A Lean Quality Improvement Initiative to Enhance Tobacco Use Treatment in a Cancer Hospital

Colleen Meyer, Sara Mitra, Ellen Ruebush, Laurel Sisler, Kyle Wang and Adam O. Goldstein
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Colleen Meyer: Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27759, USA
Sara Mitra: Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Ellen Ruebush: Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Laurel Sisler: Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27759, USA
Kyle Wang: Lineberger Comprehensive Cancer Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
Adam O. Goldstein: Department of Family Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27759, USA

IJERPH, 2020, vol. 17, issue 6, 1-9

Abstract: Sustained tobacco use after cancer diagnosis decreases treatment effectiveness while increasing treatment side effects, primary cancer recurrence, and the occurrence of secondary cancers. Delivering tobacco use treatment to fewer patients due to inefficient workflow represents missed opportunities to deliver life-saving care. In 2017, the National Cancer Institute initiated the Cancer Cessation Initiative (C3I) to push new tobacco cessation resources into cancer centers across the United States. This grant allowed the University of North Carolina Tobacco Treatment Program (UNC TTP) to dramatically expand tobacco use treatment (TUT) services to patients at the North Carolina Cancer Hospital (NCCH). With this push, the team saw an opportunity to utilize Lean Six Sigma, a set of quality improvement (QI) tools, to streamline their processes and uncover the root causes of program inefficiencies. A 12-month QI project using the Lean A3 problem-solving tool was implemented to examine the team’s workflow. The study team mapped out the processes and, as a result, developed multiple “experiments” to test within the NCCH to address workflow efficiency and clinical reach. Outcome measures from the baseline to follow-up included: (1) the number of new patient referrals per month, and (2) the number of counseling sessions delivered per month. From the baseline to final state, the team’s referrals increased from a mean of 10 to 24 per month, and counseling sessions increased from a mean of 74 to 84 per month. This project provided a deeper understanding of how workflow inefficiencies can be eliminated in the clinical setting, how technology can be harnessed to increase reach, and finally, that soliciting and using feedback from NCCH leadership can remove barriers and improve patient care.

Keywords: tobacco use; smoking cessation; cancer patients; process improvement (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2020
References: View complete reference list from CitEc
Citations: View citations in EconPapers (3)

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