Eating the patient reported measures implementation elephant one bite at a time

St Vincent’s Health Network (SVHN) was the final service in the statewide technical implementation of the Cancer Patient Reported Measures (PRMs) System (the System), marking a significant milestone for the Cancer Institute NSW (the Institute) PRMs Program. Technical implementation of the System was completed in July 2025, with the first surveys completed in October 2025. Applying lessons learned from those who came before and embracing the motto to fail fast, but small; the SVHN team approached their PRMs implementation in a structured, iterative approach that focused on breaking their implementation down into bite sized pieces.

About the St Vincents’ Health Network approach

Background

Technical implementation of the cancer PRMssystem commenced in 2019, with statewide technical implementation complete following the SVHN implementation. As the final local health district (LHD) to complete technical implementation of the cancer PRMs system, SVHN was able to apply lessons learned from the rest of the state to their local implementation of PRMs in routine cancer care. Additionally, the team leveraged strong executive sponsorship, dedicated project management resourcing and a commitment to prioritizing staff experience to maximise implementation success.

During technical implementation, the SVHN oncology information system (OIS) administrator partnered with the the Institute team, ensuring that staff experience was considered from the outset. The goal was to ensure that using the cancer PRMs system would be as seamless as possible for clinical staff, minimizing the potential for structural barriers.

Previous experience with any form of PRMs varied across the SVHN treatment centres of Kinghorn Cancer Centre Nelune and Men’s Health Centre. While the Men’s Health Centre had been collecting paper based PRMs for some time, routine collection of PRMs was new to Nelune. Additionally, the workflows for each service were different making it difficult to develop a standardized approach across services.

Recognising that a one size fits all approach to both sites would not work, and that implementation of PRMs is typically most successful when PRMs are added to existing workflows, rather than re-engineering workflows, the project manager partnered with clinical champions to break the workflow down into small ‘bit-sized’ chunks, piloting and refining elements of the workflow using rapid plan-do-study-act (PDSA) cycles. Strong engagement and executive sponsorship also meant that decisions could be made quickly which helped to maintain momentum and clinical engagement.

As clinicians gained confidence with using PRMs in routine care, responsibility for elements of the workflow were transitioned from the clinical champions to the clinical team leaders. Following transition of responsibility, existing forums such as morning handover became an opportunity to reinforce PRMs as business-as-usual, with the team discussing patients to be onboarded, or results to be reviewed.

The SVHN team is now focused on expanding their PRMs workflow to increase repeat screening and identifying triggers to offboard patients from the System. They are also exploring how to use existing spaces like the ward quality metrics board to display monitoring report results and celebrate success.

 

Implementation approach

 

1. 

   Technical implementation of the System in consultation with OIS Administrator

2. 

   Identify minimum standards for implementation in consultation with clinical champions

3. 

   Iterative PDSA cycles to pilot and refine each element of the workflow, specific to the clinical context

4. 

   Transition responsibility from clinical champions to clinical team members when PDSA cycles are completed

5. 

   Repeat the process to continue refining the workflow, and scale and embedding PRMs as routine care

Benefit

• Since clinical go-live on 13 October 2025 more than 140 surveys have been completed by more than 105 unique participants.
• Implementing PRMs has enhanced patient-clinician communication and identification of physical or psychosocial effects of treatment and care. Particularly where there is perceived stigma or embarrassment, or while patients and clinicians are establishing their relationship. The survey tools provide a clear prompt that the issues can and should be discussed with the clinical team.
• Implementing PRMs into routine care sets services up for success in the move to snap accreditation. From a service perspective, embedding PRMs as routine clinical care takes the pressure off NUMs and educators during snap accreditation because it directly links to accreditation standard two. It embeds the language of patient-centred care in day-to-day care delivery.

Tips and tricks

• During technical implementation consider what can be done to make using the cancer PRMs system and accessing results as seamless as possible for clinicians.
• Having a dedicated project manager to support clinical staff through the process meant there was a clear point of contact and a structured approach to implementation.
• Having a wide training audience from the beginning meant that the pace of implementation didn’t have to slow to allow for training of additional stakeholders. It is still important to tailor messaging and education based on immediate need and relevance, but increased awareness of the change was a key enabler.
• Focusing on establishing minimum standards rather than strict workflows. This approach has given ownership to clinical leads and then individual clinicians on how and when to collect PRMs.
• Embedding PRMs into existing forums such as monthly ward meetings and daily huddles or handovers helps embed it as routine care and creates ownership for individual clinicians.
• Display monthly reporting or other monitoring metrics in a public forum (e.g., quality learning board) to reinforce it as part of business-as-usual care delivery.
• Consider how data from the cancer PRMs system could be used to inform service improvement initiatives. This was an early consideration for the SVHN team, influencing the way they developed workflows, particularly completing the tumour stream field in the PRMs patient file, because it would provide more usable data in the long term.
• Strong executive sponsorship is a powerful enabler. It establishes the implementation of PRMs into routine clinical care as an organisational priority and acts as a lever for change.

When care listens care improves

Patient story – Empowering patients to talk about what matters to them and how they are impacted by their diagnosis and treatment.

When Catherine* completed her cancer PRMs survey, she shared an issue that was impacting her significantly. Due to the impacts of treatment, she was no longer able to work full time and was experiencing financial stress that placed her housing security at risk.

This information, captured through the survey, enabled timely follow‑up by the McGrath Cancer Care Nurse Consultant, who linked Catherine with social work. Through this referral, Catherine was supported to access temporary housing. This support positively impacted not only her wellbeing but importantly, her capacity to continue treatment.

This example highlights the value of PRMs in identifying unmet patient needs that may not be raised during routine clinical interactions, and the importance of value of multidisciplinary responses to patient‑reported concerns.

*Patient’s name changed

Clinician story: PRMs support more person‑centred follow‑up by enabling clinicians to focus on what is most important to each individual patient

When a patient completes their post‑treatment PRMs survey, the responses offer more than just data; they provide insight into what matters most to them at that point in their cancer care. This information is often more candid than what may emerge during routine clinical interactions. Guided by the survey results, cancer care coordinators can focus conversations on the issues having the greatest impact on the patient’s day‑to‑day life. This approach strengthens patient–clinician engagement by building trust, ensuring concerns are identified and addressed early, and helping patients feel heard during a pivotal stage of their care.

By using the patient’s own reported outcomes to shape these conversations, coordinators gain a clearer understanding of individual needs and can respond in a way that feels personalised, relevant, and supportive. This tailored approach creates space for meaningful discussion about treatment, recovery, ongoing challenges, and personal priorities.

Acknowledgements

We acknowledge the SVHN leadership team and the multidisciplinary implementation team that includes technical and project management specialists, along with clinical leaders for their flexible and iterative approach to integrating PRMs into routine clinical care.