The referral process as imagined versus the referral process as done: co-developing a map of the...
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Deborah Debono1, Janet Long1, Melvin Chin2, Rachel Williams2, Elizabeth Salisbury3, Tracey Dunlop4, Kim-Chi Phan-Thien4, Elizabeth Eykman4, Sharron O’Neill5, Jeffrey Braithwaite1,
Natalie Taylor1
1Centre for Healthcare Resilience and Implementation Science (CHRIS), Australian Institute of Health Innovation (AIHI), Macquarie University; 2Prince of Wales Hospital; 3SEALS, Prince of Wales Hospital;
4St George Hospital; 5Lynch Syndrome Australia
Referral as imagined versus referral as done: mapping the referral process for genetic counselling for Lynch Syndrome patients
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Introduction: What is Lynch Syndrome?
• Lynch syndrome (LS) is a genetic mutation that increases the risk of aggressive cancers, particularly colorectal cancer (CRC), at a young age
• Cancer patients with a high risk of LS can take a genetic test
• Carriers can undertake effective surveillance, detect and treat cancer early and educate relatives
• Early diagnosis of LS can save lives
However …
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The problem: referral to genetic counselling for CRC patients with high risk of LS
• Less than half of NSW CRC patients with high risk of LS are referred for genetic counselling and testing
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‘Seeing’ the problem: mapping the referral process
“If people do not see the process, they cannot improve it.”
(Deming (1900-93))
• To improve the referral process for genetic testing for LS, we first need to identify and visualise the process
• Process mapping creates a visual representation of the actors, steps, and decisions involved in a process
• Cross referencing the described process with audit data collected at various steps of the process can highlight the process as it exists (work-as-done (WAD)) rather than as it is imagined to occur (work-as-imagined (WAI))
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The project aim
To co-develop at two hospitals a map of the current referral process for genetic counselling of colorectal cancer patients with a high likelihood of LS
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Methods
• May – September 2015• Two hospitals in Sydney• Face-to-face process mapping sessions (n=6) with key
healthcare professionals involved in the referral process for genetic counselling for testing for LS
• Implementation team meetings (n=2) with multidisciplinary health care professionals (Medical Oncologists, Pathology Registrars, Genetics Counsellors, Colorectal Surgeons, Radiation Oncologists)
• Audit data collection points identified• Electronic feedback on process map iterations
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Method: co-creating the referral process map
Process begins
Process ends
Yes
Yes
No
No
A
A
A
A
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Results
• Nine iterations of the referral process map have been developed
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Results: Referral Process Map - Iteration 1
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Results: Referral Process Map – Iteration 9
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Results
Co-mapping the referral process has: • Highlighted steps of the process at which data can be
collected to validate the process map and to measure the effect of improvement strategies
• Exposed work-as-imagined (WAI) versus work-as-done (WAD)
• Helped to create a shared understanding of the current process
• Illuminated potential barriers for further exploration
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Implications
Co-developing a process map with multidisciplinary stakeholders provides a powerful tool to:• Garner their unique knowledge of different aspects of the process to
produce a detailed representation • Facilitate communication between team members• Generate a shared understanding of the current referral process (work-
as-done)• Make ‘visible’ specific challenges to appropriate referral to genetic
counselling • Highlight potential targets for intervention to improve accuracy and
timeliness of referral
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Thank you and acknowledgements
This project is a Translational Cancer Research Network’s Cancer Challenge of the Year initiative, supported by Cancer Institute NSW’s translational cancer research centre program grant