Aims and objectives:
Historically, patients that were referred to radiology from Outpatients, situated not 200 yards from main X-ray, would be sent home from clinic, a written request from the Consultant for the imaging would then be sent to relevant modality, who would then have the request vetted by a Radiologist, and the patient sent a letter advising them of the date and time of their appointment.
Patients were not given a choice in respect of their appointment, which led to many patients either not turning up, (DNA - did not arrive) or cancelling at late notice leading to lost slots.
The key objectives were;
Reduce time the referral took to get from Outpatients to X-ray
Reduce cancellation and DNA rates
Provide patient choice
Eliminate vetting delays
Reduce waiting lists
Increase utilisation
Develop an accurate scheduling and booking framework
This project has contributed towards the Trust being able to meet National Diagnostic Targets and helped reduce surgery waiting lists. We are also now more prepared to meet the 6-month surgery wait, and the 18-week GP to treatment, future targets.
Support for the change:
The process change structure came from a Project Guide written by Mark Lacey, specifically designed to help medical, and clerical staff manage changes in their department with a view to achieving long term sustained improvements.
The basic tools and techniques were, an all encompassing time out day, brain storming, elective data collection and analysis, Process Templating, Plan Do Study Act cycles, Warwick Style Flow Maps, Flow Charting, and Surveys.
Fundamental elements to the successes of the work were not only involving key people, but also regular appropriate communications to the wider audience.
The Project Teams were encouraged to lead the service redesign and take ownership, but with the full support of an experienced Redesign Manager.
Patient and public influence:
In respect of service users, again in MRI, Orthopaedic Consultants would tend not to use MRI for diagnosis, due to the wait time, but undertook invasive surgery, for say, meniscal tears in knees. Now the wait time is so short these patients are now scanned and we do not always need to undertake surgery.
In CT, due to wait times, session management, and the referral process, we would often not meet national service standards, but we do now.
(Patients detailed in section g)
Impact on the workforce:
By taking medical, and clerical staff through the redesign process, we have given them not only the knowledge, and the tool and techniques, but also the confidence to challenge working practices.
Measuring the results:
Elective data collection has enabled us to gather information for a baseline, assess a Plan Do Study Act cycle, and post implementation to evidence benefits.
The results are usually presented in financial and non-financial savings, both to the Trust and the patient, in either Excel, Statistical Process Control charts, or written reports.
To ensure an integrated approach and awareness we have a Steering Group that meets regularly with representation from each modality in terms of administrative staff and all levels of clinical staff, HR, IT, the PCT's, a Non Executive Director, Clinical Governance, Divisional Management, The Cancer Centre, and The Choose and Book Programme.
Improved performance:
MRI
Waiting list reduced from 8 months to 3 weeks from Oct 03 to May 04 - process redesign supported the commissioning of a new scanner to enable much-improved utilisation.
DNA's and Cancellations reduced from 14% to 3%
Time from Outpatient referral to patient being advised of appointment reduced from ave 148 days to 1.4 day.
Patients are now offered a choice of appointments.
Interventional Booking Desk
The delay in making the appointment caused by vetting was ave 6 days - this has been eliminated.
The time from the request being received in x-ray to the appointment date being made reduced from ave 9 days to 100% made within 24 hours of receipt.
The total journey time from decision to refer to radiology, to procedure, has been reduced from ave 32 days to 19 days
CT - baseline September 04, benefits data November 04
Time from Outpatient referral to patient being advised of appointment reduced from ave 18 days to 2 days.
CT scanner utilisation has increased by 10% in the last quarter
Delays caused by vetting the request, up to 4 days, have been eliminated.
Reflecting diversity:
By asking patients why they did not arrive for their appointment, we began to understand their fears around the imaging procedure. Now, when the patients makes their appointment we answer any questions and provide information for them to take away. We also offer the opportunity of a dummy run to see what the scanner looks like and the imaging process.
Sharing the learning:
The benefits achieved in MRI have been the subject of a slot on the local radio station and an article in the regional newspaper
Four articles have been written in the Trusts internal magazine, and a Radiology News letter is written bi monthly.
The work has also been displayed internally with the Improving Working Lives programme along with our own Service Improvement Programme road shows.
Outstanding features:
I think the big message to come out of this piece of work is 'simplicity'. Although it has taken us time to implement the new processes, mainly due to the impact and involvement from many groups, in essence allowing the patient to take control of their care, and to make their appointments while they are on site at the Trust, has bought about huge, measurable, benefits to the patients, the staff, and the Trust as a whole.
