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

Abstract

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 quality-improvement initiatives and efforts to design truly patient-centered breast cancer treatment experiences.

Lay summary: Evidence-based patient navigation in breast cancer care requires the integration of services through each phase of cancer treatment. The Translating Research Into Practice study aims to implement patient navigation for patients with breast cancer who are at risk for delays and are seeking care across 6 health systems in Boston, Massachusetts. The authors designed a 10-step protocol outlining procedures and tools that support a systematic assessment for health systems that want to implement breast cancer patient navigation services for patients who are at risk for treatment delays.

Keywords: breast cancer; health equity; implementation science; patient navigation; quality improvement.

Figure 1:

Overview of the workflow mapping process

Figure 2:

Template of the patient navigation swimlane workflow process map, by oncology department Caption: This template displays an example of a site in which navigation activities are only offered in radiology and surgical oncology. While there is a “warm handoff” from radiology to surgical oncology, there are no personnel responsible for navigation to receive patients in either medical oncology or radiation oncology. This visualization illustrates a need to identify personnel in these two departments who can perform navigation activities and support multi-disciplinary care coordination throughout a patient’s treatment experience.

Figure 3:

Template of the Regional Patient Navigation High-Level Process Map, by site