Outpatient - Establishing Productivity

Mark O'Connor ^a, Niamh Barrett ^a, Martina Behan ^a, Gary O'Callaghan ^a, Gavin O'Neill ^a, Mary Coghlan ^a, Edel Smith ^a, Jessica Polykarpou ^a, John Boland ^a

Introduction
Ireland, similar to other countries, is trying to solve 'The Productivity Puzzle'. Increased financial and staffing resources are being allocated to healthcare without similar increases in activity. To investigate this 'Puzzle' Ireland's Health Service Executive established a National Productivity Unit in June 2024. Its first area of focus was Outpatient Productivity with the deliverable of introducing service level productivity measures that would in

• Increases in the average numbers of outpatient appointments
• An 'Outpatient Toolkit' that can be deployed across all hospitals and specialties
• Compliance with waiting time targets
• Reduction in the number and percentage of Did Not Attends and Could Not Attends

Detail
Visits to 10 hospitals to observe an outpatient clinic in a high volume specialty were arranged. A consistent process was followed with

• A 'Site Visit Flatpack' was sent to each hospital in advance
• Stakeholder interviews with local observations on:
  
  • People
  • Process
  • Technology and infrastructure
• Process review
• On-site observation study to document the 'As Is' operation of each clinic
• Data collection and analysis of on-site observations
• Follow up meetings to discuss finding and results

Results
A return visit was made to each hospital to present findings and discuss the results. Feedback based on the observations was given on:

• Variance between planned and actual attendances
• New to return appointments
• Scheduled time versus actual time
• The physical environment/number of rooms
• Staffing resources available
• Staffing and room downtime
• Consultant utilisation - does the consultant see patients or float between rooms supporting junior doctors
• Average time per patient

A Strategic Outpatient Toolkit is currently a work in progress and will be finalised by the time of the conference. This toolkit will identify the 'To Be' operating model for OPD with measures at each stage in the outpatient journey where outpatient demand can be managed and capacity be better utilised to ensure patients are seen within the mandated times.

Conclusions
There are multiple steps along the outpatient pathway where the steps below can improve the relationship between demand and capacity.

• Demand management
• Supporting clinical decisions
• Greater awareness of conditions and the appropriate treatment pathways that are available.
• Alternative virtual care pathways
• Better workflow of clinics.
• Strategies to reduce DNA/CNAs and unnecessary follow up attendances

The feedback communication with each site and Strategic Toolkit look at the entire pathway with suggested improvements that will result in reduced demand, increased and better managed capacity and a more efficient pathway with shorter patient waiting times. The PCSI presentation will detail the entire OPD Productivity process.


^a National Productivity Unit, HSE, Ireland , Ireland

Original Version in PDF
PDF Version from Website