Managing outpatient appointment booking was complicated enough before the pandemic, and the subsequent care backlogs have only made it worse. An HSJ webinar invited a panel of experts to discuss the challenges and how new methods of digitisation could make things better. Claire Read reports.
In looking at the outpatient challenge in light of covid, Sarah Reed first suggests it is helpful to “zoom out and look at some of the broader contextual factors that are at play”.
And Ms Reed, senior fellow in policy and research at the Nuffield Trust, argues there is no shortage of such issues. “There are three really main high-level interconnected challenges: the number of appointments, the timing of appointments and the prioritisation of appointments.
“Covid-19 has really changed these dynamics, but in the years leading up to the start of the pandemic we were seeing a really steady rise in the number of outpatient appointments taking place in the NHS. Outpatient services in England have had the sharpest rise in activity of any hospital service.
“That demand hasn’t been matched with commensurate increases in workforce or broader system capacity, so we have the situation where outpatient services in most places are just really overstretched and patients often have to endure really long waits for appointments or, when they do have an appointment, it might be delayed.”
Ms Reed was speaking at a recent HSJ webinar. Run in association with Blue Prism, it was convened to explore how hospitals can best manage the booking of outpatient appointments.
“The challenges we were facing pre-pandemic are still the same challenges [we’re facing now],” reported Nicholas Sands, director of transformation at Royal Surrey Foundation Trust. “We’ve managed to drive through some transformation of those [outpatient appointment] pathways but there are still, I think, many unanswered questions and much more to do.”
Developing a vision
The trust began reviewing such processes in 2019, pre-pandemic, with particular focus on moving outpatient clinics from acute to community settings. But Mr Sands says developing a vision is only part of the story.
“It’s great to have a vision about different approaches to seeing patients but actually process, and good process, is at the heart of that. If you don’t have a process that’s robust and safe, it’s really easy to make the situation a whole lot worse. So we really focused on supporting our outpatient teams and our clinicians to look at their process, look at root causes of issues.”
‘We’ve seen enormous strides during the pandemic of improvement happening really quickly and rapidly’
Which presents a new problem: finding enough time to develop better processes for outpatient appointments. Mr Sands reported his trust has addressed this in part by digitising and automating some actions which previously would have been carried out manually.
“We have lots of teams doing day in, day out admin processes, searching for things, looking at reports. Actually if you can find a way of taking that away in a systematised way, something that’s repeatable and robust, you then start to free up more time for the human brain to do what it’s fantastic at, which is look for opportunities to improve.”
Sharon Osterfield, the trust’s head of automation and programme manager – transformation, said the aim was to improve efficiency. “Pre-development of an automation process, our medical secretaries were spending an hour per medical secretary just basically logging onto different systems, looking at the timeframe for these different appointments and then ensuring that they communicated back to outpatients.
“But by using an automated approach we now have our virtual worker, affectionately known as a ‘bot’, being able to delve into these applications and pull together all of that information, thereby ensuring that patients are brought into clinic in a more timely manner.
“We are utilising our capacity better but also mitigating any risk associated with these patients that have been waiting for a long time for their follow-up,” explained Ms Osterfield.
That sort of focus is a familiar one to Karen Gorman, healthcare account director at Blue Prism – which provides the automation software used at Royal Surrey County. “What we’ve seen over the last year is really a drive to look at how we can build capacity within the outpatients team, to release time for the admin teams and also for clinicians, so that they can spend more time on patient care,” she said.
“If we can use the pool of digital workers to take over some of those manual processes, admin teams can be on the phone to patients to help coordinate care. From that personal touch and using people skills, you’re potentially reducing cancellation, reducing missed appointments, and accelerating managing the backlogs.”
For Sarah Reed, keeping staff in mind will certainly be key to the NHS successfully confronting the challenges now faced on outpatient service management. “Staff right now are exhausted, they’ve just been through the most terrible year, and now there’s such pressure to do as much as we possibly can.
“Innovations are just enormous in hopefully making the lives of staff easier and able to do more. But there needs to be a reasonable expectation of what staff can really deliver at the moment, and make sure we don’t lose sight of what we’ve all been through.
“I think it’s been amazing to see how many of these innovations are becoming embedded now. I think because improvement takes a sense of common purpose, we’ve seen enormous strides during the pandemic of improvement happening really quickly and rapidly because of those components. So I think we’re in a really interesting, fertile ground to be embedding and mainstreaming a lot of these changes.”
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