Fostering a high-functioning team in cancer care using the 4R Oncology model: Assessment in a large health system.

57 Background: Delivering cancer care by high-functioning multidisciplinary teams promises to address care fragmentation and complexity, which threaten care quality, impact patient outcomes, and strain the oncology workforce. We assessed whether the 4R Oncology model (Trosman et al 2021) for team-based interdependent care delivery and patient self-management impacted team functioning at Kaiser Permanente Northern California (KPNC), a large community-based health system. Methods: We deployed the 4R intervention in breast and lung cancers at 4 KPNC centers. The intervention encompassed team development and care delivery optimizations enabling teamwork. 4R Care Sequences – novel patient-facing care plans outlining timing and sequence of care – informed team formation, activities and functioning. We assessed intervention along 4 characteristics of high-functioning teams (Vogel JOP 2016). Results: 4R facilitated development of a high-functioning team along all 4 characteristics. (1) We formed an internally and externally recognized multidisciplinary team of 24 specialties who assumed team responsibilities for relevant care. (2) All participants committed to a shared goal of delivering interdependent care at the optimal time and sequence based on Care Sequences. (3) The team conducted 40 optimizations to enable effective interdependent care: 22 in breast, 7 in lung, and 11 in both cancers (Table). The optimizations impacted 6 care domains at 4 points in care continuum. Half of optimizations entailed low effort; 70% resulted in improved process efficiency. (4) An ongoing teamwork adaptation process was established. Conclusions: 4R is an effective and feasible approach to fostering high-functioning teams, which may contribute to improvement of multidisciplinary care delivery and support viability of the oncology workforce. Our intervention and taxonomy of results inform other institutions motivated to strengthen teamwork and improve delivery of complex interdependent care.[Table: see text]