Musculo-Skeletal Outpatient Physiotherapy (MSOP)
Waitlist Management
‘The Waitlist-ectomy Project’
Lisa Ford, Alieke Van Middelaar, Jennifer Bilton,
Alayne Healey, Caroline Ranchhod
Acute Allied Health
MSOP Physiotherapy Waitlist Management
Problem background
• MSOP waiting list growing
• Waitlist targets not being met
• Patients are waiting an unacceptable length of time to receive physiotherapy for their condition
Aim Statements for this project
• By 31 March 2013, 80% of FSA referrals to MSOP will be seen within the set priority timeframes
• By 31 July 2013, 95% of FSA referrals to MSOP will be seen within the set priority timeframes
Priority 1 (P1) = to be seen within 4/52
Priority 2 (P2) = to be seen within 6/52
Driver Diagram
Aims
Primary Drivers
Secondary Drivers
Wide MSOP referral criteria
Reduce the volume of referrals
being received and accepted
by MSOP service
Lack of information given on referrals
Patient consent for referral
Referral method (e.g. post, fax, email)
By 31 March 2013,
80% of FSA referrals to
MSOP will be seen within
the set priority timeframes
Under-utilising other physiotherapy providers
By 31 July 2013,
95% of FSA referrals will
be seen within the set
priority timeframes
Model of care (1:1 vs class)
Managing staff leave
P1 = within 4 weeks
P2 = within 6 weeks
Triage system
Admin process for booking/scheduling
Maximise utilisation of MSOP
appointment capacity
Managing DNA’s and cancellations
Accessibility of clinics (evenings /
weekends etc)
Measures
Name of
Measure
Is this an Outcome,
Process or Balancing
Measure?
Operational Definition
(e.g., numerator &
denominator)
Number of referrals received by
MSOP per month
Balance
Referrals accepted by MSOP
Month
Number of available appt slots per
month
Balance
Num of MSOP appt slots available
Month
% of P1 patients seen within 4
weeks. Calculate monthly
Outcome
Number of P1 pts seen within 4/52
Total P1 on waitlist
% of P2 patients seen within 6
weeks. Calculate monthly
Outcome
Number of P2 pts seen within 4/52
Total P2 on waitlist
Average number of weeks a P1
patient waits from addition to waitlist
until FSA. Monthly
Outcome
Total weeks P1 pts wait for FSA
Total P1 pts seen
Average number of weeks a P2
patient waits from addition to waitlist
until FSA. Monthly
Outcome
Total weeks P2 pts wait for FSA
Total P2 pts seen
Change Concepts & Ideas for PDSA’s
Idea for Testing in a PDSA
Theory and prediction about what will happen
when you test this idea
Telephone appt scheduling
(instead of sending letter)
Improved efficiency in booking and scheduling will lead to
reduced wait times by 3/52
Telephone triaging P1 patients
We will reduce the number of patients on the P1 waiting list
by 30%
Adding more physiotherapy
resource
We will increase capacity to see P1 FSA’s
Telephone triaging for P2
patients
We will reduce the number of patients on the P2 waiting list
by 60%
Clearly defining MSOP referral
criteria and circulating to
referrers
We will reduce the volume of MSOP referrals accepted
by 25%
Problem: 70 priority 1 patients on MSOP waitlist, 42 waiting >4 weeks
Aim of this change: To reduce the Priority 1 waitlist by 30% and “clear the backlog”
The Change:
Priority 1 patients
are now be
contacted by
admin team
• by phone
• within 1 week of
receipt of referral
•PFB letter sent
when no phone
contact possible,
14/7 to respond.
• 83% have
appointment within
4 weeks
• Average wait 2.7
weeks in Feb
ACT:
Adopt
STUDY:
55 patients called
39 booked within next 10/7
16 removed from waitlist
= 29%
PLAN:
Contact patients by
phone instead of letter
as per patient
focused booking (PFB)
Measurement
% of Priority 1
referrals who did not
require appointment
and could be
removed from waitlist
DO:
Physiotherapist will
call all patients to
triage and either
discharge or book
appointment within
2-3weeks
Prediction: By telephoning patients we will reduce the Priority 1 waitlist by 30%
PDSA: Telephone Appointment Scheduling
2011
Month / Year
2012
P1
P2
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
18.0
16.0
14.0
12.0
10.0
8.0
6.0
4.0
2.0
0.0
Jan
Number of weeks
Average Number of Weeks a MSOP Referral Waits for FSA
(Priority 1 and 2)
2013
Problem: Insufficient Physiotherapist FTE to meet demand
Aim: Improve access to Physiotherapist FSA appointment i.e. within 4/52 for priority 1 patients
The Change:
Available
FSA slots 45-50/week
Compared to 30-35 FSA
slots/ week in Nov/Dec
2012
ACT:
Adopt.
(permanent
increase in 0.5 FTE)
SH reduced clinical load
Morale boosted!
Number of additional
FSA times available
Recruit to longstanding
vacant FTE which had been
used for other area in AAH,
experienced Physiotherapists,
Borrow FTE
Fill 2/12 rotator vacancy
Followup patients slots
available
Non clinical time is
preserved
PLAN:
Measurement
STUDY:
16/01/13 – 28/02/13
Additional
134 x 45 minute
appointments
created
DO:
16/1/13 - borrow 0.2 FTE
21/1/13 new 0.5 FTE starts
& fill 1.0 rotator position
F/U patients seen
within expected
timeframes
Prediction: Adding more physiotherapy resource will improve FSA throughput.
Problem: Priority 2 waiting list numbers are increasing and length of wait >12 weeks
Aim of this change: Improve waiting time for Priority 2 referrals to 6-10 weeks
The Change:
ACT:
Adopt
STUDY:
P2 = 239
75 contacted by
phone
15 Removed from
waitlist = 20%
(6% of totalP2
waiting)
PLAN:
Contact patients by phone
Instead of letter as per
patient focused booking
(PFB) due to short
timeframes from referral
to appointment
DO:
February 2013;
Physiotherapist will call
Priority 2 patients
waiting since 1/10/12 to
triage and either
discharge or book
appointment within
4 weeks
Prediction: Telephone triage of priority 2 patients will reduce waitlist by 60%
Measurement
Number of Referrals Accepted
0
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Re-defining MSOP Referral Criteria
Total Number of MSOP Referrals Accepted - 2010 - 2013
250
200
150
100
50
2010
2011
Month / Year
2012
2013
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Jan
Feb
Number of Referrals Accepted
Current Referral Trends
Total Number of MSOP Referrals Accepted (by priority)
2010 - 2013
250
200
150
100
50
0
2010
2011
Month / Year
P1
2012
P2
2013
Process Changes and Results
100%
90%
80%
70%
60%
2011
2012
Month / Year
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
Jan
Dec
Nov
Oct
Sep
Aug
Jul
Jun
May
Apr
Mar
Feb
50%
40%
30%
20%
10%
0%
Jan
Percentage
Percentage of P1 MSOP Referrals that Met Waitlist Target
(4 weeks)
2013
Process Changes and Results
Percentage of P2 MSOP Referrals that Met Waitlist Target
(6 weeks)
Percentage
100%
90%
80%
70%
60%
50%
40%
30%
20%
10%
0%
Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Jan
2011
2012
Month / Year
2013
Profound Knowledge Worksheet
Appreciation for a System Psychology
• Difficulty defining data required
• Difficulty accessing stats
• Human error & technology
• Staff morale / motivation
• Behaviour change challenge
• Pressure from referrers
• Team work
Theory of Knowledge
• How are our prioritisation time
Understanding Variation
• Staff triaging differently
• Admin process variation around
frames set?
•
•
DNA’s and cancellations (different
from other OP services)
14
Where to from here?
•TEAMWORK & Sustainability of gains to-date
•Stats available weekly for closer monitoring
•Closer look at capacity/week+ Recruitment!!
•FSA as classes vs individual appointments
•Priority 2 phone triage strategy
•FOCUS to achieve 80% of referrals seen within timeframes by 31/7/13