Reducing waits in elective care
How can we work together to reduce waiting times for elective care? Q Lab helped five health care teams to tackle the challenge in new ways.
Q Lab brought people together between August 2023 and May 2024 to explore how we could create collective responsibility to reduce delays in elective pathways. Five test teams applied the process to challenges in their settings, with positive results.
Background to the Lab
Our topic for the Q Lab in 2023/24 was: how can we create collective responsibility to reduce delays in elective pathways?
Waiting lists and wait times for NHS elective care are at unsustainable levels. Timely, efficient, and safe care relies on collaboration and flow along pathways. There’s already good work going on across the health system, but pressures on the system can get in the way of solutions and shared ownership of the problem.
We have been working with members on the issues of waiting lists and access to care for several years. Q Lab offers a proven approach to working together to make progress on complex health and care challenges like this.
What we did
The Lab began in August 2023 and worked together over nine months to explore, learn, innovate and test around the topic of reducing delays in elective pathways.
Test teams
From applications to join this Q Lab, we selected and provided funding to four test teams looking to participate to help tackle specific challenges in their settings.
- Aneurin Bevan University Health Board, Wales. Wanted to reduce waits for people suspected of having head or neck cancer.
- South Docs Services. Sought to improve the flow of patients through the urology pathway across Birmingham.
- Pain Management Service, Stockport NHS Foundation Trust. Aimed to reduce waiting times for patients living in pain who rely on high doses of opiates.
- Paediatric Department, University College London Hospitals. Sought to reduce non-attendance for appointments at a young people’s rheumatology clinic.
The teams joined a series of workshops with industry professionals, academics and patients to build knowledge, generate ideas, test, and learn from innovative interventions.
Each test team was allocated a volunteer co-researcher with relevant experience. They were selected from applicants to support the test teams on their journey by contributing their unique perspectives and helping them to capture and share their insights.
The approach
The Lab process followed the ‘double diamond’ approach.[ref]Design Council. The Double Diamond. [/ref] This well-established format for design and innovation breaks the process down into four stages.
- Discover. Taking time to understand the problem in detail, rather than making assumptions.
- Define. Using this understanding to define the challenge being faced.
- Develop. A creative process to generate new ideas in response to our clearly defined problem.
- Deliver. Testing and refining new solutions.
There is often a temptation in improvement and innovation to jump to solutions and actions. This can be especially true when there are immediate delivery pressures, as we are seeing in the health and care system right now. But it is also important to know when to slow down.
Explore the outcomes
Through Q Lab, each of the four test teams developed a new understanding of the issues they brought to the process. They identified and navigated barriers to improvement and tested improvement measures in their settings, some of which have had a significant impact on quality of care.
Naturally, the test teams are at different stages of their projects. You can read a summary of progress below.
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.
Contact Q Lab
Contact us about Q Lab at Qlab@health.org.uk
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