The Christie NHS Foundation
A study of Christie’s main outpatient unit, followed by a proof of concept to demonstrate the benefits of making simple changes to working practices and patient flow management at main reception
The Christie is an internationally recognised centre for the treatment of Cancer and a credit to the NHS. Everyone without exception is professional, caring and generous in their attitude to patients, carers and visitors alike. I know this from real experience when my mum was diagnosed with a rare form of GIST cancer only a few years ago.
Around the time of her diagnosis I was invited to a meeting with key stakeholders from the main outpatient department and members of the Divisional Board to review current design proposals developed by a local architectural firm. The conclusion from this meeting was that the Outpatient unit was in great need of modernisation. However, before any decision could be made, everyone agreed that the impact of changes must be fully understood and initial focus should be given to improvements in working practices and patient flow first as these problems would persist irrespective of any investment in the physical environment.
Following our meeting we were asked to carry out a targeted study of the main Outpatient Unit, to decode the patient experience and quantify the impact of any improvements on patient satisfaction, resource and revenue. The outcome from our study not only provided Christies with the information they required, it also recommended making simple changes to the welcome and arrival process, which was by far the most daunting experience, especially for new patients such as my mum.
At peak times, the queue at main reception would reach out of the door. 50% of patients and visitors in the queue had wayfinding queries and following treatment or often difficult consultations, some patients would be forced to queue again at main reception to book their follow up appointment. Despite the high demand, reception workstations were underutilised and staff would spend a large proportion of their time looking for patients, contacting doctors and locating patient records. Although patients and visitors complimented the quality of care, 80% felt that waiting was far too long and by far the worst stage of their entire journey experience.
Working alongside clinic nurses and staff at main reception, we implemented several changes to working practices and patient flow. We introduced a dedicated welcome person to segment new patients away from the main flow, reduced demand at reception by signposting patients and visitors with wayfinding queries and changed the linear process to a multi-queuing system to increase throughputs as well as patient satisfaction. We encouraged patients arriving early to check-in at a designated time and implemented a zonal system in the main waiting area to allow nurses and staff to find patients more efficiently and effectively. Patients with follow up appointments would be managed via a separate process eliminating the need for them to re-join the queue at main reception.
The impact of these changes resulted in a significant reduction in queue length, a 15% increase in the utilisation of resources and 80% of patients felt the waiting experience was OK or had significantly improved. Most satisfying of all was that my mum experienced the improvements first hand.
Thanks to the commitment and dedication of everyone at Christies not only do they continue to deliver an exceptional quality of care but now a patient experience, which is far better than before and continues to improve. The residents of Manchester should feel proud!
AT A GLANCE:
- A study of the Main Outpatient Unit experience in order to decode problems and quantify the impact of improvements on patient satisfaction, resource utilisation and revenue opportunities:
- At peak times queue at main reception would reach out of the door (max. 32) – daunting welcoming experience for new cancer patients, with some waiting over 10 minutes at main reception
- Over 50% of patients in the queue at main reception had wayfinding queries. Patients booking follow up appointments were required to re-join the queue
- 30% of patients would check-in >1 hour before appointment time causing large peaks in demand. Café area was under-utilised. Patients preferred waiting in seating close to clinic in fear of missing their turn
- Workstations at reception utilised only 50% of the time – staff conducting low value work such as finding patients, contacting doctors, looking for patient records and assisting with wayfinding queries
- Q-busting activities were reactive impacting patient’s sense of fairness and in-process feeling
- Some clinics were over-occupied, others remained empty – overall clinic room utilisation was 50%
- 80% of patients felt waiting times were too long and waiting was the worst stage of their journey
- A proof of concept to demonstrate the benefits of making simple process changes at main reception:
- Increased patient satisfaction by welcoming patients and segmenting new patients from main flow
- Reduced failed demand by signposting wayfinding queries before entering the queue at main reception
- Regulated the flow, by encouraging patients to wait in the café area and check-in at a designated time
- Increased throughput & satisfaction by changing linear process to multi-queue system in line with journeys
- Increased staff productivity by improving communication and removing waste at reception e.g. patient records organised in line with appointments; clinic informs of delays; patients wait in designated zones
- Patients with follow-up appointments would follow a separate process away from the main queue
- Quantified the impact of outpatient improvements on patient satisfaction, resources and revenue – findings used as input to the business case for modernisation
- Demonstrable improvements by changing working practices and improving patient flow at main reception:
- Reception queue length reduced from maximum 32 to 7
- 15% increase in resource utilisation at reception
- 80% of patients felt the waiting experience was OK or better than expected