To improve access for patients to the Breast Cancer Center at Roswell Park Cancer Institute, the Opportunities for Improvement Project team defined 3 goals: reduce the delay to initial appointment, reduce delays in treatment at the Breast Cancer Center, and reduce delays in the start of endocrine therapy. The team developed a set of tools using Lean methodology that helped to address variables contributing to inefficiencies that result in delays. The idea behind these tools was to integrate all the business variables, such as volume, clinical space, physician availability, services offered in the Breast Program, and patient types, to produce a system or schedule that is more predictable. A new schedule for physicians, independent mid-level clinics, a survivorship program, a primary nursing model, and new roles and responsibilities were defined and implemented. Mean scores in a Press Ganey survey for wait-time questions improved by 10 points, and patient complaints decreased by almost 40%. The team concluded that delays in the Breast Program were symptoms of a larger dysfunction in systems. Fixing the problems required a comprehensive approach to review all the variables that resulted in delays.
Jatinder Singh, Stephen B. Edge, Ermelinda Bonaccio, Kathleen Trapp Schwert, and Brian Braun
Therese B. Bevers, Benjamin O. Anderson, Ermelinda Bonaccio, Sandra Buys, Mary B. Daly, Peter J. Dempsey, William B. Farrar, Irving Fleming, Judy E. Garber, Randall E. Harris, Alexandra S. Heerdt, Mark Helvie, John G. Huff, Nazanin Khakpour, Seema A. Khan, Helen Krontiras, Gary Lyman, Elizabeth Rafferty, Sara Shaw, Mary Lou Smith, Theodore N. Tsangaris, Cheryl Williams, and Thomas Yankeelov
Therese B. Bevers, Mark Helvie, Ermelinda Bonaccio, Kristine E. Calhoun, Mary B. Daly, William B. Farrar, Judy E. Garber, Richard Gray, Caprice C. Greenberg, Rachel Greenup, Nora M. Hansen, Randall E. Harris, Alexandra S. Heerdt, Teresa Helsten, Linda Hodgkiss, Tamarya L. Hoyt, John G. Huff, Lisa Jacobs, Constance Dobbins Lehman, Barbara Monsees, Bethany L. Niell, Catherine C. Parker, Mark Pearlman, Liane Philpotts, Laura B. Shepardson, Mary Lou Smith, Matthew Stein, Lusine Tumyan, Cheryl Williams, Mary Anne Bergman, and Rashmi Kumar
The NCCN Guidelines for Breast Cancer Screening and Diagnosis have been developed to facilitate clinical decision making. This manuscript discusses the diagnostic evaluation of individuals with suspected breast cancer due to either abnormal imaging and/or physical findings. For breast cancer screening recommendations, please see the full guidelines on NCCN.org.