patient focused booking raigmore hospital radiology katherine sutton nhs highland superintendent...
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Patient Focused Booking Raigmore Hospital Radiology
Katherine Sutton
NHS Highland
Superintendent Radiographer
January 2006• Bookings undertaken
by a variety of staff• Radiographers – all
Grades• Radiography Helpers• Receptionists• Secretarial staff• In a variety of
locations
• Long Waiting Lists – up to 42 weeks
• Disgruntled & Overworked staff
• No understanding of the capacity of the booking system
• No understanding or control over utilisation of clinical capacity
• A complete lack of understanding of demand on the clinical service
April 2006
• Diagnostics Collaborative Programme was launched
• Promise of additional resources!
• Tools and techniques for Demand, Activity and Capacity measurement
• A real interest in Radiology and its internal workings!
Where were we then?
• DNA Rates of up to 15% in the modalities that were to become target focussed
• No clear systems for measuring and monitoring capacity
• Issues with taking in turn
• A complete lack of understanding leading to a lack of control over our systems
What did we do?
• Agreed to implement patient focussed booking
• Agreed to offer patient a choice by telephone
• Agreed to implement a fast track pathway
• Agreed to take in turn wherever possible
Implementing Patient Focussed Booking
• Instigated an Organisational Change Programme
• Focused on separating reception from Bookings
• Included public members involvement
• Agreed that bookings would be made via one contact centre for all modalities
Keys to success
• Booking Guidelines for all modalities
• Training plans for booking staff
• Templates set and agreed for all modalities
• Weekly meetings including all key stakeholders
• Highly motivated team
• Prioritising the tail of the waiting list
• Filling all cancelled slots
Measures of Success !!•Waiting Times have fallen from 42 weeks to 2 weeks!!•Two week position is sustainable!!•DNA Rates have fallen from 15% to 2%!!•CNA Rates – generally around 2%•Positive feedback from patients and clinicians•Patient complaints are rare – non –existent•Motivated and confident staff•Patient focussed booking is being implemented for all Highland Radiology Departments via a centralised model
Where now?
• Challenged with rolling the Radiology model of booking across all other specialities
• Successful trial for ENT – reduced waits and DNAs significantly and improved list utilisation
• Implemented for Orthopaedics and Endoscopy• Now full implementation for remaining specialities
is being requested including Non-Medical services and AHPs
NHS HIGHLAND | RAIGMORE HOSPITAL | ENT | Outpatient attendances, calendar year 2009
Comparison of actual attendances with clinic template capacity
0
5
10
15
20
25
30
2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53
Week no.
No
. of a
tten
da
nce
s
Pre-PFB: 87% Post-PFB: 91%
Refining of the Radiology System
• External expert review
• Developed an appropriate management structure
• Team Managers and Quality Coaches
• Introduced governance and procedural processes into Bookings
• Vision of one contact number for patients to book any appointment
Further refinements• Review of all patient correspondence• Set up a formal patient contact group including equality
and diversity representation• Patient Access Policy Implemented• Formal training programme for all booking staff• Business rules for booking agreed with and signed off by
clinicians• Key Performance Indicators are being developed to
measure the outputs of the booking service
NHS Highland Patient Booking ServiceSupporting Environment
Clinic Template Management
1.1 Reviewing templates1.2 Refining Templates1.3 Clinic schedule adjustment (>6 wks)
Letter Template Management
1.1 Review letter contents1.2 Refine Letter Contents1.3 Agree letter Contents
Supplies Management
1.1 Stationery1.2 Insert/enclosures1.3.Pharmaceuticals1.4 Headsets1.5 Office supplies
Telephony & System Management
1.1 Managing Booking staff Q access1.2 Message Maintenance1.3 Cross Reference table management
Operational Process
NHS Highland Patient Booking Service
Patient Booking Processes
Referrals
Returns
Triage Processes
1.1 Prepare for Triage1.2 Process from Triage
Patient Management Processes
2.1 Invitation Process2.2 Reminder Process2.3 Removal Process2.3 Potential Breach Process
Patient Slotting Process
3.1 Patient Booking3.2 Patient change3.3 Patient Confirmation Process
Clinic Management Processes
4.1 Urgent Slotting Process4.2 Spare Capacity Process4.3 Clinic Cancellation Process
END
2010•Leading to a full Admin review across Highland•Has focussed minds on a whole system approach•Leading to full understanding of demand and capacity•Further improving Radiology utilisation and organisation
Further information:
Katherine SuttonSuperintendent [email protected]
Maimie Thompson18 Weeks RTT Programme Manager