Development of a workflow process mapping protocol to inform the implementation of regional patient navigation programs in breast oncology

Abstract

and the Translating Research Into Practice (TRIP) Consortium BACKGROUND: Implementing city-wide patient navigation processes that support patients across the continuum of cancer care is impeded by a lack of standardized tools to integrate workflows and reduce gaps in care. The authors present an actionable workflow process mapping protocol for navigation process planning and improvement based on methods developed for the Translating Research Into Practice study. METHODS: Key stakeholders at each study site were identified through existing community partnerships, and data on each site's navigation processes were collected using mixed methods through a series of team meetings. The authors used Health Quality Ontario's Quality Improvement Guide, service design principles, and key stakeholder input to map the collected data onto a template structured according to the case-management model. RESULTS: Data collection and process mapping exercises resulted in a 10-step protocol that includes: 1) workflow mapping procedures to guide data collection on the series of activities performed by health care personnel that comprise a patient's navigation experience, 2) a site survey to assess program characteristics, 3) a semistructured interview guide to assess care coordination workflows, 4) a site-level swim lane workflow process mapping template, and 5) a regional high-level process mapping template to aggregate data from multiple site-level process maps. CONCLUSIONS: This iterative, participatory approach to data collection and process mapping can be used by improvement teams to streamline care coordination, ultimately improving the design and delivery of an evidence-based navigation model that spans multiple treatment modalities and multiple health systems in a metropolitan area. This protocol is presented as an actionable toolkit so the work may be replicated to support other qualityimprovement initiatives and efforts to design truly patient-centered breast cancer treatment experiences.

Challenges and recommendations for advancing respite care for families of children and youth with special health care needs: A qualitative exploration

“…While the intent of this study did not include a fulsome quality improvement process mapping approach, 52 visual display of qualitative findings 53 using cross‐functional or swim lane process maps 48 provides new and novel insights (Figure 1A,B ). Process maps have been used in quality of care research in oncology, 41 and nephrology, 40 however, to the best of our knowledge not previously been applied to respite care. Furthermore, incorporating outcomes (respite needs met/unmet) as the ‘finish’ step in the process map supports the project goal to inform respite care that is responsive and integrative, as well as a key message of the National Respite Care Project, ‘to understand respite as an outcome for the caregiver rather than simply as a service to the caregiver’, which is what would be required to truly provide respite to family caregivers.…”

“…Process mapping was used as a methodological tool to identify current respite system complexities and bottlenecks, and opportunities for improvement. 40 Process maps portray the multiple roles and steps involved in processes, 40 , 41 assisting in ‘…fostering shared understanding of current state and ideal future state processes’. 42…”

Optimizing process flow diagrams to guide implementation of a colorectal cancer screening intervention in new settings

“…The swimlanes, or rows in the process map, identified the individuals and partners involved and which process steps each would perform [5]. Swimlane diagrams are an effective approach for health interventions involving care coordination across multiple groups and have previously been applied to patient navigation [16].…”

Assessment of patient navigation programs for breast cancer patients across the city of Boston

“…These meetings concluded with a 60-90 min semi-structured workflow assessment group interview to understand the interrelated steps in each site's existing patient navigation process. We conducted the workflow assessment with the breast oncology navigation team at each site, which typically consisted of patient navigator(s), patient navigator supervisor(s), and the site's clinical champion(s) [26].…”