Some ten miles separate El Dorado airport from the National Cancer Institute (INC), on opposite sides of Bogotá, Colombia. Since 2019, however, they have been drawn together for a common purpose: providing a quicker response to emergency care for cancer patients.
The unexpected cooperation between these two institutions is transforming healthcare management for those who need it most. Underlaying this alliance is an innovative methodology that made it possible to unite disciplines as apparently dissimilar as medicine and aeronautics, thanks to the commitment of public servants devoted to improving lives.
"The INC's public servants have a great responsibility: solving the health needs of cancer patients is to serve the most vulnerable population," says Dr. Martha García, coordinator of the INC's Group for Immediate Attention to Cancer Patients (GAICA, in Spanish). With 18 years of experience at the Institute, she is well aware of the challenges she faces in fulfilling her essential work.
“Emergency care has always been defined, in all the world, as chaos. But the people who work in these services are very committed to patients,” she says. "So I sought ways to acquire the best knowledge to provide better treatment for our cancer patients."
This knowledge was found on the other side of the city, in the processes Jorge Saltarín supervises daily, as manager of the National Air Space System of Colombia’s Civil Aviation Authority.
Before the pandemic, the global aeronautical industry transported about 4,1 billion passengers annually, contending every day with numerous operational safety risks such as air traffic congestion, security threats, or the transport of high-risk materials.
Healthcare faced high demand even before the pandemic, which has exacerbated the pressure on the entire system.
Cancer, in particular, is a devastating disease that depletes the physical, mental, and emotional health of patients, caregivers, and medical personnel. In 2018 alone, it caused the death of 670,000 people in the region, making it the second leading cause of death after cardiovascular diseases.
Living with constant emergencies has forced Martha and Jorge to overcome challenges through creativity and innovation. The sum of their experiences made it possible to meet an essential goal to save lives: to reduce the waiting time for emergency care for cancer patients.
When life is at stake every second counts
Many Colombians resort to emergency medical services as the quickest way to access health services. This creates unnecessary congestion and delays the care of patients who urgently need medical attention. In the case of the GAICA emergency service, an average of about 6,500 patients are treated annually and about 1,200 consultations take place per month. Overcrowding is usual and even understandable. But cancer patients know that time is of the essence.
“As getting appointments or solutions through the regular healthcare system is so difficult, people turn to the emergency services for quicker attention and these become congested. The same thing happens at the Institute, with the added complication that cancer is a specific pathology, where patients feel the world is ending,” explains Martha.
“Going through the daily reports I thought there had to be a way to do things better. The old theories of health administration were not enough to improve results. We needed to innovate,” she says.
Faced with this challenge, in November 2019 the INC decided to incorporate a new element into its vision: excellence in management. Their ally to achieve this goal was the Inter-American Development Bank (IDB).
“This disease forces us to be at the forefront. With the IDB, we decided to change our management with new trends in results-oriented administration that prioritize simplification, knowledge and innovation as engines of public transformation,” says INC Director Carolina Wiesner.
Better public management is possible
To help institutions operate better, obtain impactful results, and provide quality services to citizens, the IDB's Innovation in Citizen Services Division (IFD / ICS) created Knowledge for Results (K4R). This methodology for knowledge and innovation management helps public servants find practical solutions to reduce bureaucracy at the lowest cost, using knowledge from inside or outside their institutions.
“The State will always have scarce resources, but this cannot be a limitation. Public administrators can use their knowledge to develop simple tools by adapting the practices of companies or NGOs that share similar dilemmas and have already solved them,” explains Diego Arisi, lead specialist in Modernization of the State at the IDB Office in Colombia. “Sometimes a simple checklist or eliminating a bureaucratic step can save millions of dollars that can be used to build schools or better serve cancer patients. This is what we do at the IDB: catalyze knowledge to solve public problems.”
The K4R experience resembles medical attention. First, vital signs and a diagnosis of the patient are taken by the institution's staff and IDB experts, then scientists from other specialties are brought in to define and test a pilot treatment, and results are monitored throughout. That is what happened at the INC.
Based on the diagnosis, the IFD / ICS expert team, with support from of the IDB's Social Protection and Health Division (SCL), identified two Colombian institutions whose experiences in emergency management could provide solutions to the National Cancer Institute: the Colombian Civil Aviation Authority and the country’s National University (UNAL, in Spanish).
"The IDB contacted me and we began to talk about the problem: how to improve access and quality of INC health services through knowledge from the aviation world," explains Jorge. “At first, we were skeptical, but when we understood how the INC operates, we realized that it’s actually very similar to us. It is a clear example of how we can work between public institutions. For free!"
"This methodology shows how effective knowledge-based synergies can be established to solve public challenges," says Jaime Cardona, senior specialist in Health and Social Protection at the IDB.
Knowledge resulting from decades of specialization in aeronautics was shared with the INC, providing the basis for reorganizing GAICA's processes and staff, as well as three tools that strengthened its management model.
The first tool was the “Navigator”, where an administrator and a nurse were relocated to the waiting room to help patients “navigate” their care path. Each case is evaluated, prioritized, and if it presents a life-threatening risk, immediately enters a special route. This made it possible to classify emergencies and avoid diverting urgent resources to clients who do not require immediate attention.
The second essential tool was the "Control Tower," a tracking scheme that simulates an air traffic control tower. Two "control nurses" monitor patients’ care route and their cases, ensuring compliance with optimal management times under international standards, from entry to exit.
Finally, a “Triage Consultation” was implemented to ensure speedier diagnosis and treatment of emergency patients. Triage is a system for selecting and classifying patients, based on their therapeutic needs and available resources. With this tool, INC specialists can now work together to issue the most timely and accurate diagnosis and treatment.
After 14 weeks of the experiment, the improvements achieved with these mechanisms were evident to all.
Where emergency service had been congested, the filtering of cases in the waiting room was improved by 60.4%, preventing hundreds of patients who did not require urgent care from entering the emergency room and diverting care from critical cases.
In a place where every minute can save a life, the waiting time for patients fell by 50%, from 1 hour and 40 minutes to only 50 minutes to access medical consultations that determine diagnosis and begin treatments.
The time of unnecessary stays of patients who were congesting the emergency care route were also reduced by 50% (from 4 to 2 days), allowing efforts to be redirected to the most pressing cases.
“It means that we are doing things well and that we are benefiting those who need it most: our patients. This initiative seeks to change the world for them. We want them to be able to go home in the best conditions,” says Martha.
From cold corridors to corridors of hope
“At our desks, amid endless paperwork, we forget who we work for. K4R seeks to recover the reason for service, work with purpose and, as in the case of INC, transform the cold corridors of our public offices into corridors of hope. This story is that of thousands of public servants who wait for an opportunity to use their experience for the benefit of their organization, and for citizens,” Arisi points out.
That hope is at the heart of the vocation of public officials such as Dr. Martha García, and of her professional and personal resilience. In 2019, as the doctor saw K4R help to achieve improvements she longed for, she was facing the disease she had battled for almost two decades.
“During the most critical months of the project I went through one of the hardest trials of my life. I was diagnosed with an acoustic neuroma, a brain tumor, and had surgery at the Institute. As I went to my appointments and my evaluations, I saw my team together with the IDB team, both totally committed. It was wonderful to see that things were going forward and to realize that I had true friends committed to making it a reality.”
Given the results achieved, INC officials applied for the 2020 National Senior Management Award known as “the Oscar” of the Colombian public administration.
On October 26, they received the highest honor from President Iván Duque, among more than 500 initiatives throughout the country. This story of transformation has now become part of the success stories of Colombia’s public sector.