Operational Excellence

Document Type


Publication Date

Summer 7-25-2019


Operational Excellence

MeSH Headings

colorectal cancer, United States, health literacy, fecal immunochemical testing, colonoscopy, internal medicine, goal, patients, patient care, employee engagement


Colorectal cancer is the third leading cause of cancer death in the United States. It disproportionally affects minorities and those in lower socioeconomic groups. The use of fecal immunochemical testing (FIT) is a low barrier, low cost and low risk screening tool as compared to the traditional colonoscopy exam. The use of FIT offers the opportunity to overcome barriers such as cultural, economic and low health literacy.

As part of a large health care system, an internal medicine clinic wanted to increase the use and return of FIT in their clinic patients. A team developed a plan for implementing improvement interventions with the goal of 80% of all eligible patients would be screened for colorectal cancer using FIT in a 12 month period of time.

Baseline metrics demonstrated numbers below 80% for screening and return rates. Several countermeasures were instituted to include resident education about FIT ordering and implementation of a project KPI that included reminder phone calls and letter to patients.

Since implementation of this project, 6 of 64 FIT test ordered were indicative of the need for further testing. These early rule-outs and/or diagnoses are essential to improving patient outcomes and cost reductions.

Next steps include identification interventions to meet set target and correlate care team participation in patient care with employee engagement scores.