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'?

Local analysis identified patient cohorts who are more at risk of becoming a long waiter (52 weeks+) including men and those from a black, mixed or other ethnic background.  This correlates with higher do-not-attend (DNA) rates in these patient populations, with some up to 50% more likely to not attend their first outpatient appointment.

This inequity of access plus long waits and missed appointments potentially contribute to worse health outcomes and experience of healthcare for these patients, as well as reduce the productivity and efficiency of the service, further contributing to the elective backlog.

We want to better understand and improve on time spent and experience of waiting for those at risk of waiting longer.  We will focus on working with representative patient and community groups to co-design and co-deliver interventions which support better engagement and navigation of services, starting with a high volume / long wait speciality.

What does your project aim to achieve?

Our aim is to identify and mitigate barriers to accessing care through trialling interventions which provide a more patient-led, proactive and personalised navigation of the health system, and thereby reduce the chances of becoming a long waiter for our priority patient cohorts (men and minority ethnic patients).  We also hope this will improve their experience of waiting for our care which might have a further positive impact on their readiness for treatment and potential health outcomes.

This will include:
1.     Completing analysis which looks at the links between waits, appointments and cancellations by protected characteristics
2.     Understanding barriers to care and experience of waiting through gathering qualitative insights from patients and community engagement
3.     Co-designing solutions which mitigate those barriers
4.     Testing those solutions and measuring the change on appointment outcomes, wait times and patient experience.

To enhance the sustainability of this project the learning will feed into the organisation’s wider Health Equity Programme.

How will the project be delivered?

To ensure strong patient / community voice and inclusive involvement throughout we will set up a dedicated Patient and Public Involvement and Engagement (PPIE) board responsible for making sure users needs are met. We will include GP and voluntary sector representation recognising the role existing social prescribing already plays to support patients waiting for hospital care.

A dedicated working group including analytical, clinical, operational and improvement colleagues is already in place which will be scaled to include patient / community representatives from the separate PPIE board.  A dedicated project manager and improvement coach will be identified.

We will measure the following and assess whether it improves the length of time for a specific patient cohort:
–        Appointment outcomes and cancellations: changes in DNAs, attendances, PICs
–        Wait times: clock stops and starts
–        Patient experience: surveys, interviews, PALs, complaints
–        Cost-effectiveness: conversion of missed to active appointments

How is your project going to share learning?

Learning of how to apply QI methodology to an equity focused improvement project and reducing the chances of becoming a long waiter will be shared internally with staff through existing improvement forums, the outpatient transformation and elective recovery programme boards plus Trust communications including intranet, lunch and learns, bulletins.  The project will also be logged on LifeQI.

Externally we believe the learning will have relevance to other secondary providers who are trying to improve management of long waiters and will update on the work through existing Trust community partnerships and our strategic lay forum, Q community network through Q events & Community blogs, relevant NHS platforms / webinars / bulletins where we will volunteer case studies as well as feeding this up to our North West London Integrated Care Board to consider spread and scale of what works to the other 3 acute providers in the ICS.