Click here to continue

Click here to continue

End of section Introduction Introduction What are the aims of the toolkit? The patient flow collaborative aims to remove unnecessary constraints or delays within the patient process. Outpatients is recognised as a key stage in the whole health care system, which assists flow for the patient. How should we implement the concepts in the toolkit? It is essential that discussion takes place around the ideas/innovations listed in this toolkit. Following discussion local adaptation will be needed to fit into the local context for engagement of clinical staff and patients and to form an improvement plan for outpatients. Goals of the toolkit Overview and strategy What is the outpatients toolkit? The outpatient toolkit has been designed to develop organisational wide strategic management and thinking to identify innovation/solution to resolve current capacity and waiting time issues. Who should use this toolkit? The toolkit will promote discussion, ideas and solutions to outpatient constraints, any member of staff who is involved in outpatient services will benefit from the toolkit. Health service team Processes Data Resources Diagnostics and tools Back to menu

End of section Goals of the toolkit Introduction • Introduction • The outpatient toolkit is based on whole system thinking and therefore includes a whole of hospital perspective, outpatients can be involved in reducing constraints in other areas following whole system redesign. • Goals • The specific goals of the toolkit are to: • Reduce waiting times in outpatients • Promote patient involvement in appointment making • Build awareness of solutions to outpatient constraints • Identify scope and possibilities for outpatients future planning • Provide a strategic tool, which will assist with planning innovation and allow capacity change, which will not adversely effect elective waiting lists. Feedback This first version of the toolkit will stimulate further versions containing tools, resources, case studies and good news stories developed by the Patient Flow Collaborative Teams. Feedback is welcome and will be incorporated into the subsequent versions. Whole systems approach A whole system approach is needed to promote best use of outpatient services. Increasing efficiency can allow future planning to increase scope of outpatients thus reducing demand on other areas, for example emergency care, short stay units and inpatient provision. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

Overview and strategy Introduction A systematic step process has been designed to allow staged innovation in outpatient services. Central to this step process is executive sponsorship, communication and involvement of all staff within outpatient services. Goals of the toolkit Overview and strategy Health service team Step 5. Appointment systems Processes Step 4. Efficiency Data Step 3. Clinic schedules Resources Step 2. Service planning Step 1. Benchmark Diagnostics and tools Click to continue Page 1 of 11 Back to menu

Overview and strategy Introduction Cyclical approach: revisit steps in process • Benchmark • Benchmarking can assist with providing: • Reality check • Identify areas for innovation • Show patterns • Track changes over time • Assist with performance targets • SPC charts can assist with benchmarking exercises as visual impact is maximised. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 2 of 11 Back to menu

Overview and strategy Introduction • Categories of benchmarking data can be agreed and measured overtime. Examples include: • Number/percentage first times seen within time band • Annual growth benchmarks • Percentage of all referral requests converted to seen patient activity • Ratio of GP referrals against other referrals, i.e., consultant to consultant • Outpatient DNA/FTA, for first appointment, second appointment, third appointment, etc. • Conversion ratio benchmarking • New to follow up ratio • New to waiting list ration • Clearance time per sample group (in numbers) • Clearance rate per sample group (in numbers) Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 3 of 11 Back to menu

Overview and strategy Introduction Step 2. Service planning Overall capacity and demand measures can be used to inform service planning, services need to be commissioned to deliver demand projections. Demand projections can then inform predicted increase in elective waiting. This systematic approach will assist overall management of outpatient activity and elective waiting lists. Basic foundations of understanding relative performance and agreed activity will assist closing the gap between waiting and treatment. Step 3. Clinic schedules Constraints in flexibility of clinic schedules can increase waiting times. Clinic schedules that base schedules around demand flexibility have shown major reductions in waiting times. Goals of the toolkit Overview and strategy Health service team Processes Step 1. Benchmark • Benchmarking is described as a method to compare a standard or reference point against which something is measures. Outpatient benchmarking can assist with reducing variation, comparisons can be made at: • High level - organisational, service, speciality area, local partner organisation • Low level - within specialties, doctor or clinics. Data Resources Diagnostics and tools Click to continue Page 4 of 11 Back to menu

Overview and strategy Introduction Clinic schedules (cont..) Review of clinic schedules, reduction in reserved clinic slots, fixed booked appointment for new and follow up slots can reduce waiting time and increase throughput. Demand fluctuations need to be mapped and included in service planning and clinic schedules. Review and agreement per clinic can produce streamlined services, clinic ‘booking rules’ signed off by the clinician can assist with providing the right patient, to the right clinicians, at the right time, in the right place, with the right resources. Consolidation of patient information, instructions, booking of clinic, codes to use can all be essential elements of clinic booking rules. Step 4. Efficiency Efficiency monitoring within outpatient services can be broken down into: • Start and finish times • Productivity profiles • DNA/FTA – broken down into overall numbers or percentage, then by specialty consultant • Cancellation by patient • Cancellation by hospital • Analysis of outcome • Efficiency can also be measured in staff tasks, available resources and equipment, allocation of staff skills against task to be performed. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 5 of 11 Back to menu

Overview and strategy Introduction • Step 5. Appointment systems • Traditional outpatient clinic appointment systems have been to provide an appointment to the patient with no discussion following receipt of referral letter. • Over the last few years appointment systems have significantly changed and can be broken down into: • fixed appointment booking • partial booked appointment • full booked appointment. • Fixed booked • This is a traditional model, on receipt of referral patient is allocated a appointment and sent details. Partial booked Partial booked involves on receipt of referral, patient is informed they are placed on outpatient waiting list and will be contacted to agree appointment around 4 weeks before appointment date and time. Benefits of partial booked appointment are reduction in FTA/DNA, reduced cancellations and rescheduling, increased patient satisfaction and involvement. Full booked Full Booked involves booking the appointment in agreement with the patient. Benefits increased patient involvement, full booked systems need short waiting times, available schedules that will deliver activity. cont… Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 6 of 11 Back to menu

Overview and strategy Introduction • Hospital outpatient departments and call centres can also provide services for Elective Audit, booking of other services outside of outpatients services, for example radiology or endoscopy. • Please note: (contact CIA If you wish to discuss call centre implementation for further advice). • Checklist for effective and efficient outpatient services: • Whole organisation strategy • Clear outpatient waiting/access policy • Performance monitoring based on actual capacity and demand • Defined staff teams and roles • Clinic rooms, treatment areas, waiting areas designed for patient flow. • Cont… • Outpatient appointment systems need to be efficient to process the demand placed on them and deliver the patient to the clinician at the right time and right place, with the right resource. • Outpatient call centre • Outpatient Call Centres have been developed to customise the process and provide an integrated choice element to appointment booking. Call Centres can be extremely cost effective, use existing resources and promote extended opening times. Call Centres with the Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 7 of 11 Back to menu

Overview and strategy Introduction Goals of the toolkit Step 5. Appointment systems Overview and strategy Step 4. Efficiency Health service team Step 3. Clinic schedules Processes Step 2. Service planning Data Step 1. Benchmark Resources Diagnostics and tools Click to continue Page 8 of 11 Back to menu

Step 2 Step 1 Whole systems Victorian data, health service data Cyclical approach revisit steps Step 3 Step 5 Closely allied Needs stable foundation and infrastructure Step 4 Overview and strategy Introduction Step 2. Service planning Step 1. Benchmark Goals of the toolkit Overview and strategy Health service team Step 3. Clinic schedules Processes Data Step 5. Appointment systems Resources Step 4. Efficiency Diagnostics and tools Click to continue Page 9 of 11 Back to menu

Overview and strategy Introduction Performance and Improvement Goals of the toolkit Overview and strategy High Degree of OP Improvement Health service team Processes Good Performance Poor Performance Data Resources Diagnostics and tools Low Degree of OP Improvement Click to continue Page 10 of 11 Back to menu

X X The 5 Steps works Need review with external support Need to re think approach Do the 5 Steps now X X End of section Overview and strategy Introduction Performance and Improvement Goals of the toolkit High Degree of OP Improvement Overview and strategy Health service team Good Performance Poor Performance Processes Data Resources Low Degree of OP Improvement Diagnostics and tools Back to menu

End of section Health service team Introduction Roles and responsibilities Outpatient senior managers need to be able to direct the outpatient service and lead a informed, skilled and motivated team. Outpatient senior nurse must ensure clinical care within outpatient areas, develop highly skilled, efficient nursing staff. Administration manager/supervisor must ensure all administration processes are well run, simple and documented, administration staff need to be motivated and encouraged to proactively book, manage and facilitate outpatient clinics. Staff meetings Outpatient whole team should meet consistently forming action plans to innovate and redesign providing modern, patient involved services. Introduction The profile of outpatient services needs to communicate the health service strategy and philosophy. Outpatient services may have the most number of attendees to any service in a hospital. Essential skilled, trained and dedicated individuals with clear reporting, performance and support need to be in place. Outpatient team Recognition of the high level of customer care and the major amounts of patients attending outpatients per day is essential. Promotion of team work, specific team building, fun activities, tidy and clean environment will all assist with good patient flow. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

Processes Introduction Processes Outpatient processes should be interlinked joining administration and clinical processes. These need to be seamless and inform smooth patient progression through the system. Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 1 of 6 Back to menu

Processes Introduction Average 5 days GP to Acute GP/Dent/other New referral send by post/courier or fax Goals of the toolkit Problem No tracking Acute has received referral Overview and strategy Letter received by Appointments centre Dated and registered (ORED) Referral could go direct to consultant Health service team Appointment clerk takes referrals to consultant sec Processes Data 24 hour target from register to sec Some sec’s write down they have received the referral Resources Diagnostics and tools Click to continue Page 2 of 6 Back to menu

Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 3 of 6 Back to menu

End of section Processes Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

Data Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 1 of 5 Back to menu

Data Introduction Improvement example Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 2 of 5 Back to menu

Data Between April 2001 and January 2002 could expect between 150 and 470 patients with an average of 310 patients waiting 13 weeks or more for a T&O outpatient appointment at the end of the month. From February 2002 can expect between 24 and 179 patients with an average of 102 patients waiting 13 weeks or more for a T&O outpatient appointment at the end of the month. Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Click to continue Page 3 of 5 Back to menu

Data Introduction Outpatient Scheduling Information Systems Simple IT access databases linked to patient administration systems can provide vital information to the outpatient management team. Goals of the toolkit Overview and strategy Example Health service team Processes Data Resources Diagnostics and tools Click to continue Page 4 of 5 Back to menu

End of section Data Introduction Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

End of section Resources Introduction • Change Concepts • Develop outpatient waiting list policy • Develop outpatient waiting time data base • Redesign outpatient room utilisation • Establish outpatient clinical, nursing and management champion • Develop referral policy and process for referring back to GP • Standardise ID checks; photo ID/bar codes • Develop a did not attend policy • Review discharge policy and FTA (failed to attend) / DNA (did not attend) policy • Develop a ‘why next visit’ approach other than why not • Advertise DNA numbers in GP practice and OPD’s • Implement telephone follow up appointments Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

End of section Diagnostics and tools Introduction • Rigorous diagnostics handbook Goals of the toolkit Overview and strategy Health service team Processes Data Resources Diagnostics and tools Back to menu

Click here to continue