The Pennine Acute Hospitals trust is a 2,300-bed acute trust in Greater Manchester, serving a population of around 800,000 across four primary care trusts, with services based at four major hospitals.
Most departments at the trust have traditionally used manual records and hand-counted referral cards to produce waiting time information. Where departments did have IT systems, they were often different at each of the four hospital sites and were unable to produce the information required.
Diagnostic services at the trust are based in two of the four divisions, with most delivered on all the trust's sites. When the requirement to monitor diagnostic waiting times was first discussed by the Department of Health in 2005, the divisions realised a robust and reliable system was needed, given the complexity and size of the task. A system was also needed to enable accurate and timely day-to-day management of the departmental waiting lists.
A small working group of information analysts and performance and improvement specialists assessed the situation and produced key recommendations and a work plan to achieve the DoH requirements in the radiology, neurophysiology, audiology and cardio-respiratory services.
The group found that although the systems themselves could not produce the required data outputs, the data could be extracted from them into a central database. This would then calculate the waiting times required, providing a solution to the DoH request.
It was also recommended that publication of data on the web would allow for the management of departmental processes - in particular chronological booking and capacity reconciliation.
Working with software consultants Geko Technologies, developing a diagnostic patient target list from concept to end product took 10 months and surpassed the trust's expectations in terms of functionality.
The list includes demographic details, site referred to, PCT of the patient, examination required, waiting time to date and breach date. The system uses existing IT infrastructure to gather, process and publish the required data via the internet to any desktop user with appropriate permissions.
Implementation of the list in the divisions followed the introduction of the access to diagnostics policy, which outlined standard booking and waiting list management practices. It was vital to get everyone on board and the change process required active and focused involvement from all levels of staff.
Changes were made to the management of patient referrals, the day-to-day use of IT systems, and the level of focused involvement from a performance and improvement manager in transferring key skills in waiting list management to departments.
Need for change
The initial roll-out began in a limited range of low-risk areas and was run in conjunction with previous systems until quality could be assured.
Most staff openly recognised the need for change and after a couple of months of the system being operational it was clear that a change had been made for the better, especially for patients.
To ensure the data was meaningful, validation of the systems was required and, as a result of this alone, a 10 per cent reduction of the waiting lists was achieved in some areas.
Giving the booking clerks the ability to chronologically manage referrals and prioritise according to urgency using an up-to-date web-based management tool contributed to a waiting list reduction to within 13 weeks in all areas by 1 April 2007. The system also enables the prioritisation and tracking of cancer referrals to ensure that patients are provided with a diagnosis in accordance with trust targets.
The system has enabled all the diagnostic departments in the trust to prioritise and manage waiting lists in real-time with an easy to use web-based IT solution - matching capacity and demand through understanding the waiting list profile.
Its development has used expertise from clinical, operational and information specialists and demonstrated the benefits of cross-directorate and cross-divisional working and effective skills use in a large NHS organisation. The trust is now confident it has a fit for purpose waiting list management system for key areas of diagnostics that can be applied across all diagnostic and therapeutic disciplines in the future.