The Forum

Three steps to improve elective care at your organisation—regardless of the political climate

by Asya Igmen and Vidal Seegobin

One of the top questions we received this year was how to improve outpatient services, particularly elective (or planned) care. While seemingly straightforward, you need to get a number of things right to deliver high-quality elective care.

This virtual service cut unnecessary post-op visits by 90%. (And you can do it too.)

That's why timely access to quality elective care is still an aspiration in most places—even in the most economically developed countries. In the UK, the waiting list for planned care will grow to 4.5 million people by March 2020, and in Australia, half of all patients wait over a month for elective procedures.

Many governments have implemented policies over the past two decades to improve planned health services: Canada created wait time benchmarks for various procedures and England plans to cut one-third of in-person outpatient appointments to reduce costs and improve patient experience. Hospitals and other providers are subsequently penalised or rewarded by governments that are under pressure by voters who experience the true burden of failed reforms.

But what does that mean for individual providers? More often than not, hospital executives become overwhelmed by government-mandated targets, losing sight of how to systematically evaluate the performance of their own elective care services.

Here are three steps to improve your elective care performance.

First, isolate your organisation's primary goal.

Beyond the obvious goal of meeting nationally mandated targets, our members most often strive to achieve the following elective care goals:

  1. Reduce unnecessary planned appointments at the acute hospital
  2. Decrease wait times for outpatient care
  3. Make outpatient care more cost-efficient

In an ideal world we'd want to achieve all three of these goals and more, but to see tangible improvements in your elective services you need to narrow your strategic focus and mute the political noise. When you say you want to improve your elective care services, what do you really mean?

Second, identify the underlying problems you need to solve for the chosen goal.

Let's take Willow Medical Centre (a pseudonym). The English hospital's goal was to decrease their wait times for outpatient care, specifically in urology.

Willow's leadership started by identifying why, beyond high demand for urology services, its patients were waiting so long. Was it because:

  1. There were no alternatives to in-person specialist appointments?
  2. The hospital throughput wasn't as efficient as it could be?
  3. There was a lag between referral and diagnosis?

The answer could've been all of the above, or something else. Willow needed to identify which problem was the most likely culprit: what was causing 80% of its patients to wait longer than necessary?

By analysing data and talking to staff, Willow found that the real problem behind long urology wait times was a lag between referral and diagnosis. Patients were returning to the hospital on separate days for various tests—MRIs, ultrasounds, and in some cases two biopsies under general anaesthesia.

Each return visit for a test came with its own delays: MRI readings often weren't ready for days; each ultrasound required an appointment with the radiology department's sonographers; and the biopsies alone accounted for 38 days of delays on average.

Third, only employ the tactic(s) that solve your core problem.

It's tempting to try to solve every single bump in the road to "perfect access to elective care", but unfortunately no organisation has enough resources to implement every solution.

In Willow's case, the most logical next step was to employ solutions that could explicitly change that delay in diagnosis. It developed a one-stop urology clinic to provide all of a patient's diagnostics on the same day—patients receive one biopsy performed under local anaesthesia; the clinic has protected MRI slots with a turnaround time of one hour; and dedicated sonogoraphers perform the ultrasounds. These changes enable Willow to diagnose patients faster and move on to treatment with fewer delays.

When it comes to elective care services, don't get caught up in the political back-and-forth or hot topic of the day. Instead, step back and assess your organisation's (or system's) most pressing goal, understand the underlying problem, and then identify the appropriate solution.

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