Table 1. List of countermeasures... | Emerald Publishing

Table 1.

List of countermeasures proposals

Root cause	Countermeasure proposal	Description
Lack of patient categorisation and prioritisation Push system Lack of rationale for layouts	Pull system for patients flows	Assuring a breast specialist visit to all patients with suspected breast cancer before mammography, to avoid useless mammography to patients who do not need it. This visit will become the process pacemaker
		Assigning a dedicated breast specialist to the staging process for new patients’ visits and medical report delivery
		Reorganising the visit schedule, alternating a first breast specialist visit to a new patient and a visit to deliver medical reports to patients coming from radiology
		Introducing a communication mechanism to support the pull system, blocking the flow when the subsequent activity is full: to this end, the breast specialist performs the first and last activity of the process
	Pull system for tissue samples collected with biopsy	Introducing a supermarket inside the room “reception of samples” in the pathological anatomy unit, to guarantee the availability of sample containers for biopsy: when the radiologic technologist delivers the tissue sample to the pathological anatomy unit, collects an empty sample container that will be used in radiology. If sample containers finish, no more patients are accepted
	Removing the agenda and waiting list for radiology and biopsy	Eliminating the waiting time between the breast specialist first visit and the subsequent radiology examination, directly referring patients to radiology with a FIFO logic. The same happens for biopsy after mammography. ( Appendix 3 – Figure A3)
	Radiology layout optimisation	Improving the health-care workers movements and creating dedicated spaces for specific activities ( Appendix 3 – Figures A4 and A5)
Difficulties in defining staff workload, roles and responsibilities Lack of standardised activities	Roles and responsibility reorganisation	To unload breast specialists, allowing them to perform a visit to all patients with suspected breast cancer: – entrust the management of medium and high-risk follow-up to the radiology unit – only oncologist and breast specialist can prescribe mammography and biopsy – new patients’ first breast specialist visit can be performed only in facilities provided with radiology equipment: the optimisation analysis suggests performing them only in the hospital, moving the radiology general visit to the secondary care ambulatories
	Standardisation	Create a new standardised procedure for the radiologic technologist
	Standardisation	Introducing standardised activities denomination in the hospital software
	Visual management	Coloured lights advise if mammography changing rooms are occupied
		Coloured pathways guide patients in their movement across units
		Explicative posters in mammography changing rooms with instructions about the procedure that patients will follow

Root cause	Countermeasure proposal	Description
Lack of patient categorisation and prioritisation Push system Lack of rationale for layouts	Pull system for patients flows	Assuring a breast specialist visit to all patients with suspected breast cancer before mammography, to avoid useless mammography to patients who do not need it. This visit will become the process pacemaker
		Assigning a dedicated breast specialist to the staging process for new patients’ visits and medical report delivery
		Reorganising the visit schedule, alternating a first breast specialist visit to a new patient and a visit to deliver medical reports to patients coming from radiology
		Introducing a communication mechanism to support the pull system, blocking the flow when the subsequent activity is full: to this end, the breast specialist performs the first and last activity of the process
	Pull system for tissue samples collected with biopsy	Introducing a supermarket inside the room “reception of samples” in the pathological anatomy unit, to guarantee the availability of sample containers for biopsy: when the radiologic technologist delivers the tissue sample to the pathological anatomy unit, collects an empty sample container that will be used in radiology. If sample containers finish, no more patients are accepted
	Removing the agenda and waiting list for radiology and biopsy	Eliminating the waiting time between the breast specialist first visit and the subsequent radiology examination, directly referring patients to radiology with a FIFO logic. The same happens for biopsy after mammography. (Appendix 3 – Figure A3)
	Radiology layout optimisation	Improving the health-care workers movements and creating dedicated spaces for specific activities (Appendix 3 – Figures A4 and A5)
Difficulties in defining staff workload, roles and responsibilities Lack of standardised activities	Roles and responsibility reorganisation	To unload breast specialists, allowing them to perform a visit to all patients with suspected breast cancer:– entrust the management of medium and high-risk follow-up to the radiology unit– only oncologist and breast specialist can prescribe mammography and biopsy– new patients’ first breast specialist visit can be performed only in facilities provided with radiology equipment: the optimisation analysis suggests performing them only in the hospital, moving the radiology general visit to the secondary care ambulatories
	Standardisation	Create a new standardised procedure for the radiologic technologist
	Standardisation	Introducing standardised activities denomination in the hospital software
	Visual management	Coloured lights advise if mammography changing rooms are occupied
		Coloured pathways guide patients in their movement across units
		Explicative posters in mammography changing rooms with instructions about the procedure that patients will follow

Source: Authors’ own work