Exploring the Role of Leadership in Facilitating Change to Improve Cancer Survival: An Analysis of Experiences in Seven High Income Countries in the International Cancer Benchmarking Partnership (ICBP)

Document Type : Original Article

Authors

Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK

Abstract

Background 
The differences in cancer survival across countries and over time are well recognised, with progress varying even among high-income countries with comparable health systems. Previous research has examined several possible explanations, but the role of leadership in systems providing cancer care has attracted little attention. As part of the International Cancer Benchmarking Partnership (ICBP), this study looked at diverse aspects of leadership to identify drivers of change and opportunities for improvement across seven high-income countries.
 
Methods 
Key informants in 13 jurisdictions were interviewed: Australia (2 states), Canada (3 provinces), Denmark, Ireland, New Zealand, Norway and United Kingdom (4 countries). Participants represented a range of stakeholders at different tiers of the system. They were recruited through a combination of purposive and ‘snowball’ strategies and participated in semi-structured telephone interviews. Interview transcripts were analysed thematically drawing on the World Health Organization (WHO) health systems framework and previous work analysing national cancer control programmes (NCCPs).

Results 
Several facets of leadership were perceived as important for improving outcomes. These included political leadership to initiate and maintain progress, intellectual leadership to support those engaged in local implementation of national policies and drive change, and a coherent vision from leaders at different levels of the system. Clinical leadership was also viewed as vital for translating policy into action.
 
Conclusion 
Certain aspects of cancer care leadership emerged as underpinning and sustaining improvements, such as appointing a central agency, involving clinicians at every stage, ensuring strong leadership of cancer care with a consistent political mandate. Improving cancer outcomes is challenging and complex, but it is unlikely to be achieved without effective leadership, both political and clinical.

Keywords

References

  1. Allemani C, Matsuda T, Di Carlo V, et al. Global surveillance of trends in cancer survival 2000-14 (CONCORD-3): analysis of individual records for 37 513 025 patients diagnosed with one of 18 cancers from 322 population-based registries in 71 countries. Lancet. 2018;391(10125):1023-1075. doi:10.1016/s0140-6736(17)33326-3
  2. Arnold M, Rutherford MJ, Bardot A, et al. Progress in cancer survival, mortality, and incidence in seven high-income countries 1995-2014 (ICBP SURVMARK-2): a population-based study. Lancet Oncol. 2019;20(11):1493-1505. doi:10.1016/s1470-2045(19)30456-5
  3. Walters S, Benitez-Majano S, Muller P, et al. Is England closing the international gap in cancer survival? Br J Cancer. 2015;113(5):848-860. doi:10.1038/bjc.2015.265
  4. Forbes LJ, Simon AE, Warburton F, et al. Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival? Br J Cancer. 2013;108(2):292-300. doi:10.1038/bjc.2012.542
  5. Pedersen AF, Forbes L, Brain K, et al. Negative cancer beliefs, recognition of cancer symptoms and anticipated time to help-seeking: an international cancer benchmarking partnership (ICBP) study. BMC Cancer. 2018;18(1):363. doi:10.1186/s12885-018-4287-8
  6. Evans RE, Morris M, Sekhon M, et al. Increasing awareness of gynaecological cancer symptoms: a GP perspective. Br J Gen Pract. 2014;64(623):e372-380. doi:10.3399/bjgp14X680161
  7. Hall N, Birt L, Banks J, et al. Symptom appraisal and healthcare-seeking for symptoms suggestive of colorectal cancer: a qualitative study. BMJ Open. 2015;5(10):e008448. doi:10.1136/bmjopen-2015-008448
  8. Niksic M, Rachet B, Warburton FG, Forbes LJ. Ethnic differences in cancer symptom awareness and barriers to seeking medical help in England. Br J Cancer. 2016;115(1):136-144. doi:10.1038/bjc.2016.158
  9. O'Mahony M, Comber H, Fitzgerald T, et al. Interventions for raising breast cancer awareness in women. Cochrane Database Syst Rev. 2017;2(2):CD011396. doi:10.1002/14651858.CD011396.pub2
  10. Neal RD, Tharmanathan P, France B, et al. Is increased time to diagnosis and treatment in symptomatic cancer associated with poorer outcomes? systematic review. Br J Cancer. 2015;112 Suppl 1:S92-107. doi:10.1038/bjc.2015.48
  11. Winpenny E, Miani C, Pitchforth E, et al. Health Services and Delivery Research. Outpatient Services and Primary Care: Scoping Review, Substudies and International Comparisons. Southampton, UK: NIHR Journals Library; 2016. doi:10.3310/hsdr04150
  12. Uyl-de Groot CA, de Vries EGE, Verweij J, Sullivan R. Dispelling the myths around cancer care delivery: it's not all about costs. J Cancer Policy. 2014;2(1):22-29. doi:10.1016/j.jcpo.2014.01.001
  13. Rubin G, Berendsen A, Crawford SM, et al. The expanding role of primary care in cancer control. Lancet Oncol. 2015;16(12):1231-1272. doi:10.1016/s1470-2045(15)00205-3
  14. Brown S, Castelli M, Hunter DJ, et al. How might healthcare systems influence speed of cancer diagnosis: a narrative review. Soc Sci Med. 2014;116(100):56-63. doi:10.1016/j.socscimed.2014.06.030
  15. de Azambuja E, Ameye L, Paesmans M, Zielinski CC, Piccart-Gebhart M, Preusser M. The landscape of medical oncology in Europe by 2020. Ann Oncol. 2014;25(2):525-528. doi:10.1093/annonc/mdt559
  16. Mathew A. Global survey of clinical oncology workforce. J Glob Oncol. 2018;4:1-12. doi:10.1200/jgo.17.00188
  17. The Royal College of Radiologists (RCR). Clinical Oncology UK Workforce Census 2018 Report. London: RCR; 2019.
  18. Cherny N, Sullivan R, Torode J, Saar M, Eniu A. ESMO European Consortium Study on the availability, out-of-pocket costs and accessibility of antineoplastic medicines in Europe. Ann Oncol. 2016;27(8):1423-1443. doi:10.1093/annonc/mdw213
  19. Davis C, Naci H, Gurpinar E, Poplavska E, Pinto A, Aggarwal A. Availability of evidence of benefits on overall survival and quality of life of cancer drugs approved by European Medicines Agency: retrospective cohort study of drug approvals 2009-13. BMJ. 2017;359:j4530. doi:10.1136/bmj.j4530
  20. Salas-Vega S, Mossialos E. Cancer drugs provide positive value in nine countries, but the United States lags in health gains per dollar spent. Health Aff (Millwood). 2016;35(5):813-823. doi:10.1377/hlthaff.2015.1453
  21. Coleman MP, Forman D, Bryant H, et al. Cancer survival in Australia, Canada, Denmark, Norway, Sweden, and the UK, 1995-2007 (the International Cancer Benchmarking Partnership): an analysis of population-based cancer registry data. Lancet. 2011;377(9760):127-138. doi:10.1016/s0140-6736(10)62231-3
  22. Ades F, Senterre C, de Azambuja E, et al. Discrepancies in cancer incidence and mortality and its relationship to health expenditure in the 27 European Union member states. Ann Oncol. 2013;24(11):2897-2902. doi:10.1093/annonc/mdt352
  23. Philipson T, Eber M, Lakdawalla DN, Corral M, Conti R, Goldman DP. An analysis of whether higher health care spending in the United States versus Europe is 'worth it' in the case of cancer. Health Aff (Millwood). 2012;31(4):667-675. doi:10.1377/hlthaff.2011.1298
  24. Stevens W, Philipson TJ, Khan ZM, MacEwan JP, Linthicum MT, Goldman DP. Cancer mortality reductions were greatest among countries where cancer care spending rose the most, 1995-2007. Health Aff (Millwood). 2015;34(4):562-570. doi:10.1377/hlthaff.2014.0634
  25. Weller D, Vedsted P, Anandan C, et al. An investigation of routes to cancer diagnosis in 10 international jurisdictions, as part of the International Cancer Benchmarking Partnership: survey development and implementation. BMJ Open. 2016;6(7):e009641. doi:10.1136/bmjopen-2015-009641
  26. Morris M, Landon S, Reguilon I, Butler J, McKee M, Nolte E. Understanding the link between health systems and cancer survival: a novel methodological approach using a system-level conceptual model. J Cancer Policy. 2020;25:100233. doi:10.1016/j.jcpo.2020.100233
  27. World Health Organization (WHO). The World Health Report 2000: Health Systems: Improving Performance. Geneva: WHO; 2000.
  28. Yukl GA. Leadership in Organizations. 8th ed. Pearson; 2013.
  29. World Health Organization (WHO). Everybody's Business--Strengthening Health Systems to Improve Health Outcomes: WHO's Framework for Action. Geneva: WHO; 2007.
  30. French J, Sutcliffe SB. Planning for cancer control programs: leadership considerations. Healthc Manage Forum. 2018;31(1):5-8. doi:10.1177/0840470417731783
  31. World Health Organization (WHO). Monitoring the Building Blocks of Health Systems: A Handbook of Indicators and Their Measurement Strategies. Geneva: WHO; 2010.
  32. World Health Organization (WHO). National Cancer Control Programmes: Policies and Managerial Guidelines. 2nd ed. Geneva: WHO; 2002.
  33. Weintraub P, McKee M. Leadership for innovation in healthcare: an exploration. Int J Health Policy Manag. 2019;8(3):138-144. doi:10.15171/ijhpm.2018.122
  34. Shubeck SP, Kanters AE, Dimick JB. Surgeon leadership style and risk-adjusted patient outcomes. Surg Endosc. 2019;33(2):471-474. doi:10.1007/s00464-018-6320-z
  35. Taylor N, Clay-Williams R, Hogden E, Braithwaite J, Groene O. High performing hospitals: a qualitative systematic review of associated factors and practical strategies for improvement. BMC Health Serv Res. 2015;15:244. doi:10.1186/s12913-015-0879-z
  36. Braithwaite J, Herkes J, Ludlow K, Lamprell G, Testa L. Association between organisational and workplace cultures, and patient outcomes: systematic review protocol. BMJ Open. 2016;6(12):e013758. doi:10.1136/bmjopen-2016-013758
  37. Butler J, Foot C, Bomb M, et al. The International Cancer Benchmarking Partnership: an international collaboration to inform cancer policy in Australia, Canada, Denmark, Norway, Sweden and the United Kingdom. Health Policy. 2013;112(1-2):148-155. doi:10.1016/j.healthpol.2013.03.021
  38. Independent Cancer Taskforce. Achieving World-Class Cancer Outcomes: A Strategy for England 2015-2020. London: NHS England; 2015.
  39. Bradshaw C, Atkinson S, Doody O. Employing a qualitative description approach in health care research. Glob Qual Nurs Res. 2017;4:2333393617742282. doi:10.1177/2333393617742282
  40. Neergaard MA, Olesen F, Andersen RS, Sondergaard J. Qualitative description - the poor cousin of health research? BMC Med Res Methodol. 2009;9:52. doi:10.1186/1471-2288-9-52
  41. Knai C, Nolte E, Brunn M, et al. Reported barriers to evaluation in chronic care: experiences in six European countries. Health Policy. 2013;110(2-3):220-228. doi:10.1016/j.healthpol.2013.01.019
  42. Pitchforth E, Nolte E, Corbett J, et al. Community hospitals and their services in the NHS: identifying transferable learning from international developments–scoping review, systematic review, country reports and case studies. Health Serv Deliv Res. 2017;5(19):1-220.
  43. Novick G. Is there a bias against telephone interviews in qualitative research? Res Nurs Health. 2008;31(4):391-398. doi:10.1002/nur.20259
  44. Green J, Thorogood N. Qualitative Methods for Health Research. 4th ed. London: SAGE Publications Ltd (UK); 2018.
  45. Atun R, Ogawa T, Martin-Moreno JM. Analysis of National Cancer Control Programmes in Europe. London: Imperial College London; 2009.
  46. NVivo Qualitative Data Analysis Software [computer program]. https://qsrinternational.com/nvivo/nvivo-products/1999.
  47. Coleman MP, Gatta G, Verdecchia A, et al. EUROCARE-3 summary: cancer survival in Europe at the end of the 20th century. Ann Oncol. 2003;14 Suppl 5:v128-149. doi:10.1093/annonc/mdg756
  48. Coleman MP, Quaresma M, Berrino F, et al. Cancer survival in five continents: a worldwide population-based study (CONCORD). Lancet Oncol. 2008;9(8):730-756. doi:10.1016/s1470-2045(08)70179-7
  49. Department of Health. The NHS Cancer Plan: A Plan for Investment, A Plan for Reform. England: NHS; 2000.
  50. Danish Health Authority - Sundhedsstyrelsen. National kræftplan: Status og forslag til initiativer i relation til kræftbehandlingen / National Cancer Plan: Status and proposals for initiatives related to cancer treatment. 2000.
  51. National Cancer Control Programme. Report on the Implementation of ‘A Strategy for Cancer Control in Ireland 2006’. Dublin: Health Service Executive; 2014.
  52. Clinical Oncological Society of Australia, The Cancer Council Australia, National Cancer Control Initiative. Optimising Cancer Care in Australia. Melbourne: National Cancer Control Initiative; 2003.
  53. Cancer Institute NSW. NSW Cancer Plan 2011-2015. Sydney: Cancer Institute NSW; 2010.
  54. Department of Health and Children. Cancer Services in Ireland: A National Strategy. Dublin: Department of Health and Children; 1996.
  55. National Cancer Forum. A Strategy for Cancer Control in Ireland. Dublin: Health Service Executive Cancer Services; 2006.
  56. Cancer Care Ontario. Ontario Cancer Plan 2005-2008. Ontario: Cancer Care Ontario; 2004.
  57. Cancer Care Ontario. Ontario Cancer Plan 2008-2011. Ontario: Cancer Care Ontario; 2007.
  58. Cancer Care Ontario. Ontario Cancer Plan IV 2015-2019. Ontario: Cancer Care Ontario; 2014.
  59. Department of Health. Cancer Reform Strategy. England: NHS; 2007.
  60. Department of Health. Improving Outcomes: A Strategy for Cancer. England: NHS; 2011.
  61. Cancer Care Ontario. Ontario Cancer Plan 2011-2015. Ontario: Cancer Care Ontario; 2010.
  62. Victoria State Government. Victoria’s Cancer Action Plan 2008-2011. Melbourne: Victorian Government Department of Human Services; 2008.
  63. Cancer Australia. Strategic Plan 2011-2014. Australian Government; 2011.
  64. Saskatchewan Cancer Agency. Strategic Plan 2011-2014: Beyond the Horizon in Healthcare. Saskatchewan: Saskatchewan Cancer Agency; 2011.
  65. An Roinn Slainte/Department of Health. National Cancer Strategy 2017-2026. Dublin: Healthy Ireland, Department of Health, National Patient Safety Office; 2017.
  66. Cancer Control Taskforce. The New Zealand Cancer Control Strategy: Action Plan 2005-2010. Wellington: Ministry of Health; 2005.
  67. Weiner BJ, Shortell SM, Alexander J. Promoting clinical involvement in hospital quality improvement efforts: the effects of top management, board, and physician leadership. Health Serv Res. 1997;32(4):491-510.
  68. Canadian Strategy for Cancer Control. Canadian Strategy for Cancer Control: A Cancer Plan for Canada. Canadian Strategy for Cancer Control; 2006.
  69. Canadian Partnership Against Cancer. The Canadian Strategy for Cancer Control: 2017-2022. Canadian Partnership Against Cancer; 2016.
  70. Government of Alberta. Changing Our Future: Alberta’s Cancer Plan to 2030. Government of Alberta; 2013.
  71. Danish Health Authority - Sundhedsstyrelsen. Strengthened efforts in the cancer field - a healthcare presentation. 2010.
  72. Saskatchewan Cancer Agency. Strategic Plan 2015-2020. Saskatchewan: Saskatchewan Cancer Agency; 2015.
  73. Department of Health & Human Services. Victorian Cancer Plan 2016-2020: State Government of Victoria. 2016.
  74. NSW Government. NSW Cancer Plan: 2011-2015. NSW Government; 2010.
  75. Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394-424. doi:10.3322/caac.21492
  76. Bergin RJ, Emery J, Bollard R, White V. Research evidence supports cancer policymaking but is insufficient for change: findings of key informant interviews from five countries. Health Policy. 2019;123(6):572-581. doi:10.1016/j.healthpol.2019.04.003
  77. Timmins N. The Practice of System Leadership: Being Comfortable with Chaos. London: King's Fund; 2015.
  78. Seguin M, Morris M, McKee M, Nolte E. "There's not enough bodies to do the demand:" an exploration of key stakeholder views on the role of health service capacity in shaping cancer outcomes in 7 International Cancer Benchmarking Partnership countries. Int J Health Policy Manag. 2020. doi:10.34172/ijhpm.2020.254
  79. Institute for the Future of Oncology. Oncology Leadership: Looking to the Future in a Shifting Healthcare Environment. Rockville, MD: Association of Community Cancer Centers; 2014.
  80. Caridi-Zahavi O, Carmeli A, Arazy O. The influence of CEOs' visionary innovation leadership on the performance of high-technology ventures: the mediating roles of connectivity and knowledge integration. J Prod Innov Manage. 2016;33(3):356-376. doi:10.1111/jpim.12275
  81. Mintzberg H. Managing. Berrett-Koehler Publishers; 2011.
  82. Wisdom JP, Chor KH, Hoagwood KE, Horwitz SM. Innovation adoption: a review of theories and constructs. Adm Policy Ment Health. 2014;41(4):480-502. doi:10.1007/s10488-013-0486-4
  83. Bucciarelli L. A review of innovation and change management: stage model and power influences. Univers J Manag. 2015;3(1):36-42. doi:10.13189/ujm.2015.030106
  84. West MA, Borrill CS, Dawson JF, Brodbeck F, Shapiro DA, Haward B. Leadership clarity and team innovation in health care. Leadersh Q. 2003;14(4-5):393-410. doi:10.1016/S1048-9843(03)00044-4
  85. Committee on the Future of Healthcare. The Cancer Strategy as a Case Study of Health Service Reform: Professor Tom Keane. Ireland: Irish Parliament; 2016.
  86. Murray CJ, Frenk J. A framework for assessing the performance of health systems. Bull World Health Organ. 2000;78(6):717-731.
  87. Greer SL, Wismar M, Figueras J, McKee C. Governance: a framework. In: Greer SL, Wismar M, Figueras J, eds. Strengthening Health System Governance: Better Policies, Stronger Performance. New York: McGraw Hill Education, Open University Press; 2016.
  88. Smith PC, Anell A, Busse R, et al. Leadership and governance in seven developed health systems. Health Policy. 2012;106(1):37-49. doi:10.1016/j.healthpol.2011.12.009
International Journal of Health Policy and Management

Articles in Press, Corrected Proof
Available Online from 04 August 2021

Files

History

  • Receive Date: 06 November 2020
  • Revise Date: 24 June 2021
  • Accept Date: 12 July 2021
  • First Publish Date: 04 August 2021

Share

How to cite

Statistics