Case Study: ServiceRedesign/Service Improvement in Ultrasound Service
What were the problems?
- Longest wait in excess of 9 weeks and rising
- Variable DNA rate
- Variation in staffed capacity due to annual leave and staffing issues
- A large number of appointments were being changed / rebooked every month
- Patient dis-satisfaction with changing / waiting facilities
- Variation in range of expertise making segmentation a necessity
- A need to reduce reliance on Golden Jubilee Hospital capacity
- A need to be able to respond to the demands of the 18-week Outpatient pathway target ie. Earlier diagnostics
- Improved linkage of diagnostics required for better management of the patient pathway
- A wish to improve the Clinical Governance of the service provided by developing a system of peer review and double-scanning
- Some operational difficulties with differences in processes between the clinical departments
- A desire to reduce access times to less than 4 weeks for all patients thereby avoiding carve-out and the development of a multi-tier system
What improvement tools used?
ForthValley held their first Rapid Improvement Event (RIE) in General Ultrasound in Falkirk District Royal Infirmary and Stirling Royal Infirmary from the 28th May to the 1st June 2007. This was a 4.5 day process using Lean Methodology and informed by Capacity, Activity and Demand analysis. A team of individuals who represented all parts of the Ultrasound Patient Pathway spent time working to undertake a focused review of the quality of the service to patients and referrers with a view to making rapid and sustainable improvements. The process was examined from start to finish, mapping every step and identifying areas of non-added value. There was also an opportunity to speak to staff and patients about their experiences to inform the service redesign.
An action plan from the week was carried forward for 3 months after the event and processes were stream-lined, ensuringthat a timeous, high quality, patient-focused service is delivered at all times.
What is the situation now?
In-patient Process–Improved scheduling
–New IP reception
–New patient information leaflet
–New patient preparation / Out-patient Process
–Centralised OP appointing office
–Standardised scheduling
–Scanning protocol standardisation
–New information leaflets
–New appointment letters
–Reduced session variability
Electronic Referral Process
–Planned development of electronic referral through SCI gateway
–The Provision of referral guidelines for Primary Care
–RCR referral guidelines made available / Patient Experience
–The provision of a separate waiting area for undressed patients
–The provision of additional waiting room seating
–Reorganised waiting areas on both sites
–Waiting/changing areas cleaned and painted.
–The provision of a more confidential reception area at FDRI
–New signage
Clinical Governance
–A Clinical Standard monitoring programme established / Waiting Times Group
–A Radiology Waiting Times Group has been established.
Out-patient Scanning Capacity
–Refurbishment of former CT scan room at SRI to provide OP ultrasound scanning capacity
Measureable Outcomes
What are the benefits to patients?- Improved patient information for patients visiting either site.
- Improved access times due to increased sessions and standardised scheduling
- Improved environment on both sites
- Improved patient care
- Calmer environment
- Reduction in time spent rebooking DNAs or cancelled slots.
- Calmer environment
WHAT ARE THE BENEFITS TO THE ORGANISATION?
- Reduced waiting times.
- Increased utilisation of capacity
KEY SUCCESS FACTORS
- Strong Clinical and Project Leadership.
- Involvement of staff who know the process inside out
- ‘Quick wins’ at the start of the week gave added enthusiasm and willingness to pursue and achieve harder goals.
- Senior Management support gave the team the power to push harder and ensure the sustainability of the changes.
- The team were empowered to make changes.
WHAT WOULD WE DO DIFFERENTLY NEXT TIME?
- Allow more than four weeks to plan the event.
- Service redesign should be built into job plans
Further Information available from:
Dr Emma Beveridge
Consultant Radiologist
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