Abstract P3-09-14: Using lean methods to increase access to support services in younger breast cancer survivors

Abstract

Background: A variety of ‘structured support services’ (services) are available to patients (e.g. genetics, fertility, counseling, physical functioning, nutrition). Many of these services have value for breast cancer survivors (survivors) as they are often likely to face issues regarding genetic factors, fertility, parenting, relationships, work, and financial hard-ships. As part of an ongoing CDC-funded initiative, we report about barriers to services use for survivors. Methods: We used lean techniques to analyze system complexity including: process mapping; inventorying support services, providers/staff, and referral methods; stake holder leadership events; and Kaizen events to facilitate system improvements. Results: We identified several barriers to patients getting services which reflect the complexity of cancer care delivery in an academic cancer center including: varying care pathways, lack of standard processes; lack of staff awareness of available service (hospital staff are located in 5 different clinics and include physicians, APPs, clinic nurses, nurse navigators, and patient schedulers); numerous different contact and referral methods to services (tribal knowledge of staff necessary to make SS referrals). We initially identified 7 and found 38 services through inventorying and mapping systems. We implemented a number of systematic and non-systematic interventions to address these barriers. Systematic implementations include assisting in the development and piloting new patient orientation binders to include services, implementation of a revised scheduling form to streamline referrals, created and disseminated a quick reference referral guide to educate staff for how to make referrals. Non-systematic interventions included hosting services fair for breast cancer providers to meet and learn about them and advertising services on waiting room TVs. Conclusions: Patients and providers both perceive many challenges accessing support services. Applying improvements in a complex health care system is difficult and incrementally addresses identified barriers. We will now be measuring the impact of these changes on the receipt of support services in breast cancer survivors. Funding: CDC Grant 1U58DP003414 (PI Marks, L.). Citation Information: Cancer Res 2013;73(24 Suppl): Abstract nr P3-09-14.