October 2016 VOL 7, NO 9

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Research/Quality/Performance Improvement

Patient Experience Project (PEP): Understanding the Patient Experience to Enhance Patient Satisfaction and Care Using the DMAIC Process

Kimberly J. Maynard, BSN, RN, OCN; Ellen J. Curri, MSW; Sarah Washburn, MBA
Norris Cotton Cancer Center, Dartmouth-Hitchcock Medical Center, Lebanon, NH 

Objectives: To evaluate the plethora of available materials and standardize information provided to breast cancer patients along the care continuum, with a goal to improve the patient’s experience from diagnosis through treatment at the Dartmouth-Hitchcock Medical Center (DHMC).

Methods: The nurse navigator and social workers in the Comprehensive Breast Program partnered with 2 breast cancer patients at regular team meetings over several months. Utilizing the DMAIC (Define, Measure, Analyze, Improve, Control) improvement process, we created process flow maps and a list of resources provided to patients. The DMAIC process has been used to improve turnaround time (clinic visits/patient flow), customer satisfaction, and interdisciplinary collaboration in healthcare settings.1-3 Feedback was obtained from patients using surveys and one-on-one interviews. Seventeen of 20 patients responded to the survey, and 15 patients were interviewed.

Results: The project identified and cataloged resources provided to patients throughout treatment at touchpoints where nurses, social workers, and ancillary clinicians provide care at DHMC. Three treatment CarePaths were created from the process flow map and refined using input from patient interviews. Feedback from patients who had completed treatment was used to create a patient handout entitled “What I Wish I Knew before Treatment” (for surgery, chemotherapy, radiation, hormonal therapy). Timely and relevant educational brochures were defined based on patient needs and placed into interdisciplinary clinic rooms.

Conclusions: Of 14 proposed improvements, 5 were implemented. Resources provided are shared with clinicians and kept current via annual update to assure the large care team is aware of potential areas of duplication. Feedback solicited via patient interviews during CarePath development included statements such as “Who is in charge of my care?” and “It would be helpful to have a binder to organize information you give me.” CarePaths are now used as a teaching tool during patient information sessions. “What I Wish I Knew before Treatment” handouts are provided to new patients at their first clinic visit. The poster will reflect the key findings from interviews and surveys. Feedback will be obtained in 6 months from the original patient cohorts and revisions made to handouts. Brochures/handouts are kept current with biweekly checks for replacements and alternating materials. Control of resources is the navigator’s responsibility. Now a trained volunteer from DHMC’s Center for Shared Decision Making is available to attend each new patient’s first consult visit. Utilizing these tools at the start of the patient’s journey and providing resources at patient appointments can potentially decrease patient anxiety and provide accurate, up-to-date information to enhance patient care and satisfaction.


  1. Hemaid A, Mohamed A, Elshennawy A. Improving patient check-in and check-out processes utilizing six Sigma DMAIC tools at a medical clinic. The Journal of Management and Engineering Integration. 2012;5(1):62-70.
  2. Leaphart CL, Gonwa TA, Mai ML, et al. Formal quality improvement curriculum and DMAIC method results in interdisciplinary collaboration and process improvement in renal transplant patients. J Surg Res. 2012;177:7-13.
  3. Smith C, Wood S, Beauvais B. Thinking lean: implementing DMAIC methods to improve efficiency within a cystic fibrosis clinic. J Healthc Qual. 2011;33:37-46.

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