Operations management, according to Wikipedia, is an area of management concerned with designing and controlling the process of production and redesigning business operations in the production of goods or services. It involves the responsibility of ensuring that business operations are efficient in terms of using as few resources as needed and effective in terms of meeting customer requirements. It is concerned with managing the process that converts inputs (in the forms of raw materials, labor, and energy) into outputs (in the form of goods and/or services). It’s not often thought of as being related to the healthcare industry, but it should. Without efficient methods in place to perform cancer screening, diagnosis, and treatment, quality of care cannot be achieved; even ensuring that the cancer patient receives the right care in the right setting at the right time by the right provider cannot happen.
Identification of barriers to care actually is at the heart of the principles and practices of operations management. A navigator should not be serving as a band-aid for a broken process, especially when the barriers can be identified up front, are recognized to be impacting many patients, and are related to patient flows and processes of care.
The first phase of work that a navigator should do before even attempting to navigate any patient is to study the patient flow through the healthcare delivery system beginning with how patients get access to the system. Each intended touch point for the patient needs to be reviewed and documented, then analyzed to see whether there are barriers associated with the patient going from one phase of care to another. Then determine if there is a global solution for alleviating that barrier, or if it is a barrier that is very patient specific and cannot be corrected through implementing an intervention at that touch point. Such analysis needs to be assessed across the continuum of care.
Anytime there is a change in protocols, operations management needs to be reassessed. For example, when neoadjuvant chemotherapy became a new standard of care, this dramatically changed the patient flow process and, in turn, identification of the most efficient and effective way to implement this work flow change needed to be determined and implemented.
There is great value in the entire multidisciplinary team having a good understanding of the patient flow process. They are stakeholders and should be considered as such. The ultimate stakeholders, however, are the patients.
Following are examples of how uniform changes, through operations management, can be made to address barriers that impact a measurable volume of patients.Case Studies
Access to Screening Mammograms
The analysis showed that despite recruiting 45 women to come in for screening mammograms, only 10 actually came and had their imaging done. Operations management analysis demonstrated that the primary reasons for patients being no-shows were that they lacked transportation or that they didn’t want to take off from work. The solution was to provide taxi vouchers to get them to the mammography facility (and their return home taxi voucher after they completed the mammogram that day), as well as providing evening and Saturday hours for getting their imaging performed. As an added safeguard, women were contacted the night before by phone to remind them to come in for their mammogram the next day, and ensure they would follow through. For the next group of women recruited, the no-show rate was only 10%. When these women were contacted, their barriers were quite individual—fear of the results being a primary barrier. Having a survivor volunteer of the same race and ethnicity to speak with prior to and after the mammogram diminished the fear and further decreased the no-show rate to 5%.Inefficiencies in Getting Patients Seen
Postoperatively by Medical Oncology
The analysis showed that there was a wait time of 3 to 4 weeks before patients were able to get in for their appointments with a medical oncologist after surgery was completed. These delays were due to inadequate staffing. It was thought, however, that if the backlog could be addressed and changes in the timing scheduling these appointments were made, the wait time would likely be reduced to 10 days after surgery. The interventions that were done were having medical oncologists taking add-ons for a period of approximately 3 weeks, as well as changing the timing of making the appointments. Based on the patient flow, the patient sent to breast cancer surgery was seen post-op by the surgeon 5 to 7 days later. This appointment was proactively scheduled at the time the surgery was arranged. At the post-op appointment, the patient was then scheduled for the medical oncology appointment; this wait time was 3 to 4 weeks, delaying getting chemotherapy under way for those needing adjuvant treatment. The change that was made was to not wait until the post-op visit to arrange the medical oncology consultation, but instead to also proactively arrange it when the surgery was scheduled, lining up a date 10 to 12 days after surgery. Since most surgeries were arranged 2 to 3 weeks ahead of time, the scheduling of the medical oncology appointment was much easier to obtain within the window desired.
Check your knowledge!
1. Operations management is designed to be conducted within
a. Large industries
b. Healthcare institutions
c. Midsize organizations
d. All of the above
2. The oncology nurse navigator can best determine the current patient flow process across the continuum by
a. Following several patients through observation from one phase of care to the next
b. Asking the staff what the flow process is
c. Intervening when she sees there is a patient flow problem
d. Asking a patient what his or her experience was like
3. A primary day-to-day function of an oncology nurse navigator is to
a. Identify and resolve individual barriers to care that are unique for that patient
b. Serve as a solution to global barriers that are noted through operations management
c. Serve as the healthcare assistant to the providers in clinic
d. Identify when someone is making an error
4.Without effective operations management, a patient may
a. Get overtreated
b. Get undertreated
c. Not receive quality of care
d. All of the above
1, D; 2, A; 3, A; 4, D.
Wren DA, Bedeian AG. The Evolution of Management Thought. 6th ed. Hoboken, NJ: Wiley; 2009.
Klemm F. A History of Western Technology. New York, NY: Charles Scribner’s Sons; 1959.
Shockney LD. Becoming a Breast Cancer Nurse Navigator. Sudbury, MA: Jones & Bartlett; 2011.