Explicit efforts to integrate services can improve patient experience, care quality and efficiency and strengthen equity but require
- Clear governance structures
- Sustainable financial strategies
- Extensive stakeholder collaboration
- Continuous professional development, and
- Robust digital health infrastructures.
Proactively identifying and addressing barriers, maintaining flexible policies, and regularly evaluating implementation efforts are critical to achieving sustainable improvements.
Malta’s Directorate for Cancer Care Pathways (DCCP) and the Upper Austrian Tumour Centre provide useful insights into the establishment of integrated cancer care networks. Malta’s DCCP, established in 2014, aims to enhance coordination, diagnostics, and patient-centred cancer care through integrated pathways. The Upper Austrian Tumour Centre, initiated in 2012, focuses on creating a collaborative oncology network among regional hospitals, standardizing guidelines, and improving patient outcomes.
Malta The DCCP, established in 2014, aims to enhance coordination, diagnostics, and patient-centred cancer care through integrated pathways.
Upper Austria The OOTZ founded in 2012, focuses on creating a collaborative oncology network among regional hospitals, standardizing guidelines, and improving patient outcomes.
Both initiatives are built on strong governance and clear care protocols
A key similarity between these initiatives is the establishment of clear governance frameworks together with standardized clinical care protocols.
In Malta the DCCP introduced nurse navigation services, fast-track referrals, and digital health solutions, supported by clearly defined policies, standardized operational procedures, and regular audits. The OOTZ took a similar approach, introducing transparent governance structures through the creation and implementation of regional clinical guidelines, standardizing patient management protocols, and comprehensive digital platforms facilitating patient data exchange and disease tracking.
Digital tools and multi-stakeholder collaboration helped overcome fragmented services
These two cases highlight the importance of multi-stakeholder collaboration and the integration of digital health solutions to improve cancer care. Malta employed digital innovations to address systemic fragmentation and enhance service integration, improving patient navigation and reducing service delays. Initiatives included an online GP fast-track e-referral system, enhanced digitalization of patient management throughout the care pathway, and development of various IT systems for oncology centres or nurse navigation.
The Upper Austrian approach developed interoperable digital infrastructures to facilitate inter-hospital collaboration, patient transfers, and to record patient-reported outcomes, enhancing continuity and quality of cancer care. The creation of a joint clinical tumour registry facilitated effective patient tracking and improved clinical decision-making.
Financial sustainability and effective resource management are prominent enablers across both initiatives
Malta secured sustained government funding to underpin innovative cancer care interventions, ensuring ongoing support for the DCCP’s programs. Upper Austria implemented collaborative financial arrangements among hospital operators, which helped maintain the network’s sustainability and scalability.
Implementation barriers included workforce gaps and operational resistance
Malta faced significant workforce shortages, particularly in nursing and other key healthcare roles, limiting the expansion of services and the full integration of digital solutions. Healthcare professionals were initially resistant to adopting digital tools which underscored the importance of targeted training and supportive strategies. Upper Austria experienced challenges in aligning diverse clinical practices and harmonizing collaboration among multiple hospital operators, highlighting the importance of ongoing stakeholder engagement and clear communication.
Several key lessons for building better cancer care system emerge from these initiatives
Malta faced significant workforce shortages, particularly in nursing and other key healthcare roles, limiting the expansion of services and the full integration of digital solutions. Healthcare professionals were initially resistant to adopting digital tools which underscored the importance of targeted training and supportive strategies. Upper Austria experienced challenges in aligning diverse clinical practices and harmonizing collaboration among multiple hospital operators, highlighting the importance of ongoing stakeholder engagement and clear communication.
The experiences from Malta and Upper Austria offer lessons for the successful implementation of integrated cancer care networks. They underscore the necessity of clear governance structures, sustainable financial strategies, extensive stakeholder collaboration, continuous professional development, and robust digital health infrastructures. Additionally, proactively identifying and addressing barriers, maintaining flexible policies, and regularly evaluating implementation efforts are critical to achieving sustainable improvements in healthcare quality, system efficiency and equity.
Resources:
https://health.gov.mt/public-bodies/cancer-care-pathways
