Abnormal Cancer Screening

Study Name: 
Using Lean Quality Improvement Tools to Improve the Management of Abnormal Cancer Screening Results
Study Period: 
July 1, 2012 to January 31, 2014
Self-funded Project
Principal Investigators: 
Daren Anderson, MD

Care coordination is crucial in the delivery of high-quality primary care, and is emphasized as a core attribute in the Patient Centered Medical Home model. CHC has made great strides in providing coordinated care to its patients, but significant gaps persist. CHC recently identified its rate and timeliness of follow-up to abnormal pap, abnormal mammogram, and positive fecal occult blood test (FOBT) results as a major weakness. These tests screen for cervical, breast, and colorectal cancer, respectively; fast and appropriate follow-up to abnormal results is crucial to ensuring patients’ health. To address the issue, CHC held a Kaizen, a multi-day event dedicated to the application of Lean thinking to a process of interest. Lean is a quality improvement philosophy pioneered by Toyota that focuses on eliminating any wasteful aspects of a current process. The Kaizen team produced a playbook of a redesigned process, centered around a designated nurse at each CHC medical site who tracks all abnormal cancer results. The nurse notifies patients of their abnormal result, facilitates appointment scheduling with specialists, and follows up with patients who no-show to their specialist appointments. The process was pilot-tested and optimized, and is currently being spread to all CHC medical sites.


This project has immediate and significant impact on the quality of care that CHC patients receive. Before the process redesign, although almost all of CHC’s patients were informed of their abnormal cancer screens within 30 days, many who required additional imaging did not receive it within 60 days, and many who required additional treatment did not receive an initial specialist appointment within 90 days. Preliminary results suggest that the new process leads to all abnormal results being actively managed and to significantly reduced delays in the receipt of appropriate follow-up.