Implementing large scale fast track diagnostics in a comprehensive cancer center, pre- and post-measurement data

• Published in: BMC health services research Vol. 18; no. 1; p. 85
• Main Authors: van Harten, W H, Goedbloed, N, Boekhout, A H, Heintzbergen, S
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 07.02.2018; BioMed Central; BMC
• Subjects: Breast cancer; Cancer care facilities; Cancer treatment; Communication; Critical pathways; Critical Pathways - organization & administration; Data analysis; Diagnostic services; Early Detection of Cancer; Efficiency; Female; Health services; Health Services Research; Humans; Interdisciplinary Communication; Lean manufacturing; Magnetic resonance imaging; Male; Managed competition; Management; Medical diagnosis; Medical referrals; Multidisciplinary teams; Neoplasms - diagnosis; Netherlands; NMR; Nuclear magnetic resonance; Oncology; Oncology service hospital, Organizational, Organizational management, Operations management; Oncology Service, Hospital - organization & administration; Operations management; Organizational change; Patient centered care; Patient logistics, Early cancer detection; Patients; Performance evaluation; Prostate; Sarcoma; Theory of constraints; Tomography; Tumors; Netherlands; Patient logistics, Early cancer detection; Oncology service hospital, Organizational, Organizational management, Operations management; Health services; Patient centered care; Cancer care facilities; Critical pathways
• ISSN: 1472-6963; 1472-6963
• DOI: 10.1186/s12913-018-2868-5

In 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. The 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. In 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. Throughput- 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.