Many will be familiar with the impromptu visit to the local hospital. That anxious rush to arrive at the reception desk to register your arrival with the admin staff on hand, to then need to sit and wait with the other attendees until you are eventually called in for assessment, then after no short while finally on for treatment, transfer or discharge. Or perhaps you have entered the system more subtly, via a referral from your GP to an outpatient appointment.
Either way, this is the most many of us will ever experience of this healthcare juggernaut. To filter through the various departments when the need arises. You will have noticed however the timescales involved between appointments, that oftentimes they seem to take longer than we’d like. This is something we might not appreciate.
A fitting analogy to help us see the overall picture is traffic flow. Each leg of a route can be thought of as an individual ‘process’ in the overall journey. As variations in speed at different legs of a journey can equate to delays, each ‘process’ affects the efficiency of the entire journey as a whole.
Just as the flow of traffic is improved by controlling the variation in the speed of cars and the havoc stop-starting causes in the endless lines of caterpillar-esque traffic, the flow of patients can also be improved by understanding the causes of variations of processes within the healthcare system.
Whole healthcare systems have been analysed: from GP practices, to ambulance services, secondary care, tertiary care, and including social services. This work has shown that improving patient flow across health and social care systems is beneficial to patients and staff alike in many ways, such as:
• improving the clinical outcome and experience of patient’s journey.
• eliminating waits and delays.
• saving time and effort by avoiding duplication of work.
• saving money from the cost of overtime, waiting list initiatives, locum and agency fees.
• improving the trust of the healthcare organisation.
The need to apply Quality Improvement shouldn’t be viewed as a box ticking exercise either, but rather, as healthcare organisations dedicated to the welfare of the general population and the NHS, they have a responsibility to identify and review these processes with statistical accuracy so improvements can be implemented and audited. That should mean taking into account all the costs related to any process, including the loss of income to a patient attending an appointment and the impact of transport on public health. The inefficiencies of our health system impact on the general health of our society as a whole.
In order to deliver high-quality healthcare, establishments must start to think in terms of value and sustainability; this means the need to identify a balance between cost and outcomes (value) and long-term impacts (sustainability). There is no ‘one-size fits all’ solution to the inefficiencies we encounter in the current healthcare system, but there are innovative solutions to address many of these sticking points; healthcare organisations need to acknowledge these deficiencies honestly and utilise new technologies to advance care for all.
A case in point is whether there is a legitimate need to physically attend a consultation. If there is not, are we not then forcing a one-size fits all solution to a legacy issue without taking advantage of the modern day tools at our disposal?- As Apple’s trademarked slogan goes, “there’s an app for that”.
Outpatient appointments and the sheer number of users flowing through a system may be the bread and butter of many establishments, but the reality is that cost is borne out in more than how taxpayer contributions are expended.
By Medicalchain’s Tim Robinson.