'Demand and Capacity Management - Choice Appointments'
An Innovative and Patient-Centred Quality Appointment System
Dr Robert Jones
Head of Therapy Services Directorate
East Sussex Hospitals NHS Trust
Fiona Jenkins
Formerly Clinical Director of Therapy Services
South Devon Healthcare NHS Foundation Trust
Purpose
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To improve patient access, reduce “did not attends” (wasted appointments), reduce waiting times and improve patient satisfaction,
providing more clinically effective interventions as patients no longer have to wait for treatment.
To restructure use of staff time, basing the system on capacity planning.
•
Relevance
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•
System in operation 6 years in Eastbourne and 4+ years in Torquay
Designed to make more effective use of physiotherapy time and improve patient experience
Description
Designed and developed by Eastbourne Physiotherapy service, East Sussex, “Choice Appointments” is a system of Physiotherapy same day
out-patient appointments given by phone for musculoskeletal conditions for new referrals and follow up appointments, achieved within existing
resources. The process includes:
• Department demand and capacity calculation
• Patient referral to the service
• Patient telephones to book an appointment on the day they wish to attend
• Minimum pre-booking
• Patients agree goals to achieve before accessing further intervention
• Follow-up appointments managed in the same way
Evaluation
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•
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“Did not attends” and waiting times minimised to < 2% in Eastbourne and Torquay.
Formal audits on patient experience indicating 94% of patients were able to book an appointment convenient to them
Complaints about waiting times eliminated
Reduced time per patient episode - leading to greater capacity
Eastbourne
Torquay
Eastbourne
Torquay
% "Did Not Attends"
25
16
14
12
10
8
6
4
2
0
20
15
10
5
0
2002
2003
2004
2005
2006
2007
2008
Fig 1 - % “Did Not Attends”
2009
Routine Waiting time (weeks)
Eastbourne
Eastbourne
Waiting time Complaints
Torquay
Torquay
200
25
20
150
15
100
10
50
5
2002 2003 2004 2005 2006 2007 2008 2009
Fig 2 - Routine Waiting time (weeks)
0
Patient episode time
Mins.
2002
2004
2006
2008
Fig 3 - Waiting time Complaints
0
2002
2009
Fig 4 Minutes per treatment episode
Outcomes
•
•
•
•
•
•
•
•
The change has been sustainable for 6 years and has been replicated in 18 other Trusts to date
No increase in staffing or costs
Improves access and clinical service provision
Improved patient satisfaction and excellent clinical outcomes
No waiting times or “DNAs”, challenges existing work practices, empowering patients to choose when they come for treatment
Suitable for services wanting to reduce referral to treatment time
The system is transferable to other locations, services and countries
The process re-design uncovers extra capacity at no extra cost
Reference and Contact Details
Jones R, Jenkins F 2007 – “Key Topics in Healthcare Management – Understanding the Big Picture” – Allied Health Professions – Essential Guides. Radcliffe Publishing Limited, Oxford
Contact: RF@jjconsulting.org.uk
Produced by the Medical Illustration Department at Eastbourne District General Hospital