Is your oncology access strategy creating a bottleneck?

A patient receives a cancer diagnosis and gets referred to an oncology program. The referral goes through, but key records are missing. The first available appointment with the right specialist is weeks away. And when the patient is finally seen, the waiting continues as the care team coordinates diagnostic testing, imaging, pathology, authorization, and treatment.

No single delay may seem out of the ordinary, and no department may appear to be underperforming. But to the patient, there is only one question: When will my care begin?

That is a common challenge with oncology access. Health systems often manage cancer care as a series of appointments, departments, and handoffs, but patients are looking for one continuous journey.

And that journey is becoming more demanding. The Vizient Impact of Change forecast projects outpatient cancer volumes will grow 20% over the next decade, while inpatient discharges will grow 2% and become more complex. As overall demand grows and more diagnostics and advanced therapies shift into outpatient settings, programs must coordinate transitions between sites of care, prioritize timely triage, and ultimately match patients to the right resource and level of care.

Following the patient can reveal barriers that traditional departmental views miss. For example, does every record need to arrive before the first visit, or just certain ones? Does a patient need to wait for the ideal subspecialist before someone on the oncology team makes contact, or would a first visit with a medical oncologist get the patient into the system to feel cared for? Does every initial interaction require a clinician, or would a nurse navigator be able to answer first questions?

None of those requirements is inherently wrong. Many were created for good reasons. But layered together over time, they can add days to weeks to a cancer journey.

Navigation should follow the same principle. Leaders in recent Vizient Cancer Service Line Network discussions emphasized designing navigation around what patients need to move forward rather than around existing organizational structures. That means aligning intake workflows, staffing, and escalation pathways so patients can reach the appropriate provider without unnecessary handoffs or delays.

The first step is to map the journey from referral forward. This includes tracking the number of steps that occur before first contact such as how many calls the patient makes, which handoffs add clinical value, and which exist primarily because that's how the organization has historically operated.

Processes designed around departmental or physician efficiency look very different from those designed around patient progression. Following the patient exposes that difference.

Measure the waiting, not just the work

A full physician schedule, strong clinic utilization, or efficient infusion operations may all signal good performance, but none of them answer how long the patient is waiting for care.

Track progression across the continuum through metrics such as referral-to-treatment intervals, cycle time by phase, and the percentage of patients progressing without delay. These measures expose constraints that provider- and encounter-level metrics may miss.

Cancer programs should look further upstream at time to first contact: how quickly a nurse, advanced practice provider, navigator, or other team member reaches a patient after referral.

The period between a suspected or confirmed diagnosis and hearing from the health system is intensely uncertain for the patient. While earlier contact doesn't eliminate downstream access constraints, it can reduce that uncertainty while giving leaders another way to understand access from the patient's perspective.

The data need to follow the patient, too. Track timestamps across the patient continuum including EHR, registration, and treatment systems to see where progression slows.

Manage the full cancer journey through survivorship

Health systems understandably devote significant attention to getting patients into cancer care. But one of oncology's biggest capacity opportunities may be at the other end of the journey.

The study identifies transition as the least mature of its three domains. Many oncology programs track entry and treatment access but lack systematic measurement around therapy changes, survivorship handoffs, or escalation to higher-acuity care. Starting measures should include time to handoff, survivorship care plan delivery, and therapy escalation intervals.

Beyond improving care coordination, appropriate transitions to survivorship care or primary care can free oncology capacity for new patients. When patients remain indefinitely on oncology panels after their specialty care is complete, they occupy appointments that could serve others.

That’s why survivorship and repatriation are more than clinical decisions and form an essential part of the oncology access strategy.

In Vizient Cancer Service Line Network discussions, leaders have also emphasized the need to think about survivorship and supportive care as an enterprise care model rather than a discrete phase that begins when treatment ends. That requires clear ownership, standardized services, and shared-care relationships with primary care and other specialties so patients can move to the appropriate setting when their needs change.

That raises a bigger leadership question: Who owns the patient's progression across the continuum?

In many health systems, responsibility is divided among referral teams, clinics, infusion services, navigation, authorization, and survivorship. Each team may perform well against its own objectives while no one is accountable for how long it takes a patient to move across them.

The study proposes a single operational leader accountable across entry, throughput, and transition, with authority to redesign workflows, establish performance targets, and resolve cross-functional bottlenecks. Local teams can retain decision-making authority while one leader remains accountable for how the entire journey performs.

Shared dashboards, cross-functional access reviews, and clear decision rights can reinforce that accountability. As value-based care expands, this accountability becomes even more critical as organizations will be tasked with and assessed on how well they manage the totality of a patient’s needs across settings, rather than focus only on individual departments or subspecialties. Without these mechanisms in place, patient flow risks becoming another improvement initiative rather than an ongoing management discipline.

Optimize before you build

When newly referred patients are waiting for appointments, adding capacity can feel like the obvious answer. Sometimes it is. But a new clinic, more infusion chairs, or another navigator won't solve a process that's fundamentally poorly designed.

Before investing, leaders should understand how effectively they are using the capacity they already have. Are referral requirements creating unnecessary delays? Is centralized intake truly centralized? Could work move to another member of the care team? Is technology removing friction or merely automating it?

Until leaders see the entire patient journey, they don’t know whether they need more capacity or need to use existing capacity differently.

Apply that same discipline to growth. Adding sites, expanding services, or launching new therapies creates more ways for patients to enter the system without ensuring the rest of the system can absorb the additional demand.

Evaluate growth decisions against operational readiness across entry, throughput, and transition before implementation. Sometimes the evidence will point to additional staffing, equipment, or facilities. Operational improvement alone can't overcome every capacity constraint. But understanding the patient journey gives leaders a stronger basis for deciding where investment will actually create capacity.

Oncology access will remain a moving target. Treatments will change, care will continue moving across settings, patient expectations will evolve. And the operating model must evolve with them.

A patient who enters a program doesn't know where entry ends and throughput begins. They’re focused on the days between “You have cancer” and “Here's what happens next.” Health systems need to see those days just as clearly and work to design the care journey accordingly.

Learn more about Vizient Networks—including the Cancer Service Line Network—that drive healthcare performance improvement to help hospital and healthcare leadership teams accelerate their high-performance journeys.