Seattle Cancer Care Alliance APPs Focus on Collaborative Approach

Employer of Excellence Award Winner Encourages Practice at Top of License

November 7, 2018

By Eileen Denne, CAE, APR

(L to R) Marc Stewart, MD, Lisa Vanderhoef, PA-C, Gabrielle Zecha, PA-C, Lauren Low, PA-C, and Barbara Silko, ARNP

Seattle Cancer Care Alliance (SCCA) PAs and NPs are central to caring for patients in multi-disciplinary teams, managing and bringing continuity to day-to-day care of patients, according to the top SCCA PA as well as its medical director.

“Working at a top-notch cancer center is hard work, but it’s incredibly fulfilling,” says Gabrielle Zecha, PA-C, MHA, SCCA director of Advanced Practice Providers (APP). “We really want to hire, train, and retain the best APPs we can. I don’t think it’s enough to be an expert at what you do. You have to be able to work within a multi-disciplinary team.”

Seattle Cancer Care Alliance is a nationally ranked cancer treatment center that brings together the leading research teams and specialists from Fred Hutchinson Cancer Research Center, Seattle Children’s and University of Washington Medicine to translate scientific discovery into the prevention, treatment, and cure of cancer.

It is a full-service cancer center, committed to delivering patient-centered, state-of-the-art care through a multidisciplinary approach that combines cancer experts, comprehensive care from referrals to survivorship, and groundbreaking treatment in collaboration with its partners.

U.S. News & World Report has consistently ranked Seattle Cancer Care Alliance/University of Washington Medical Center (UWMC) in the top 10 cancer care hospitals in the U.S. for 13 consecutive years.

Medical Director and Senior Vice President Marc Stewart, MD, explains that SCCA applied for the Center for Healthcare Leadership and Management’s (CHLM) Employer of Excellence (EOE) award to achieve recognition for “how great our APP program is, how it evolved, and how the PA leadership has come to a point where it’s a model for best practices.” Zecha agrees that SCCA’s collaborative approach is unique.

SCCA was named a 2018-2019 EOE winner last May. Among the EOE criteria exceeded by SCCA were: establishing a positive and supportive PA work environment; providing opportunities for meaningful input that lead to positive organizational change; and keeping PAs informed and involving PAs in leadership efforts to improve the quality of care.

SCCA has more than 150 PAs and NPs embedded in all of its disease groups and in-patient service. There is an onboarding process and orientation tailored to the needs of new staff members and each new PA or NP is assigned a mentor to bring them through their first year of practice. A Senior APP Leadership Team meets regularly to discuss opportunities to improve the work environment. In addition, APPs participate actively on a range of operational and executive committees. SCCA recently accepted its first cohort of fellows into its APP Fellowship in Medical Oncology or Blood and Marrow Transplantation.

85 percent of patient visits independent

According to its EOE application, “SCCA APPs are highly involved in the care of patients from screening and prevention to active intensive treatment in both outpatient and inpatient settings, and ultimately survivorship and long-term care.” PAs and NPs on the SCCA teams manage the day-to-day needs of SCCA’s patients who are receiving high intensity therapy, says Zecha, and its physicians delegate patients to be seen independently by the PA or NP.

“We have an organizational goal ensuring that we’re using PAs and NPs at the top of their license and by that, designating 85 percent of visits are independent visits, which really helps with job satisfaction for our folks,” says Zecha.

“I think that the collaborative approach that we have here is something that I don’t see everywhere,” she continues. “It really helps us to take care of our patients within the multi-disciplinary teams that we have. Our relationships are really important with the physician colleagues, medical oncology, surgical oncology, specialty care, as well as within all of our multidisciplinary teams including nursing, nutrition, social work, and they continue to grow.”

Having a seat at the table

Although Zecha has been at SCCA for more than 10 years, she became director of the APPs in 2015. She says it is important for APPs to have a seat at the table.

“They [APPs] need to have someone who understands the work they do on a pretty granular detail. That representation in knowing that someone who understands their work, will advocate on their behalf, and also hold them accountable, is really important. APPs have to make tough decisions about the amount of work people are doing, how they’re doing the work, and the variety of other more challenging decisions.”

Stewart, who has championed medical leadership training at SCCA for a number of years, adds that it does take a balance to “make sure that our PAs are heard and that they have a voice, that we listen to them, accommodate to changes in practice pattern, and that we’re competitive, because hopefully that means our PAs are happier. At the same time, we have to hold people to standards and make sure that our institutional goals are achieved, which is also equally important. Investing in your workforce is the key to success.”

He has allocated funding for local and national leadership training of PAs, NPs, and physicians. He also touts diverse opportunities for PAs in SCCA’s blood and marrow transplantation, the evolving area of hard T-cells, pain and palliative care services, and psychiatric oncology services.

Impact in retention and recruitment

Zecha feels that SCCA’s communication and leadership opportunities contribute to its appeal for APPs.

“Having leaders in our disease groups and in-patient service does impact our retention. We’re able to problem-solve as fast as possible while improving the team dynamic. We work really closely with our physicians and nurses and everyone to make sure that our patients are getting the best possible care. The access to care is a major issue that a lot of organizations are grappling with.

“We’ve identified a number of key approaches to formalize that including a program called our ‘undiagnosed clinic’, which facilitates patients coming into our system that don’t have a pathologic diagnosis and we get them set up with the right oncologist for the correct ongoing care.”

Zecha concludes that SCCA candidates, “see our commitment, our dedication, our passion, that we have both for our patients and our team. That’s really an important piece of our culture here. It’s an intellectually challenging place to work. I can’t imagine working anywhere else in oncology.”

Apply for Employer of Excellence Award

The EOE Awards are designed to recognize and showcase employers that create a PA-positive environment and encourage collaborative provider teams. CHLM partnered with HealthStream in 2017 to better understand what PAs value in their place of employment. Based on the findings, CHLM identified five key drivers as criteria for its EOE Awards, including:

  • Establishing a positive and supportive PA work environment.
  • Providing opportunities for PAs to provide meaningful input that leads to positive organizational change.
  • Keeping PAs informed of organizational activity and decisions.
  • Involving PAs in leadership efforts to improve the quality of patient care.
  • Creating processes for effective conflict management.

CHLM works directly with hospitals and health systems to enhance team-based patient care and optimize PA practice.

Eileen Denne is director of Corporate Communications at AAPA. Contact her at edenne@aapa.org.