Waiting List Management: themes from a trouble shooter

1
Waiting List Managementthemes from a trouble
shooter

• Invited following work at Mid Yorks, but drawing
  on work on lists, 4 hours, and assessing Trusts
  in trouble across the NHS in England , Wales and
  N.Ireland

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Priority

• Waiting times are of huge national priority so
  Trusts and PCTs have to do whatever it takes to
  get them right.

3
Headlines

• Visible commitment from the top vital
• Communications /hearts and minds
• Avoiding fragmentation of systems and
  accountability
• Auditing compliance
• Good performance management information
• Understanding the signs of risk
• Capacity planning
• Following good practice
• Real Trust-PCT engagement

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Visible commitment from the top vital

• Boards must take an active interesthave good
  clear reports, and know the key signs to look for
  Dont just rely on exec say so.
• CEOs and D-Ops must be seen to be interested and
  personally committed to hitting targets.
• Delegation is fine, but given the priority top
  execs have to be right in there, understanding,
  driving and winning hearts and minds
• Challenge is often in multi-problem Trusts where
  energy is spread over many topics

5
Communications /hearts and minds

• The best Trusts have found ways to talk about
  targets in terms of patient care. ie speed is
  good for patients. This enhances sign up at all
  levels
• Nearly every member of staff contributes to
  waiting time improvement---clinical, admin,
  facilities etc. So dont restrict hearts and
  minds work to the docs!
• Process improvement comes from everyone playing
  their part
• Celebrate success, but make sure people also know
  the risks so they can help remove them

6
Avoiding fragmentation of systems and
accountability

• Reduce points of access to PAS
• Clarify who runs the waiting list (Inpts/outpts
  etc)
• Clarify who is monitoring progress
• Beware of too many fingers in the pie, and no top
  overview
• Beware of risks in medical lists ( as list
  expertise is usually in surgery)
• Cut down local variation in how things are done
• Rigorous central approval of extra paid sessions
• Centralised systems, sensitive to clinical views
  works best

7
Auditing compliance

• All the key principles (eg date stamping on
  arrival, date order of appts) should have an
  audit standard ie a regular check on compliance
• Put the standards in the waiting list policy
• Dont wait for Audit Commission Data Spot Check

8
Capacity planning

• Dont wait until decisions in outpatients plan
  operating capacity on outpatient referrals and
  conversion rates
• Understand the volume of outpatients that can be
  seen in 13 weeks, and dont take referrals you
  cant treat in time, either as inpatients or
  outpatients

9
Good performance management information

• As up to date as possible
• Cleaning up info. is energy that could be used to
  shorten waits
• Study by specialty, even consultant. Average or
  combined performance hides risks
• Monitor PTL trajectory by specialty, not just
  overall
• Make it easy for pts. to be chosen in date order
• Waiting list shapes are easy to read
• PTLs are what matter not numbers on lists

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Understanding the signs of risk

• Cherish the stats!
• Its simple stuff
• PTL treated, against time left
• PTL without TCIs
• No. to be treated in month to hit 9m/17w
• No. of outstanding TCIs
• How many have to come off each week vs how many
  are coming off
• Compare performance with England and comparable
  Trusts
• Watch GSupp and other outsourced cases like hawk!
• Find an anorak!

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Following good practice

• Some examples Are they really followed,
  monitored, and managed?
• Strict date order
• Pooling similar lists
• Only routines and urgents
• Un-suspending early in the month
• Regular validation
• Policy followed on DNAs etc

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Real Trust-PCT engagement

• There is a fine balance between referrals,
  outpatients, operations and waiting times
• This needs constructive discussions at as high a
  level as necessary, and not the usual if only
  the PCTs would demand manage..if only the Trust
  would be more efficient.. battles !
• Capacity planning must be a shared exercise
• Agreed referral protocols and care pathways
  reduce disputes and are good for patients

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SummaryBedfords Cs

• Commitment from the top
• Communications
• Clarity on responsibility
• Cherishing the performance figures
• Clarifying and correcting risk
• Consistency on compliance and good practice
• Collaboration across the health community