A qualitative study of the adoption of Value Stream Mapping in breast cancer centers. (October 2021)

• Record Type: Journal Article
• Authors: Dittmer, Kerstin; Hower, Kira Isabel; Beckmann, Marina; Karbach, Ute; Pfaff, Holger
• Is Part Of: European journal of oncology nursing. Volume 54(2021)
• Publication Date: 2021-10
• Subjects: Total quality management -- Qualitative research -- Breast cancer -- Nurse specialists -- Patient-centered care -- Organizational innovation; Cancer -- Nursing -- Periodicals; Cancer -- Research -- Periodicals; Oncology -- Periodicals; Oncology Nursing -- Periodicals; Neoplasms -- nursing -- Periodicals; Cancer -- Soins infirmiers -- Périodiques; Cancer -- Recherche -- Périodiques; Cancérologie -- Périodiques; Verpleegkunde; Kanker; Cancer -- Nursing; Cancer -- Research; Oncology; Electronic journals; Periodicals; Electronic journals; 616.9940231
• DOI: 10.1016/j.ejon.2021.102037
• Languages: English
• ISSNs: 1462-3889

Abstract

Abstract: Purpose: In order to design a patient-centered discharge process, the entire process is visualized in Value Stream Mapping. The duration of the process steps and waiting times are measured and presented. As a team, health professionals discuss problems and agree on suitable solutions. Methods: After applying Value Stream Mapping, we conducted eight interviews in 2018, four with physicians and four with breast care nurses. We used the Consolidated Framework for Implementation Research to develop the interview guide and to identify categories for content analysis. To identify the differences in attitude and experience between the occupational groups, we conducted a framework analysis. Results: Each team of health professionals developed action steps to optimize the discharge process. Obstacles became apparent in the implementation of these action steps. The lack of adequate staff and complex structures were identified as the main factors. These hierarchical structures also prevented a patient-centered discharge process independent of patient-centered care by health professionals. Self-efficacy varied more among breast care nurses than physicians. The group of physicians perceives standardization in the discharge process critically and therefore assumes limitations in transferring Value Stream Mapping to hospitals. The breast care nurses were open in their attitude. Financial incentives contribute to the acceptance of the method. Conclusion: Value Stream Mapping is a simple way to uncover waste and develop applicable action steps. Since the implementation of the action steps was hindered by hierarchical problems and a lack of resources, management involvement and a hospital-wide approach could be beneficial. Highlights: Value Stream Mapping increased participant knowledge of the entire process. Breast care nurses' self-efficacy varied widely. Self-efficacy appears to an impact on successful implementation of change. The process needs to be patient-centered, not just individual steps.