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Innovation to Improve Outpatient Clinic Efficiency Team at Royal Bolton Hospital wanted to see where in their outpatient clinic processes there was waste, and work out how to eliminate it

  • At Royal Bolton Hospital, there was a perception that the workload capacity of outpatient clinics was being pushed to overloading and the team wanted to know why. They wanted to ensure that outpatient departments were offering the safest and highest possible quality care to their patients.
  • Following an initial audit, the team identified a number of areas to focus on redesigning outpatient clinic services.
  • The programme was a one-year cycle of improvement, running from April 2010 to March 2011.

In early 2010, a hospital team conducted an audit of its general outpatient clinics to understand the barriers preventing a smooth process of appointment booking and treatment.

The key areas they identified were:

  • Patient wait time – there was a need to reduce waiting time for a new patient appointment.
  • Poorly managed clinic lists and appointment bookings – collectively, clinic appointments were being both underutilised and overbooked.
  • Double booking appointments – the system failed to capture changes properly to release unwanted appointments, leaving gaps and the perception that patients were not attending.
  • Case note management – variable ways of managing case notes led to delays, duplicated information gathering and created dissatisfaction for patients and staff.
  • By addressing these issues the team aimed to eliminate waste within the system and improve productivity to safely see more patients sooner.


Some highlights from their work are:

  • Better outpatient bookings: Changes to how staff handled cancellations reduced rework from 1,004 hours per month to 141 hours per month.
  • Improving the use of appointment slots: Use of general surgery slots improved by 45%, well above the initial target of 15%.
  • Centralising outpatient case notes: A new process for storing and preparing notes centrally released the equivalent of 90 hours per week of band 2 time.
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