinical care processes. Both clinics had strong leaders in place.

Tower initiated the deep-dive analysis by observing the workflows end to end, from the patient's viewpoint, and by digging into operational processes that were not visible to the patients, but were key points in preregistration. Every email, phone call and mailed document was analyzed from the patient's mental model. The business drivers behind decision points were noted, as were the complexities and bottlenecks during preregistration.

Off to the Best Start

At some hospital providers, a patient's first visit is a courtesy appointment during which the physician reviews the medical history. At MD Anderson, clinicians obtain pertinent past medical records and read pathology reports prior to the patient's arrival. As a result, approximately 24 percent of diagnoses change once the specialized pathologists at MD Anderson review them, ensuring a patient's first appointment is with the right subspecialist physician treating the correct diagnosis.

For the patients, however, a delay in seeing the physician was causing anxiety. More than 40 percent of the incoming phone calls to the clinics and call center were from patients and their caregivers asking if the center received their medical records. Days were passing during which the patients had not received any updates; they didn't know how diligently and quickly the staff were working on their behalf.

Now that MD Anderson has PreCare, patients become engaged the second they make contact with us. All patients, regardless of the referral path, are invited to join PreCare. The site tells them what they can do to expedite the process and what steps they need to complete; it also provides transparency into MD Anderson's progress in accepting patients into its care. In addition, it shows them information about their type of cancer, how MD Anderson treats it, what tests may be required and how to prepare for them. In effect, it starts the clinical care process, something patients are eager to do right away.

In addition, the site tells patients what to expect and how they can play an active role in their care. Patients and caregivers are able to inform us of any advanced directives, as well as whether genetic counseling might be appropriate for their family based on a simple questionnaire, and whether they would like to consider clinical trials as part of their treatment plan. The site also introduces them to phrases and terminology with patient-friendly text as well as concepts that will be extremely important in understanding their condition.

A cancer diagnosis is already overwhelming; sifting through cancer information or processes that do not apply to a particular patient is unnecessary. We want to use the patient's data to personalize, making each patient's experience uniquely his or her own, and acknowledge and support his or her goals.

Testing and Improving

In focus groups, patients and caregivers were overwhelmingly positive about the website. Participants told us what else could be helpful and comforting during the pre-registration phase of their treatment.

Responding to their suggestions, MD Anderson made a video of former patients talking to new patients about things they wish they had known, such as what the experience is like through a patient's eyes, and what to bring to your first appointment. We also included a video that showed the street view of the building. We made sure the interface was simple and guided the user through the process.

We gave presentations to cross-functional teams describing preregistration from the patient's perspective. The website allowed us to streamline printing, cut costs by 70 percent and simplify the experience for these patients. In addition, an initiative is under way to modify and standardize new patient scheduling templates to better triage and support incoming patients. When patients arrive for their first appointment, staff and clinicians who meet them are prepared with a summary of key points about who their caregivers are, what they have already done online, and clues about their needs and interests regarding their care.

PreCare is available to patients in 19 outpatient clinics, with the remaining clinics going live by the end of the year. In an internal survey, on a scale of 1 to 5, 86 percent of patients have rated PreCare with the highest score of 5, and 14 percent have rated it with a score of 4. Early studies are showing a 47 percent reduction in overall patient anxiety. Our patient satisfaction scores continually climb.

These scores show us that MD Anderson is making a difference in the way we provide care for our patients. It is another step in the right direction; it ensures that we recognize and support all individuals in their journey. At MD Anderson, we believe that patient satisfaction, staff satisfaction and operational efficiency together create the optimum patient experience.

Gerard Colman is senior vice president and chief of clinical operations for the University of Texas MD Anderson Cancer Center in Houston.