Applying Lean Kaizen to improve timely CT scan appointments for oncology patients in a safety-net hospital.

Abstract

e18627 Background: Timely radiographic studies are essential to oncology care. At our institution, a safety net hospital in a large metropolitan area, baseline assessment determined that the overwhelming majority of outpatient computed tomographic (CT) scans for oncology patients were overdue for scheduling. We applied the Lean Kaizen quality improvement model to improve on-time scheduling of CT scans in our hematology-oncology clinic. Lean Kaizen is centered around eliminating waste, improving productivity, and maintaining sustained improvement through collaborative efforts from multiple departments to analyze system workflow inefficiencies in a stepwise fashion. Methods: In collaboration with our Kaizen Promotion Office, we conducted a series of interdisciplinary meetings including staff from radiology, oncology, scheduling, and administration. All aspects of the scheduling workflow were critically reviewed and barriers to scheduling were identified using an Ishikawa root-cause diagram and the Kaizen principle of gemba (“go and see the work”). A new workflow was developed in which clinic staff scheduled patients for CT scans prior to clinic discharge. To implement the new workflow, we employed the principles of shojinka (“create flow”) and nagara (“eliminate waste”). We developed and distributed workflow guides, conducted simulation events, and provided one-on-one training to ensure a successful rollout. Three months after our initial meeting, the new workflow was launched. The workflow was refined based on feedback from daily pre-clinic team meetings. Results: Preliminary data were gathered approximately 3 weeks following implementation of our new workflow. Since our intervention, the percentage of CT scans overdue for scheduling decreased from 87% (65 of 75 CT scans) to 17% (9 of 53 CT scans). Conclusions: Our study showed that the Lean Kaizen QI model was successful in improving the rate of oncology patients scheduled for CT scans in a timely fashion. This study demonstrated the importance of interdepartmental collaboration and continuous monitoring for improvement. Given the success of this project, this workflow will be expanded to other services within our institution following the Kaizen principle of yokoten (“sharing knowledge”).

Improving Care Continuity in Oncology Settings: A Lean Management Approach to Minimize Discharges Without Follow-Up Appointments

“…The application of the Kaizen principle facilitated continuous input acquisition, leading to incremental yet significant modifications. This approach aligns with previous research emphasizing the importance of gradual changes in achieving lasting improvements [ 20 ]. The study was conducted from Quarter 3 of 2022 to Quarter 2 of 2023 and resulted in a notable decrease in the proportion of patients discharged without scheduled follow-up appointments, dropping from 9% in September 2022 to 0% in March 2023.…”

“…Interdisciplinary collaboration, technology integration, and patient engagement strategies have been associated with improved care continuity and patient outcomes. The reduction in missed appointments aligns with research emphasizing efficient procedures and effective communication in preventing missed follow-up visits [ 17 , 21 , 7 , 9 , 11 , 20 , 13 , 22 ]Sarvandi & Shahroodi, 2016).…”