Abstract
BackgroundIn general, patients with a cancer suspicion visit the hospital multiple times before diagnosis is completed. Using various “operations management” techniques a few fast track diagnostic services were implemented in the Netherlands Cancer Institute (NKI) in 2006. Growing patient numbers and increasing process complexity, led to diminished service levels. To decrease the amount of patient visits and to extend these services beyond the (obvious) breast cancer services, fast track diagnostics is now implemented for all 18 cancer types that present with a frequency of minimally one per week.MethodsThe throughput time (first visit to diagnosis conversation) was measured before, and after implementation of fast track diagnostics. The process was redesigned closely involving the multidisciplinary teams. In an eclectic approach elements from lean management, theory of constraints and mathematical analysis were used to organize slots per tumor type for MRI, CT, PET and echography. A post measurement was performed after 3 and 6 months.ResultsIn pre measurement access time was calculated to be 10 to 15 workdays, mean throughput time was 6.0 workdays. It proved possible to design the process of 18 tumors as a fast track, of which 7 as “one stop shop” (diagnosis completed in one visit). Involvement of clinical- and board leadership, massive communication efforts and commitment of physicians to reschedule their work proved decisive. After 3 and 6 months of implementation, the mean access time was 8.2 and 8.7 workdays respectively and mean throughput time was 3.4 and 3.3 workdays respectively.ConclusionsThroughput- and access time were considerably shortened after implementation of fast track diagnostics for 18 cancer types. The involvement of physicians in reorganizing their work and rapid responding to their needs during the implementation phase were a crucial success factor.
Highlights
Patients with a cancer suspicion visit the hospital multiple times before diagnosis is completed
In the pre measurement throughput time was retrospectively measured for 175 patients and 10 cancer types; we involved a group of patients who received fast track diagnostics, as introduced in 2006, from October to December 2011
Evaluation We developed a 14 items digital satisfaction questionnaire especially focusing on patient experiences with the diagnostic process
Summary
Patients with a cancer suspicion visit the hospital multiple times before diagnosis is completed. In operations management literature we can find various papers referring to service improvement using redesign or lean management techniques [12], but so van Harten et al BMC Health Services Research (2018) 18:85 far little evidence is found on large scale- or multiple service improvement, especially in the hospital environment. This is especially relevant as, at least theoretically, improvement in isolated services by allocating fast track slots, can lead to suboptimalization elsewhere in the organization. Reports on isolated services, such as breast cancer in oncology are available, but papers on large scale improvement interventions are rather scarce and not found on cancer services
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