title: Development of an instrument to analyze organizational characteristics in multidisciplinary care pathways; the case of colorectal cancer.
abstract: BACKGROUND
  To analyze the organization of multidisciplinary care pathways such as colorectal cancer care, an instrument was developed based on a recently published framework that was earlier used in analyzing (monodisciplinary) specialist cataract care from a lean perspective.
  
  
  METHODS
  The instrument was constructed using semi-structured interviews and direct observation of the colorectal care process based on a Rapid Plant Assessment. Six lean aspects that were earlier established that highly impact process design, were investigated: operational focus, autonomous work cell, physical lay-out of resources, multi-skilled team, pull planning and non-value adding activities. To test reliability, clarity and face validity of the instrument, a pilot study was performed in eight Dutch hospitals.
  
  
  RESULTS
  In the pilot it proved feasible to apply the instrument and generate the intended information. The instrument consisted of 83 quantitative and 24 qualitative items. Examples of results show differences in operational focus, number of patient visits needed for diagnosis, numbers of staff involved with treatment, the implementation of protocols and utilization of one-stop-shops. Identification of waste and non-value adding activities may need further attention. Based on feedback from involved clinicians the face validity was acceptable and the results provided useful feedback- and benchmark data. The instrument proved to be reliable and valid for broader implementation in Dutch health care. The limited number of cases made statistical analysis not possible and further validation studies may shed better light on variation.
  
  
  CONCLUSIONS
  This paper demonstrates the use of an instrument to analyze organizational characteristics in colorectal cancer care from a lean perspective. Wider use might help to identify best organizational practices for colorectal surgery. In larger series the instrument might be used for in-depth research into the relation between organization and patient outcomes. Although we found no reason to adapt the underlying framework, recommendations were made for further development to enable use in different tumor- and treatment modalities and in larger (international) samples that allow for more advanced statistical analysis. Waste from defective care or from wasted human potential will need further elaboration of the instrument.
authors.affiliation: Department Health Technology and Services Research, University of Twente, School of Management and Governance, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. d.pluimers@gmail.com.
authors.forename: Dorine J
authors.initials: DJ
authors.lastname: Pluimers
authors.affiliation: Sint Franciscus Hospital, Kleiweg 500, 3045 PM, Rotterdam, the Netherlands. ejvanvliet@online.nl.
authors.forename: Ellen J
authors.initials: EJ
authors.lastname: van Vliet
authors.affiliation: Department Health Technology and Services Research, University of Twente, School of Management and Governance, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. anneniezink@hotmail.com.
authors.forename: Anne Gh
authors.initials: AG
authors.lastname: Niezink
authors.affiliation: Department Health Technology and Services Research, University of Twente, School of Management and Governance, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. m.s.vanmourik@gmail.com.
authors.forename: Martijn S
authors.initials: MS
authors.lastname: van Mourik
authors.affiliation: Deventer hospital, Nico Bolkesteinlaan 75, 7416 SE, Deventer, the Netherlands. eh@eddes.nl.
authors.forename: Eric H
authors.initials: EH
authors.lastname: Eddes
authors.affiliation: The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. m.wouters@nki.nl.
authors.forename: Michel W
authors.initials: MW
authors.lastname: Wouters
authors.affiliation: Leiden University Medical Center, Albinusdreef 2, 2333 ZA, Leiden, the Netherlands. r.a.e.m.tollenaar@lumc.nl.
authors.forename: Rob A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.affiliation: Department Health Technology and Services Research, University of Twente, School of Management and Governance, Drienerlolaan 5, 7522 NB, Enschede, the Netherlands. whvanharten@utwente.nl.|The Netherlands Cancer Institute - Antoni van Leeuwenhoek hospital, Plesmanlaan 121, 1066 CX, Amsterdam, the Netherlands. whvanharten@utwente.nl.
authors.forename: Wim H
authors.initials: WH
authors.lastname: van Harten
mesh_terms: D000465:Algorithms; D015179:Colorectal Neoplasms / Q000175:diagnosis / Q000473:pathology / Q000601:surgery / Q000628:therapy*; D003625:Data Collection; D003663:Decision Trees; D019468:Disease Management; D006295:Health Resources / Q000458:organization & administration* / Q000706:statistics & numerical data; D006801:Humans; D017060:Patient Satisfaction; D019990:Perioperative Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires