In March 2011, 27 cancer health professionals developed a big picture map of the current state of the Cancer Service at Cabrini Health. The picture served as a tool to exemplify the complexity of the cancer system from the patients’ perspective. Using the metaphor of a stream, it was evident that the patients’ flow of care was complicated by system issues.
Demand analysis, extended value stream mapping and patient focus groups were conducted to understand the problem further. It was evident there was much waste at a time when patients had little time and energy to waste.
Root cause problem analysis revealed, amongst other factors, two important generic system issues:
1. Lack of person-centered care in the cancer journey
2. Scheduling and rostering mismatch in day oncology units, resulting in delays, frustration and poor utilisation of chair space
With the goal to create value, two improvement plans were initiated:
1. Development and deployment of a shared patient care plan
2. Rescheduling and rostering to match patient demand and activity.
Working with patients and staff directly involved in the work has enabled a co-created and fully owned change process. Visual management of the measureable improvements and feedback has also assisted the teams.
Among many positive outcomes, there has been a 20% increase in satisfaction levels using Press Ganey questions. Significantly also, improvements in waiting times have created improved flow in the unit and subsequent increased capacity and utilisation.
No one but the patient experiences the health system journey and yet health services and processes are built primarily on health professionals’ views of what is needed, rather than the customer’s experience and knowledge of system requirements. There are multiple system issues. Working with one issue at a time in a disciplined way is an important factor to achieve our goals of excellence.