Despite the best efforts of the Government and NHS to reduce hospital waiting times, there are still wide variations in the service UK patients receive.
A Healthcare Commission report published in August 2006 found that in some parts of the country, patients are still waiting up to two years for hospital tests. For example, the Commission found that the wait for a routine MRI scan in Birmingham was 338 days, while a routine colonoscopy in Walsall involved a wait of over two years.
Dr Makani Hemadri is an award holder on The Health Foundation’s Leaders for Change scheme and is working to re-design service delivery for day and short stay surgical patients. The scheme aims to equip health professionals working in service improvement with the skills and knowledge to lead change projects. It is designed to give them the time and space to develop a new understanding of the change process and to apply this to their own work.
Dr Hemadri’s project is addressing the problem of waiting times for short stay patients by introducing a one-stop same day service for all day and short stay patients at Scunthorpe General Hospital. Using this approach, consultation, tests, pre-assessment and surgical operation are all provided on the same day and no routine post-operative visit is scheduled unless it is essential.
Impact on patients
“Let’s say you have a fairly straightforward problem like a small lump or a hernia,” Dr Hemadri explains. “Once you’ve been referred to a surgeon in a hospital, you have to wait about twelve weeks for the appointment. You might then need an x-ray or a blood test, which means a few more weeks wait and you’ll have to come back for the results. You’ll then get put on a waiting list for three to six months, during which time the pre-assessment nurse or anaesthetist might send for you again. Then you come back in for your actual surgery, after which there is yet another post-operative visit.”
Dr Hemadri’s project aims to radically streamline this process for minor cases, thereby improving services for patients, saving time and money and freeing up resources to deal with more major cases. “What I’m trialling right now is to see if for minor and intermediate surgical problems the patient can come in one morning, have all their assessments and surgery done and be discharged either the same day or as soon as they’re ready,” he says. “They would not be seen on a routine follow up basis unless there’s a strong reason like a biopsy result.”
“In a financial sense, it saves a fair bit of money,” he adds. “I’ve estimated that it saves about £300 per patient between the primary care trust and the hospital.”
From a patient’s point of view, the new system replaces a frustrating series of queues and waits with just one wait. “They’re offered a date and they come in just for that day,” Dr Hemadri says. “In the early feedback we’ve had, one of the patients said it was even better than going private!”
In essence, Dr Hemadri’s approach is about unclogging the system. By doing all the minor and intermediate cases using his one stop single visit system, clinics’ timetables are freed up and more time can be spent with patients with more major problems, such as cancer or cardio-vascular problems.
Methods and techniques
One of Dr Hemadri’s main challenges in making the scheme successful was to change the way that hospital staff work and think. To achieve this, he began by bringing a few patients in and dealing with them on the same day. He then asked colleagues and managers to get feedback from the patients, so they could see for themselves how much better a one day service was from the patients’ perspective.
Next, he put together a rough idea of the new process and trialled it on increasing numbers of patients, getting feedback from colleagues along the way. “There was actually no existing system for this, so we took the initiative and got one of our medical secretaries to ring patients,” he says. “We did an initial check on whether they were suitable for a single visit, and if they were willing to participate in the new way of working.”
There were also IT challenges to overcome, as the existing systems were not designed to log one day visits and staff were worried that the hospital wouldn’t get properly paid for them. This was solved by bringing the relevant people on board and showing them the benefits of redesigning their systems. “There was a lot of proactive intervention,” Dr Hemadri says.
The system has already developed from the initial model through the input and involvement of different people and departments. “We now have a fairly formal system,” Dr Hemadri explains. “There’s an experienced surgical nurse who rings round and finds out more about the patients. The administrators know that it’s a single visit and they now have a system of clocking it so that we get paid properly.”
Benefits of the scheme
Dr Hemadri says that the support he received from The Health Foundation gave him a personal boost and leant an additional credibility to his work. “It’s a very positive thing to be recognised by a major organisation like The Health Foundation,” he says. “It’s a recognition of your idea, which is very important for people who are trying to do new things.
“When you take your project to the hospital level, because it’s had outside recognition, people take it more seriously and are more willing to help. That’s been an extremely important factor.”
In terms of the leadership training, Dr Hemadri describes this as an entirely different way of thinking. “When you work with people from different backgrounds and specialities, including doctors, nurses, managers and accountants, you realise how the system really works and how you need to develop yourself and your attitudes towards coping with it,” he explains. “I’m really thankful to The Health Foundation for giving me that opportunity.”
Sustaining change
Dr Hemadri’s project has another six months to run, but he’s already given some thought to how it might be expanded. “At the local level, we’ve got serious buy-in, including from the Deputy Chief Executive.” he says. “We’ve been able to show some fairly large financial benefits, so they are looking into it quite seriously.”
“I think for the future it will be the model for most day cases and short stay patients in our trust, if not in our area,” he concludes.
05 February 2007