Roadworks ahead: a collaborative approach to process redesign

The symptomatic breast service at James Cook University Hospital has recently undergone a pathway review, the catalyst for the review being the Cancer Services Collaborative (CSC) Phase II programme, which began in April 2001. A pathway review had previously taken place in 1998, with one of the aims being to provide a one-stop clinic allowing regular analysis of variants to prove clinical effectiveness and service efficiency. Due to service pressures, one of which was the impact of the 2-week wait, not all patients requiring the one-stop service could receive triple assessment. This was in the main due to lack of clinic time along with mammography and ultrasound availability. Using the CSC methodology the current process was mapped, redesigned and audited. The changes have resulted in: extending the new patient clinic, with greater mammography and ultrasound availability; where patients require ultrasound and mammography outside the clinic appointments can be booked within the clinic. The MDT has been moved from prior to the breast clinic to post clinic, allowing more timely discussion of patients both before and after surgery. Acquisition of a computer printer, projector and network facilities for the MDT has resulted in the ability to enter data in real-time and generate referrals to Oncology.