What is the challenge your project is going to address and how does it connect to the theme of 'How can improvement be used to reduce delays accessing health and care services'?

“Why have I had to wait so long to be seen?”

Our Urology team is working hard and working under pressure to get through all the people referred into their service. We know there is a long wait to see a specialist, and we know that the process that leads to appointment has undergone a number of changes as a result of the wider recent context.

We believe that if we apply Theory of Constraints to the pathway in a person centred way, the team will understand where the bigger constraints are, will be able to formulate ideas about what to do about those constraints.

The team will then be able to test and implement measurable and sustainable changes which will benefit patients in terms of experience and speed of access, and the team will feel more in control of their system.

What does your project aim to achieve?

Some patients wait significantly longer than others depending on where they live and what their needs are.

Our Urology service is under the most pressure locally with regard to waiting times. The service has worked hard using Waiting List Initiative funding to address long waits.

If the underpinning pattern of demand and activity continues however, long waits are likely to reappear.

The highest volume pathway within the service is for Lower Urinary Tract Symptoms (LUTS).

We would like to improve waiting times for the LUTS service to the extent that demand for new LUTS appointments and activity delivered for new LUTS appointments are in balance or better, and the experience of using the service is reported favourably by patients.

How will the project be delivered?

We plan to form a multidisciplinary change team consisting of Improvement Advisor, Information Analyst, Capacity Manager and representation from the Clinical and Non-clinical parts of the Urology service.

We will schedule weekly meetings underpinned by data and Theory of Constraints to;

1. Agree the goal for the work with the team (a waiting times goal and an experiential goal)
2. Understand the pathway quantitatively such that the bottleneck is identified
3. Generate ideas and then test them to alleviate the bottleneck
4. Check that the constraint has been alleviated in a sustainable way, and
5. Chart our progress along the way such that the team can then apply the method to their next constraint OR their next pathway.

How is your project going to share learning?

The project will be a proof of concept project which will sit within our Planned Care Programme. That programme has a remit to support improvements in planned care pathways across our whole system. The programme has the mechanisms in place to gather stories of success and of learning and to share them across our Care Groups.

This project will report to the Planned Care Programme Board at regular intervals both in terms of progress around the service improvement and in terms of the methods, tools and approaches being designed. These will then be assessed for use across the wider system of care.

Through this process, the approach taken and its impact will be shareable across the Q network.