Team improves rate of needed cancer tests
The staff at the Radiation Oncology department at the Los Angeles Medical Center knew well the importance of identifying cancer early.
It was part of their clinical routine, and when necessary, they knew patients could begin treatment and slow the spread of the disease.
“We see what happens when you don’t screen regularly,” says Sandra Miller, the department administrator and the UBT’s management co-lead.
So, the UBT was determined to deliver on Kaiser Permanente’s promise of preventive care and leverage the Proactive Office Encounter to increase the percentage of regularly scheduled mammograms, colorectal and Pap screenings by December 2013.
“With Proactive Office Encounter, we are treating the whole member,” says Maria Caceres, an assistant department administrator who was involved with the improvement project.
But the team also had to overcome resistance from patients.
“I think most of our patients that come to us do not want to deal with [one more test],” says union co-lead and medical assistant Monica Villanueva, SEIU UHW. “However, the more we reinforce the importance of having it done, they are more willing.”
Electronic reminders on KP HealthConnect helped ensure patients were getting their screenings, but the team also used a process map to examine its own workflow.
They put color-coded sheets on providers’ keyboards in exam rooms as visual alerts to indicate a patient is due for a screening (pink for mammogram, orange for colorectal test, green for Pap test) and created a pending order in KP HealthConnect.
Medical assistants checked the Proactive Office Encounter before each appointment to alert physicians when screenings were needed, and to check results and make reminder calls to patients.
They gave staff access to the radiology department’s appointment system so appointments could be made for patients while they were in the office, and provided training by laboratory colleagues on how to instruct patients on using the Fecal Immunochemical Test (FIT) kits.
“We had to sit down and break down every step,” Miller says. “We would ask, ‘Where were we not taking advantage of an opportunity to communicate with the doctor or the patient?’ Our process really changed after that.”
As a result colorectal screenings improved by 25 percentage points, Pap smears got a 12-point bump and mammograms increased by 46 points.
And when results for two patients showed they had additional health issues, the physicians, employees and managers were convinced.
“They could see the value and the impact of their hard work,” Caceres says.