An established partnership between the primary care medical home and the mammography provider is critical to delivering quality breast health care. A one-to-one relationship between the two organizations will facilitate continuous communication between two single points of contact. The resulting relationship can improve handoffs, decrease cycle times, provide a quick turnaround for mammogram reports, and improve overall efficiency.
Steps for implementation
- Project Team members (see Element 6: Process Improvement Meetings with Clinic Project Team) identify priority clinic mammography providers among existing relationships. Priority setting may depend on several factors including: payment options, geographical location, transportation options, services offered, and existing contracts, if any.
- Establish a point of contact at the mammography facility if the clinic does not already have one. The point of contact should be someone who can make changes in processes; this person may be the head of the radiology department, the lead mammography coordinator, the community health director, etc.
- Set up an initial meeting with the leadership at the mammography facility to discuss the current referral, screening, and follow-up processes. Create a process map or flow chart including current roles of staff members from both institutions.
- Use the Model for Improvement to decide on a Plan-Do-Study-Act (PDSA) cycle to improve a priority area of the current process. (See Element 6: Process Improvement Meetings with the Clinic Project Team)
- Set up regular meetings with the mammography facility to review data and PDSA results and to continue to enhance the partnership. (See Element 3: Data Collection Plan to Measure Progress).
- Optional: Develop and execute a Memorandum of Understanding between the two institutions to document the working relationship.
Block Scheduling: Community Health Care Network – Inova Fair Oaks Hospital, Fairfax County, Virginia
The Community Health Care Network (CHCN) wanted to test block scheduling with their sole mammography provider, Inova Health System. CHCN leadership decided to test the process at the North County site, which refers all patients to Inova Fair Oaks Hospital (FOH). Staff from CHCN and FOH gained support from senior leadership and after three meetings, the partners developed a proposed process for block scheduling and set a start date. The partners met bi-weekly during the testing phase to promptly address concerns with scheduling and no-shows. After initial success, the partners increased the block of weekly appointments from 9 slots to 19. The partners continued to check in at least monthly to monitor results and solve problems. After eight months, results demonstrate:
- Cycle time from referral to mammogram decreased to 18 days.
- Mammography completion rate increased to 80% from a baseline screening rate of 55%
- No-show rate decreased from 27% to 6%.
- The streamlined process reduced the amount of staff time spent by both partners on scheduling.
- The partners are working together to spread block scheduling to other sites.
Note: While the majority of patients received mammograms through the block appointments, FOH allowed for patients to schedule outside the block when necessary.
Streamlined Appointment Scheduling to Increase Screening Rates: Community of Hope – George Washington University Hospital, District of Columbia
A portion of COH’s clinic population receives mammography screening services at George Washington University (GWU) Hospital. Prior to establishing a relationship between the two facilities, patients often had trouble making appointments through the hospital’s central scheduling system. When patients had the responsibility to make their own appointments, data showed a low completion rate. Of the 37 patients with outstanding mammograms and were referred to GWU Hospital between July 2010 and August 2011, 31 never made an appointment.
To improve patient follow-through, the Referral Specialist at COH met with the Manager of GWU Hospital’s radiology department to examine the process and establish a contact to better resolve issues. As a result, the Referral Specialist now calls GWU’s central scheduling the day of the clinic appointment to schedule a screening mammogram before the patient leaves the clinic. The Specialist faxes the referral directly to the radiology department and the patient then leaves the clinic with an appointment. Knowing of the exact date and time of the appointment allows the clinic to provide prompt follow-up and ensure procedure completion.
Frequently Asked Questions
Q1. What is a Process Map?
A1. A Process Map is an effective tool used to identify opportunities for improvement in clinic flow. To create a Process Map, the staff works together to understand, examine, and visually represent all the steps a patient must go through in order to receive care. The activities generates a flow chart which allows the clinic team to pinpoint specific steps or parts of the process that may be problematic for the patient or staff member. Also, the exercise promotes a better understanding of roles and responsibilities within the clinic to eliminate duplication of efforts and streamline communication.
Q2. What if we refer to multiple mammography providers?
A2. While we recognize that there are variations in clinic models and some clinics and patients face limits in facility options due to multiple insurers or geography, a one-to-one partnership is ideal. A simplified one-to-one relationship streamlines communication and processes and facilitates matching supply with demand for mammography services, enhancing systems to better serve patients. Managing care when patients are sent to multiple providers becomes more difficult because the clinic must track multiple processes, forms, contacts, and possibly sources of funding. We recommend identifying a priority provider, which may be a facility taking all payers, offering interpretation options, and/or transportation, and focusing process improvement efforts with that facility first. If your clinic has no alternative but to utilize more than one mammography provider, there should be clear criteria to determine who is referred to each provider, and the same activities (process mapping, regular communication) are required with each.
Q3. What if we select the Breast and Cervical Cancer Program (BCCP) to be our priority partner? Is it different from selecting a mammography facility?
A3. As with a mammography facility, the clinic needs to set up a system with the BCCP to make sure that patients enrolled in the program get the referral, screening, and diagnostics as needed. The clinic should establish a contact and begin regular meetings to discuss and agree upon a process for the partnership, including transparency around patient referral and follow-up. In general, the BCCP does not offer direct services (i.e. mammograms, sonograms). BCCP differs from a mammography facility because it is a referral to a facility; however, this may be the best way to meet patient need and a clear, streamlined process with regular communication will improve outcomes.