Reducing waits in elective care

Background

This multidisciplinary team in Wales focused on improving patient flow between point of suspicion to reaching a decision to treat for patients with head or neck cancer. The target is 28 days.

Their research and discovery phase uncovered that the average wait for patients is currently 55 days. Delays occurred at multiple points, including at information transfer, triage, access to ultrasound scans and non-attendance by patients. 

Test interventions 

The team trialled two interventions to remove triage stages:

• Applying a ​‘straight to book’ category for initial consultant appointments upon receipt of referral.
• Introducing an ​‘unconfirmed cancer patient’ tag to patient records, to streamline bookings into a prearranged time slots. 

They increased the capacity of the ultrasound service by upskilling existing staff and employing more specialists, at a cost. 

The team also secured funding to hire a mathematical modeller to help predict patients’ likelihood of missing appointments. The aim being for Macmillan cancer nurses to proactively engage those at high risk of non-attendance, to support them to attend. 

Early outcomes

Bypassing triage has successfully reduced waits for the initial consultant appointment from up to 15 days to just 2–6 days. 

Increasing the ultrasound capacity has reduced the wait for a scan by 18 days so that there is now no significant wait. 

Learning

The team has been aware and keen to address the waits for some time. Having the Q Lab process and funding to focus on it has been vital for progress. 

The team worked hard to engage the right stakeholders. However, due to competing priorities and high workloads, it has been difficult to secure sustained involvement from all teams involved in the early cancer pathway. However, a next step for improvement is to avoid delays in surgical investigation, so the team will be striving to involve the theatre team. 

Background

South Docs Services (SDS) encompasses nine primary care networks covering a diverse patient base across Birmingham.

At the outset of the project, patients were waiting around 62 weeks for an initial outpatient urology appointment. There was no insights into waiting times across subspecialties.

SDS aimed to redesign the patient pathway to take advantage of urology expertise in primary care, freeing up capacity in secondary care for those who need it most. 

Test interventions

First, the team trialled remote reviews of urology referrals with the aim that the consultant would triage them and decline those not requiring onward secondary care intervention. 

However, the team found that referrals were too skeletal for the specialist to offer sound judgement on how to appropriately manage referrals. 

In the second iteration, the specialist was given remote access to the patient’s full primary care record to fill in gaps on the referral. 

In the third iteration, in-person clinical reviews were added to bolster this new urologist-supported service. 

Early outcomes

The addition of in-person reviews to the urologist-supported service meant that almost 60% of patients avoided a hospital appointment and were managed in primary care. 

In a survey, 92% of patients reporting being satisfied with the service.

Learning

SDS spans multiple organisations. It was a crucial early activity for the team to map the stakeholder groups with influence and interest in their challenge. They found that having an awareness of the different agendas of key players helped to tailor conversations to align the project with their scope of work and secure buy-in.

Following the success of the pilot, the team is expanding the trial for longer-term evaluation. 

The team benefited enormously from learning from other teams in Q Lab, and ​‘pinching with pride’ any relevant strategies that worked elsewhere. In exchange they were happy to inspire others with the successful elements of their stakeholder buy-in, namely passion, targeting and persistence. 

Background

Clinic non-attendance has significant consequences, including delays in care for urgent patients. The Adolescent Rheumatology Department sought to improve patient engagement with their service, becoming more proactive in supporting their young patients. 

Previously, AI had identified inequalities that contributed to high clinic non-attendance, such as socioeconomic status and geography. The test team planned to work with their young people and other stakeholders to explore these and other barriers contributing to poor engagement. 

Early outputs

Working with willing young people, the team has strengthened the rapport between themselves and their patients. They developed a value stream map of a young person’s journey, from appointment booking to clinical consultation. 

Using this and outputs from co-design workshops, the team identified two main sets of barriers that prevent engagement with the service.

• Those within patient control, such as health behaviour.
• Those outside patient control, including systemic barriers.

Following an away day with the clinical team and young people, which drew on tools and techniques learned at Q Lab, they identified three key areas for intervention.

1. Building continuity and stability for the young people. 
2. Rebuilding confidence in the service for the young people.
3. Rebuilding trust in the system for the young people.

Next is to prototype solutions to address these areas. 

Learning

In trying to link their Q Lab project with another at the hospital, the team experienced some obstacles that hindered meaningful collaboration with external stakeholders. They had to take a step back and reflected that they needed to better manage expectations and set boundaries within the collaboration to achieve results.

To engage with young people not currently accessing the service and at high risk of not attending, the team needed to consider bespoke strategies in collaboration with their steering committee.