title: Managing patient pathways to achieve lung cancer waiting time targets: mixed methods study.
abstract: OBJECTIVE
  England's National Health Service (NHS) introduced a 62-day target, from referral to treatment, to make lung cancer patient pathways more efficient. This study aims to understand pathway delays that lead to breaches of the target when patients need care in both secondary and tertiary setting, so more than one institution is involved.
  
  
  METHODS
  Mixed methods cross case analysis.
  
  
  METHODS
  Two tertiary referral hospitals in London.
  
  
  METHODS
  Database records of 53 patients were analysed. Nineteen sets of patient notes were used for pathway mapping. Seventeen doctors, four nurses, eight managers and administrators were interviewed.
  
  
  METHODS
  Qualitative methods include pathway mapping and semi-structured interviews. Quantitative analysis of patient pathway times from cancer services records.
  
  
  RESULTS
  The majority of the patient pathway (68.4%) is spent in secondary centres. There is more variability in the processes of secondary centres but tertiary centres do not have perfect processes either. Three themes emerged from discussions: information flows, pathway performance and the role of the multidisciplinary approach.
  
  
  CONCLUSIONS
  The actions of secondary centres have a greater influence on whether a patient breaches the 62-day target, compared with tertiary centres. Nevertheless variability exists in both, with potential for improvement.
authors.affiliation: Guy's and St Thomas' NHS Foundation Trust ,  London SE1 7EH ,  UK.
authors.forename: Hugh
authors.initials: H
authors.lastname: Ip
authors.forename: Tarik
authors.initials: T
authors.lastname: Amer
authors.forename: Michael
authors.initials: M
authors.lastname: Dangoor
authors.forename: Affan
authors.initials: A
authors.lastname: Zamir
authors.forename: Darryl
authors.initials: D
authors.lastname: Gibbings-Isaac
authors.forename: Ranjeev
authors.initials: R
authors.lastname: Kochhar
authors.forename: Timothy
authors.initials: T
authors.lastname: Heymann