Applying value stream mapping to improve patient flow and satisfaction.

244 Background: Value Stream Mapping (VSM) is a tool commonly used in manufacturing environments to analyze the current state process and to design an improved future state. VSM is a dynamic visual management tool that can be applied in the context of clinical activities to identify value-added (VA) and non-value added (NVA) activities along the spectrum of patient care. A VSM was created for the Breast Cancer Program to identify improvement opportunities in patient quality, flow, and communication across disciplines.

METHODS: A multidisciplinary team of physicians and clinical specialists were assembled to detail patient flows and coordination of care. Data for each process step was identified, and included, but not limited to: (1) lead times and (2) cycle times for each process. Clinical huddles were established to collect "real-time" patient information (n = 101 patients), and used to populate and validate the VSM. Additionally, retrospective analysis was performed using information from the tumor registry (n = 566 patients).

RESULTS: Visual representation of a patient's journey revealed distinct opportunities to improve the coordination of care and communication. The Breast VSM identified 53 discrete steps, and illuminated 3 focus areas for action: (1) coordination and navigation of patients at multiple points of entry, (2) communication of diagnosis, and (3) reduction of time between major clinical activity (diagnosis to surgery or first treatment). NVA identified opportunities to reduce the number of steps (13) between diagnosis and first treatment, whereby up to 15% of these steps are financial clearance that can delay care. Process differences were discovered between external and internally referred patients, leading to delays in first consult, and a need for better patient navigation.

CONCLUSIONS: VSM is an effective way to collaborate and drive improvements with multi-disciplinary teams. The non-value added activity highlighted on the maps provides an opportunity for improvements and reducing waste and delay in patient care. Providing timely communication and care will drive patient satisfaction around value-added steps.