Roswell Park Cancer Institute (RPCI) started working on an NCCN-sponsored Opportunity for Improvement (OFI) project in April 2011. The project originally focused on improving concordance with the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines). In conjunction with this, RPCI was spurred by poor Press Ganey patient satisfaction scores and complaints about wait times. Thus, a secondary goal of solving these issues was included, which led to a patient experience initiative and redefined the OFI project charter to focus on access and wait times in the Breast Cancer Center.
The team that coordinated the improvement was the Breast Product Line, co-led by the clinical chief and the breast imaging chair. This leadership group meets every other week. The OFI team also included the clinical chief, a nurse manager, a physician in mammography, a nurse practitioner or physician assistant, and an industrial engineer.
A toolkit was developed using Lean methodology to address all of the variables contributing to the inefficiencies in the breast program leading to wait times and delays. This toolkit was standardized to analyze patient flow and address inefficiency in any service or clinic at RPCI.
Using the toolkit, the team made major changes in patient flow, scheduling, and the staffing model, which led to a significant enhancement of the quality and experience of care in the Breast Cancer Center at RPCI. All the changes have had a positive impact on the patient experience. The mean wait-time scores on a Press Ganey measurement improved by 10 points, and complaints decreased by 40%. The project also led to implementation of several new programs, such as a patient and family advisory council, a navigation program, a survivorship program, and independent mid-level clinics.