One of the assumptions in healthcare is that improving care means adding something new. If patients are not receiving enough support, perhaps the organization needs another educational resource, another training program, another specialist, or another initiative. Those additions can certainly be valuable, but they are not always the place where the greatest opportunity lies.

As I’ve been working with more and more organizations, I noticed pretty early on that many already have far more pieces in place than they realized. They had clinicians who cared deeply about whole-person care. They had survivorship programs, psychosocial support, rehabilitation services, patient education materials, and community partnerships. Some had specialists with remarkable expertise in sexuality, pelvic health, or relationship concerns. Viewed individually, these were thoughtful and important investments.

Yet patients often have a very different experience.

Some never have the subject of intimacy raised. Others find helpful resources only after months of searching on their own. Some happen to meet a clinician who feels comfortable opening the conversation, while others move through treatment without realizing support even exists. Two people receiving care within the same organization could have entirely different experiences, not because one clinician cares more than another, but because the experience depends on who they happen to meet and when.

The question I now see is not whether organizations have resources. It’s whether those resources function as part of a connected system that patients can reliably experience.

Patients do not experience healthcare the way healthcare is organized. They are not thinking in terms of departments, disciplines, committees, or reporting structures. They experience a series of conversations, appointments, referrals, transitions, and relationships that together become their cancer journey. From their perspective, the organization either feels connected or it does not.

Healthcare organizations, however, have understandable reasons for developing in ways that are less connected. Departments are created at different times. Programs evolve independently. Individual clinicians develop expertise that may not be widely known outside their immediate team. Resources are produced by one department, referrals are managed by another, and educational efforts emerge wherever someone has the passion to champion them. None of those decisions are inherently problematic. In fact, they are often signs of committed people working hard to improve care.

The challenge is that strong individual programs do not automatically create a strong patient experience.

A beautifully written patient guide has little impact if staff do not know it exists or are unsure when to introduce it. A specialist cannot help patients who are never referred. A workshop may increase awareness, but if expectations, workflows, and referral pathways remain unchanged, much of that knowledge gradually fades under the pressures of everyday clinical demands. Excellent pieces can coexist without ever becoming a coordinated whole.

This is one of the reasons I think conversations about implementation deserve more attention. Implementation is often misunderstood as the final step that follows education or planning. I see it differently. Implementation is the work of helping good ideas become dependable experiences. It asks how resources are introduced, how conversations are supported, how referrals occur, how responsibilities are shared, and how patients encounter the right support at the right time.

When organizations are encouraged to begin asking those questions, the conversation changes. Instead of focusing primarily on what is missing, they begin examining how the existing parts of the system relate to one another. They start noticing where communication breaks down, where expectations are unclear, where support depends too heavily on individual initiative, and where relatively small changes could create a much more consistent experience for patients.

I have found this perspective to be encouraging rather than discouraging. Organizations often discover they are not starting from scratch. They already possess many of the ingredients needed to provide excellent intimacy-informed care. The work is less about replacing what exists than about helping those strengths become more visible, more connected, and easier for patients and clinicians to navigate.

That way of thinking has become the foundation of the CancerEVOLVE Framework.

Rather than beginning with recommendations, the framework begins with observation. It encourages organizations to look carefully at how intimacy-informed care is currently experienced across the patient journey and to ask questions that are often overlooked. Where do meaningful conversations already happen? Where are patients most likely to fall through the cracks? How do people find support? Which resources are consistently used, and which remain largely invisible? Where does the system depend on individual champions instead of shared and embedded responsibility?

Those questions rarely produce simple answers, but they often produce something more valuable. They help people develop a shared understanding of the organization they have today before deciding what they want to build tomorrow. Meaningful improvement begins with understanding the foundation that’s already in place. 

Ultimately, that is the difference I hope organizations begin to see. Strengthening individual programs and strengthening the system that connects them are not the same task. And both ultimately matter. But when the connections become stronger, patients are far more likely to experience the compassionate, coordinated care that organizations have been aiming to provide all along.