Why some clinicians are now at the centre of waiting list management

It’s fair to say that the intricacies of waiting list management has traditionally not been a key area of involvement for clinicians. A recent HSJ webinar heard, however, that covid has changed that in some organisations.

Karina Malhotra – managing director of Acumentice, which supported the event – explained how a new clinical prioritisation system at Imperial College Healthcare Trust had meant much greater clinical engagement in managing performance on elective waits.

Reprioritisation

In response to the swelling waiting lists caused by the pandemic, the trust has gone through a process of clinical reprioritisation of lists. Clinicians have decided which patients will be harmed by long waits and which can, if need be, wait longer than the specified target time.

It’s meant healthcare professionals becoming much more closely involved in reviewing data quality. “In the past the clinicians were reasonably far removed from waiting list management; it became an administrative function,” said Ms Malhotra. “A lot of departments were managing it slightly removed from the clinical input.

“But now we’ve put waiting lists right in front of clinicians. Not only have they welcomed it – because they can decide what’s important for their patients and how long they should wait – but indeed they can look at their waiting list and say: ‘These patients have already been treated or this patient doesn’t need this procedure any more.’”

Clinicians are making prioritisation decisions based on a harm and priority matrix developed within the trust. But, according to Professor Catherine Urch, it’s still an approach which supports real clinical engagement.

“The definitions of harm are given to you but as a clinician you’re able to bring your expertise,” said Professor Urch, divisional director for surgery, cardiovascular and cancer at Imperial College Healthcare Trust.

“It allows them to say: ‘I need to do this operation very quickly’ or: ‘I know on paper this looks like an emergency but actually it isn’t.’ It suddenly starts changing how we approach this whole [area of] elective care.”