Background
South Australia's regional cancer services operate across 15 geographically diverse outpatient chemotherapy units facing inherent challenges, including workforce shortages, isolation, and low-volume caseloads. The Regional Cancer Services team has implemented a single, centrally governed quality framework designed to deliver safe, equitable, and evidence-based care across the state.
Methods
A comprehensive review of the regional cancer service against safety and quality standards and workforce guidelines were conducted to design a governance and quality framework. The design of a regional cancer framework needed to address the areas of standardised oversight, peer review and multidisciplinary collaboration, and safety mechanisms while supporting flexibility for local service delivery.
Impact on practice
Implementation of the framework has led to multidisciplinary review of all new patients referred into the regional cancer service, resulting in 1625 cases discussed (1313 new patients and 233 existing patients) since June 2022. In addition, documented decision-making and treatment planning has improved safety and accountability of patient care. Morbidity and mortality meetings are held to review and discuss patients with poor or sub-optimal outcomes.
Six of the ten medical oncologists hold formal quality portfolios and provide regional representation on statewide committees. These portfolios capture multidisciplinary meetings, clinical trials, electronic prescribing, and education.
Shared governance and centralised strategies have allowed for scalable and replicable components of the regional cancer service. Pharmacist-led verification drives full treatment compliance with approved protocols from statewide committees, protocol-specific nursing education has allowed for increased site capacity and capability, and a remote locum pool has reduced costs for clinic cover by 40%
Discussion
A single, coordinated quality framework has enabled delivery of modern, safe, and peer-reviewed cancer care in regional South Australia. This model addresses structural inequity and offers a roadmap for sustainable, high-quality oncology services in dispersed health systems.