This element includes two parts: The first establishes a culture of continuous process improvement throughout the entire clinic system. The second develops a Clinic Project Team, comprised of clinical and non-clinical staff who are dedicated to improving the quality of breast health care. The NCA Regional Breast Healthcare Improvement Initiative used the Model for Improvement framework to assist teams in testing and adopting changes in the delivery of care and to foster continuous improvement.
Strong support from leadership and a foundation of process improvement knowledge empowers the Clinic Project Team to make effective improvements and facilitates all other elements of the Change Package.
Steps for Implementation
- Engage support from senior leadership to prepare your organization for process improvement focused on breast health.
- Educate all staff on process improvement concepts.
- Use the Core Project Team Description document (sidebar) to identify members of the Clinic Project Team, which should include staff who represent each step of the clinic breast health process and are committed to driving and championing breast health improvement throughout the clinic.
- Determine a regular monthly meeting time for Team process improvement activities.
- Identify and prioritize areas for improvement, using baseline and monthly data reports, process mapping, and the Know Your Processes Questionnaire (sidebar).
- Plan and implement small tests of change, using Plan-Do-Study-Act (PDSA) cycles from the Model for Improvement and the PDSA template (sidebar).
- Evaluate test results and plan new tests at each monthly meeting.
- Celebrate success and communicate results throughout the clinic. Report back to providers, staff and senior leadership regularly, through provider meetings, all-staff meetings, and clinic newsletters.
- Work with senior leadership to implement and institutionalize changes that demonstrated
- success when tested.
Identifying the Clinic Project Team: Greater Baden Medical Services, Prince George’s County, Maryland
The Project Team met with GBMS leadership three times to discuss specifics of project implementation. After agreeing to participate, GBMS leadership determined that focused process improvement would begin at the Capitol Heights site with the plan to spread successful practices to the other four GBMS sites.
The Clinic Project Team included the following:
- Sponsors: The Executive Director and the Vice President of Development. The Sponsors did not attend monthly meetings; however they received regular updates and participated in larger quarterly administrative oversight meetings to assist with spread and institutionalization.
- Provider Champion: Family Practice Physician at the Capitol Heights site.
- Key Contact: GBMS Quality Coordinator. The Quality Coordinator for GBMS is also a practicing Nurse Practitioner. She generated monthly reports and communicated measures and updates with the provider teams, both at the site and system-wide.
- Other Members:
- Capitol Heights Clinic Manager, who drove processes with non-clinical staff as well as partnership development with the mammography provider.
- Additional Clinical Providers at Capitol Heights, who regularly reviewed referral and screening metrics and brainstormed ideas for PDSAs.
PDSA Cycle: Scheduling a Mammography Appointment: Community of Hope, District of Columbia
After reviewing baseline data, the Team at Community of Hope decided to focus on activities to increase their screening rate and decrease cycle time from referral to mammography screening. The Team, including one physician provider and the Referral Specialist, evaluated current processes and decided on a small test of change. Instead of leaving without a referral in hand or a scheduled mammography appointment, the provider ordered the referral within the EMR and then asked the patient to wait in the lobby. The Referral Specialist retrieved the referral order and met with the patient to schedule a mammography appointment. The patient left with an appointment and referral in hand. Not only did this ease the process for the patient, but assisted with follow-up on no-shows, receiving results, and overall communication with the mammography provider and patient. The Team tested this with referrals and scheduling at one mammography facility and plans to spread the approach to others.
Frequently Asked Questions
Q1. Can the Clinic Project Team be smaller or be just one person?
A1. Ideally, the Clinic Project Team will include representatives of all types of staff members that have a role in patient care, and more specifically a role in the breast health screening, referral, and follow-up process. The wider representation facilitates testing at each step as well as communication of results to other staff.
Q2. How do we spread successful changes to other providers or sites?
A2. Working with your Clinic Project Team and senior leadership, identify 2-3 tests resulting in demonstrated improvements. Report these best practices to the entire staff and/or staff who will be involved in implementation at other sites. For example, a best practice may be to have CMAs document mammography history within the medical record as a prompt to providers to issue a referral when necessary. All CMAs and providers should be trained on this new clinic protocol and any concerns addressed as a part of spread activities.