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The objective of this pilot study was to assess the inter-rater reliability of a newly developed A3 Quality Assessment (QA) rubric to evaluate the quality of completed Plan-Do-Study-Act (PDSA) projects that used an A3 Thinking Tool (A3) for problem solving. One A3 was independently reviewed by 7 PDSA experts using 5 main levels and 22 sublevels. Evaluations were compared and coded for agreement and used for statistical analysis. Fleiss’ kappa statistics was performed to test for inter-rater reliability between experts across 5 main and 22 sublevels. Preliminary results suggest that the A3 QA rubric meets reliability criteria with a moderate level of agreement beyond chance alone (κ = 0.44) and it is applicable to measure progress on problem solving abilities spearheaded via PDSA cycles. Additional verification testing is needed across multiple A3 improvement projects completed in multiple A3 Thinking templates.

Purpose To present our approach and results from our quality and safety program and to report their possible impact on our culture of patient safety. Methods and materials We created an event learning system (termed a "good catch" program) and encouraged staff to report any quality or safety concerns in real time. Events were analyzed to assess the utility of safety barriers. A formal continuous quality improvement program was created to address these reported events and make improvements. Data on perceptions of the culture of patient safety were collected using the Agency for Health Care Research and Quality survey administered before, during, and after the initiatives. Results Of 560 good catches reported, 367 could be ascribed to a specific step on our process map. The calculated utility of safety barriers was highest for those embedded into the pretreatment quality assurance checks performed by physicists and dosimetrists (utility score 0.53; 93 of 174) and routine checks done by therapists on the initial day of therapy. Therapists and physicists reported the highest number of good catches (24% each). Sixty-four percent of events were caused by performance issues (eg, not following standardized processes, including suboptimal communications). Of 31 initiated formal improvement events, 26 were successfully implemented and sustained, 4 were discontinued, and 1 was not implemented. Most of the continuous quality improvement program was conducted by nurses (14) and therapists (7). Percentages of positive responses in the patient safety culture survey appear to have increased on all dimensions ( p Conclusions Results suggest that event learning and continuous quality improvement programs can be successfully implemented and that there are contemporaneous improvements in the culture of safety.

143 Background: A variety of ‘structured support services’ (SS) are available to patients (e.g., genetics, fertility, counseling, physical functioning, nutrition). Many of these SS have value for breast cancer survivors (BCS) as they are often likely to face issues regarding genetic factors, fertility, parenting, relationships, work, and financial hard-ships. As part of an ongoing CDC-funded initiative, we report our preliminary findings regarding perceived needs and actual rates of use of these SS, and identified barriers to their use for BCS. Methods: We assessed the needs for and utilization of SS by 1) conducting a survey of younger breast cancer survivors; and 2) performed chart reviews for documentation of assessment and referral for each SS. To identify barriers to the receipt of SS we 1) conducted key informant interviews, and 2) performed extensive observations in the clinic to value-stream map the flow of the patient throughout the care process. Results: Survey results: Women (n= 59/283) responded with a mean age of 39 (range 19-46) at the time of diagnosis. The most common limitations to using SS included lack of information about SS (60%), distance from services (54%), and inconvenient times (51%). Chart results: We reviewed 57 charts from 2011 for assessment and referral for any SS. The lack of consistent documentation made it challenging to extract meaningful data. Observation and interview results: Common barriers to the receipt of SS include lack of patient and staff education about available services, lack of consistent referral mechanisms, heavy burden on the provider to make referral, and poor feedback loop between SS and provider. Conclusions: Patients and providers both perceive many challenges to the delivery of support services. We are applying lean processes to improve the delivery of consistent information about SS to patients and providers, to standardize methods to refer patients for them, and to provide feedback to providers, in order to improve the delivery of SS to BCS, therefore improving their quality of care.