Out Patient Program

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THE OUTPATIENT PROGRAMME

Measuring up to changein Scotlands outpatient services


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THE OUTPATIENT PROGRAMME

Measuring up to changein Scotlands outpatient services

Scottish Executive, Edinburgh 2006


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Crown copyright 2006

ISBN: 0-7559-5048-8

Scottish Executive

St Andrews House

Edinburgh

EH1 3DG

Produced for the Scottish Executive by Astron B46065 06-06

Published by the Scottish Executive, June 2006

Further copies are available from

Blackwells Bookshop53 South Bridge

Edinburgh

EH1 1YS

The text pages of this document are printed on recycled paper and are 100% recyclable


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The Centre for Change and Innovation (CCI) is supporting the NHS to spread

good practice and to increase its capacity for sustainable improvement.

It works alongside the National Waiting Times Unit to improve patient access,

a key challenge for the NHS over the next few years. This document provides

a brief overview of the CCI Outpatient Programme from 2003 to 2006.

It is not intended to be a comprehensive analysis of all local projects butrather an overview of the type of service improvements supported by

the programme, its impact and associated learning points.

The Outpatient Programme was designed to support NHS Boards to meet

and sustain the Partnership for Care (2003) target that no patient should

wait more than 26 weeks for an outpatient appointment by December

2005. Over the lifetime of the programme NHSScotland implemented

streams of work to support comprehensive service improvement (redesign)

projects across a range of specialties, affecting millions of patients.

Demand: The Programme has influenced demand on acute outpatient

services through the production of 80 Patient Pathways for local

adaptation and adoption, the introduction of referral management

services and development of community-based outpatient services.

Activity: By introducing Patient Focussed Booking (PFB) to an annual

equivalent of 1 million appointments the Programme has reduced Did

Not Attend (DNA) and cancellation rates positively impacting upon

variation in clinic activity.

Capacity: The Programme has helped to identify and release bottlenecks

in service capacity through training 171 alternative staff to see patientsin new ways, creating in excess of 48,000 patient appointments a year.

Capital funding also supported the release of capacity.

Queue: For the first time an outpatient waiting list exists in every NHS

Board and is being actively managed by those in medical records. PFB is

helping to ensure that routine patients are being seen in date order and

principles of queuing theory (routine patients being seen fairly in turn)

are being applied.

Culture: The beginning of a culture shift towards further measurement

and better informed planning of services is being seen across NHSScotland.

Further details of the outcomes of individual projects and further

resources are available at: www.cci.scot.nhs.uk

Key Outcomes

INTRODUCTION


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Specialty-based projects

PlasticDermatology ENT Neurology Orthopaedics Surgery

NHS Argyll & Clyde IG IG IG

NHS Ayrshire & ArranIG IG IG

NHS Borders IG G IG

NHS Dumfries & Galloway IG G

NHS Fife I I

NHS Forth Valley IG IG I

NHS Grampian IG IG IG IG I

NHS Greater Glasgow IG IG IG IG I

NHS Highland IG IG

NHS Lanarkshire IG IG I

NHS Lothian IG IG I I

NHS TaysideIG G IG I IG

Key: I Redesign Projects G Capital Projects

NHS Orkney ran a joint redesign project between Dermatology, ENT and Orthopaedics, supported by a capital

project. They also began implementation of the Patient Pathways and, with NHS Grampian, set up a

neurological tele-medicine link.

NHS Shetland have implemented a number of the Patient Pathways and Patient Focussed Booking for both

new and return appointments.

NHS Western Isles ran redesign projects in ENT and community based Orthopaedics, supported by a capital

project. They have also implemented a number of Patient Pathways and Patient Focussed Booking for new

appointments.


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Community Modernising Implementing PatientOutpatient through Patient Focussed Referral

Services IT Pathways Booking Services

NHS Argyll & Clyde IG I I I

NHS Ayrshire & Arran I I

NHS Borders I I

NHS Dumfries & Galloway I I I

NHS Fife I I

NHS Forth Valley IG I I

NHS Grampian IG I I I I

NHS Greater Glasgow IG I I I I

NHS Highland I I I

NHS Lanarkshire I I I I

NHS LothianIG I I I I

NHS Tayside IG I I I

5

Cross-specialty projects

Key: I Redesign Projects G Capital Projects


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AHP Allied Health Practitioner

CEO Chief Executive Officer

CHPs Community Health Partnerships

COS Community Outpatient Services

DNA Did Not Attend

GPwSI General Practitioner with a Special Interest

ISD Information Services Division

MPT Multi Professional Team

PFB Patient Focussed Booking

PID Project Initiation Document

PwSI Practitioner with a Special Interest

RIS Referral Information Services

RMS Referral Management Services

SAS Scottish Ambulance Service

SEHD Scottish Executive Health Department

SPAHP Specialist Practitioner Allied Health Professional

ABBREVIATIONS


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Outpatient demand may be difficult to measure as it encompasses all

requests for a service. This will include new patient referrals from GPs,

tertiary referrals and return appointments.

NHSScotland does not currently record demand for services. Information

Services Division (ISD) collect and collate the numbers of new referrals

to consultants, however, this does not reflect the full extent of demand

for services (as defined above) nor describe the nature of the demand.

As it is believed that the nature and volume of demand is changing with

the ageing population, understanding demand is even more important.

Actively measuring, analysing and managing demand for consultant

services facilitates planning of services and evidence for resource

allocation and utilisation.

NHS Boards bid for funding for projects that would allow them to

better manage demand. Projects attempted to identify and direct

demand or provide alternative pathways for previously identifiedpatient groups, thus changing demand to consultants.

Some projects changed demand on consultant time by providing

alternatives to consultant return appointments. This changes the new

to return ratio, that is, more new patients can be seen providing

quicker access for those requiring diagnosis.

In NHS Tayside, referral management was introduced alongside community

outpatient services in orthopaedics. Over the course of the project

71% of referrals were directed to primary care-based services with only1.2% requiring a consultant opinion.

NHS Greater Glasgow and Clyde (formerly NHS Argyll and Clyde)

introduced physiotherapy-led low-back pain clinics in seven community

sites. Patients can access this service through their GP or direct through

self referral. Referrals to the service have increased from 55 in July 2005

to 250 in November 2005. In the first four months of the service only

one patient was referred on for consultant opinion.

Illustrations

DEMAND01


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NHS Lanarkshire introduced a community-based vascular service.

A multidisciplinary team see approximately 500 patients per year and

the onward referral rate to consultants is only 16%. The average clinic

wait is five weeks. This has contributed to a reduction in the waiting

time to see a vascular consultant from 73 weeks to 15 weeks.

In NHS Borders, a multidisciplinary team has been set up to treat

orthopaedic patients. The service has only referred on 15% of all patients

seen, saving a total of 264 consultant patient appointments. The waiting

time to see the multidisciplinary team has been consistently 13 weeks

shorter than the consultant waiting time.

NHS Grampian has been running a dermatology telephone helpline

for patients since March 2005. Over the nine months the telephone line

has been running they have received 124 calls from patients; 60%

received telephone advice, 30% were referred to a nurse, 5% were

referred to a doctor (5% were wrong numbers). Not only has this

service saved outpatient appointments, it has enabled patients to

access specialist care immediately.

NHS Tayside has established a digital referral service for skin cancer

patients in 34 GP practices. An image of the lesion is taken at the GP

practice and is electronically sent through to consultant plastic surgeons

at Ninewells. The images are vetted by the consultants and either

management advice for primary care or an appointment for the patient

is given to the GP. Over the life of the project, 300 electronic referrals

were made to the plastic surgery department at Ninewells. Of the 300

patients audited, only 57 required an outpatient appointment,

releasing 243 consultant plastic surgeon outpatient appointments. The

waiting times for this service, from referral to vetting, has also reduced

from 10.5 days to two days over the life of the project.

DEMAND01


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Changing historical referral patterns takes time to achieve. Being

aware of this, being patient and providing ongoing support and

communication to GP practices is time well spent.

Onward referral to other specialities when indicated has received a

mixed reception. Some consultants made it very clear they would not

accept referrals from an ESP even on the recommendation of the

orthopaedic consultant. This impacts on what should be a seamless

service resulting in patient delays.

Consider effects of change on other parts of the system, and plan for

these effects (e.g. seeing more outpatients will generally mean more

patients listed for surgery).

Depending on medical staff for referrals failed to maximise referrals

for nurse/AHP-led clinics resulting in an irregular referral pattern.

MRI access has been hugely beneficial. Positive MRI findings whichrequire an orthopaedic opinion arrive at their consultation with all relevant

information. Conversely, results which do not need orthopaedic

management are no longer automatically given a consultant appointment.

These patients are extended scope practitioner managed.

Establish and maintain communication links with GPs. Face-to-face

encouragement to use the protocols as they see many protocols from

different sources with regularity. Once a personal connection is made

GPs use the service more appropriately and feel free to telephone and

speak to someone they have met.

As well as providing resource for projects such as those described

above, the Outpatient Programme:

Produced 80 patient pathways in 12 specialties for local adaptation

and adoption;

Provided training and raised awareness on measuring demand;

Described alternative pathways for demand with presentations on

best practice throughout the UK;

Collated and presented demand information for local projects

where provided.

Local Learning Points

Programme Action


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Measurement can be difficult for local systems;

Many services plan only on the average GP referral rate leading to

shortages in capacity because at least 50% of the time demand will

be higher than capacity provided;

Referral Management and community-based services together canhelp reduce waits in under two years more effectively than referral

information services alone;

Alternative referral options are key to changing demand for

consultants;

Referral management services have a knock-on effect upon other

services, e.g. Physio, Podiatry;

Having a single referral point simplifies clinic coordination;

Consideration of impact of changes on staff;

No one size fits all, but learning is transferable.

DEMAND01Programme LearningPoints


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Activity reflects the actual number of patients being seen by consultants

(or other professionals) in clinics. The data is widely collected and

reported by ISD. Activity is not capacity, though it is often described

as such.

The importance of measuring activity lies in variation. Variation in

activity occurs for a number of reasons including:

Staff absence;

Clinic cancellation;

Patient failure to attend.

A large amount of variation in activity will contribute to a queue

(waiting list) developing.

The Outpatient Programme encouraged people to measure activity in

order to better understand the queue and to evaluate their use ofavailable capacity.

One major stream of work looked at reducing variation at clinic level,

through the introduction of Patient Focussed Booking (PFB). PFB reduces

variation in activity by reducing hospital clinic cancellation and patient

DNA rates. It also has a positive impact upon queue management

(mentioned later in this document) and has the obvious advantage

of introducing choice for patients.

PFB projects were run by 13 of the Health Boards to offer patients

greater choice in booking appointments and to improve clinic efficency.

Patients are advised of the probable wait for their outpatient appointment

and are then contacted six weeks prior to this date and invited to call

the hospital. The patient then calls and can be offered appointments

that are available over the next six weeks. Patients are able to choose

appointments that are more suitable to them and so consequently are

more likely to attend.

Through the PFB process patients are only booked into clinics that occur

up to six weeks in advance. With a strict six-week hospital cancellation

policy, patients are not affected by clinics or appointments being moved

or cancelled.

02 ACTIVITY


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In NHS Grampian, the hospital cancellation rate fell from 6% in

September 2003 to 2% in September 2005.

In May 2004, the DNA rate for new dermatology patients in NHS

Tayside stood at 14%.12 months later, the rate recorded for patients

who had been through the PFB process was only 3.5%.

NHS Lanarkshire experienced a 10% removal rate in general

medicine at the six-week validation point. Without PFB these patients

would not have been identified at this stage and would have been

likely to DNA.

As the graph below demonstrates, the number of patients affected

by hospital cancellations in NHS Argyll and Clyde has halved since

PFB was introduced.

Graph 1: Impact of PFB on cancellation rates in NHS Argyll and Clyde

The graph overleaf demonstrates the impact of PFB at Yorkhill

Hospital on DNA rates. Note the green and red lines which

demonstrate the difference between those patients booked using

PFB and those who were not.

ACTIVITY02Illustrations

Percentage of new and return outpatient capacity cancelled by hospital,

all specialties, Argyll & Clyde

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Graph 2: Impact of PFB on Did Not Attend rates at Yorkhill Hospital

Six NHS Boards developed the IT capability to include PFB for patients

returning for a further appointment. The effects on DNA and

cancellation rates have been very similar to those experienced with

new patients. We estimate that 200,000 return appointments are

currently going through the PFB process per annum.

Graph 3: Impact of PFB on return patient DNA rates, Yorkhill and Dumfries & Galloway

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Percentage of new outpatient DNAs, all specialties, Yorkhill

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25.0DNA rate (overall)

DNA rate (no PFB)

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D&G

Percentage of return outpatient DNAs, all specialities

Yorkhill and Dumfries & Galloway


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One reason for short-notice cancellation by junior doctor staff is that

leave is applied for in another department or hospital and staff arrive in

a new department with pre-approved leave. All orientation and induction

material sent to new staff should include details of the six-week

notification of leave policy. A Guide to Good Practice (2005),

National Leadership and Innovation Agency for Healthcare.

As well as providing resource for project management and measurement

of projects such as those described above, the Outpatient Programme:

Produced a Patient Focussed Booking update document and

distributed this across Scotland;

Supported a PFB project managers group for problem solving and

spreading good practice;

In collaboration with PFB project managers produced a Guide to

Implementation to inform future work.

The effectiveness of IT and telephone systems have a direct impact

on PFB;

Senior managerial and clinical support is required throughout PFB

implementation to drive the process change;

PFB is most successful where clinic cancellation and patient

non-attendance policies are in place and robustly applied;

There are circumstances where PFB may need to be adapted, e.g.

where waiting times are less than six weeks or clinics are arranged

with less than six weeks notice. Also, circumstances where very

specific appointments dates/times need to be arranged. For example

obstetrics or where multiple appointments with set times are needed

(ophthalmology). In addition, every effort must be made to ensure

that specific patient groups, e.g. those with communication needs,

are accommodated and receive the same choice as other groups.

ACTIVITY02Learning Point

Programme Action

Programme LearningPoints


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Capacity is measured by the time that all the elements required to see a

patient are available, e.g. space, equipment and a clinician. Clinician

time is often seen as the constraint in a service and therefore as

defining capacity. However, this is not always the case. Sometimes

there is an appropriate clinician available (not always a consultant) but

there is no space or the equipment required is not available.

Measuring capacity is an essential part of understanding the system as

a whole. Often services are surprised to find that capacity is not the

issue or that the limitation on capacity can be resolved. It is

recommended that, in a planned service without a substantial backlog,

capacity is set at the 80th percentile of the variation in demand.

All redesign projects were asked to measure the capacity of their service.

Most found this difficult. Only 24 out of 45 were able to measure capacity

but not all of this information was completely correct. Specialist

Practitioner capacity proved easiest to measure for the projects.

The Outpatient Programme offered all NHS Boards the opportunity to

bid for capital funding to support redesign work and these can be seen

in terms of capacity gains. A total of 15 million was available across

the Programme. The funding format was a bidding process where the

bids had to show support of redesign and or/improvement in access.

The bids for funding contained one or more of the following three

elements:

1. Equipment to enhance local services or equip new practitioners;

2. Small-scale renovations to provide clinical space for redesignedservices;

3. Large-scale building projects.

Thirteen NHS Boards applied for funding for a variety of purposes.

Most projects successfully spent their funding. Those that bid for monies

to fund large-scale projects, however, were generally unable to

complete their build within the timescale but their projects will help

sustain new ways of working.

03 CAPACITY


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In NHS Greater Glasgow, orthopaedic services are being redesigned

in both the acute and community setting. Supporting these new ways

of working are capital projects at the Glasgow Royal, the Western

Infirmary and Southern General Hospitals. The project will create the

appropriate capacity and environment for modern multidisciplinary working.

These capital projects are well underway and should allow for morethan 4,000 extra new patients per annum to be seen.

In NHS Grampian, capital funding was provided to purchase nasendoscopes

for peripheral clinics. This means that patients do not need to return to

Aberdeen Royal Infirmary for a second appointment if a scope is

required. The full impact of this will be realised when consultant clinic

templates are altered to reflect the decreased need for return

appointments, increasing available new appointment slots.

Community-based dermatology clinics covering NHS Forth Valley

employ three GPwSI and a Specialist Nurse. Together they see 1200

new, 2400 return patients per year, and do 200 biopsies. This has

contributed to reducing the consultant new to return ratio from 1:2 to

1:1, releasing consultant capacity to see new patients.

Long delay with the development to the unit at the hospital finding

out about how long the process is to progress a capital build and how

important the accuracy of the costing for the development is.

The physical relocation of the service and phototherapy equipment has

been of tremendous benefit to the Department.Limited accommodation reduces the ability to develop service

significantly. It is preferable for nurse clinics to be held at the same time

as consultant clinics so that any complications can be referred over at

the time of the clinic. This prevents patients requiring another

appointment and timely action for any necessary treatment.

CAPACITY03Illustrations



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The Outpatient Programme was not primarily concerned with adding

capacity but rather with releasing bottlenecks within the system.

Training in identifying bottlenecks and constraints within the system

was provided and mapping of patient pathways was encouraged.

Support was provided where requested with process mapping.

Capital monies in short-term projects are most likely to be able to be

spent on equipment or renovations. Smaller amounts of capital are

most likely to be useful in limited term projects;

CCI advocate that local services look for the constraint on capacity.

This is not always staff or space and services need to be closely

examined accordingly.

Programme Action

Programme LearningPoints


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The queue for outpatient services is perhaps the element of which we

are most aware. Queue is commonly measured in two ways:

1. The size of the queue is the number of people waiting;

2. The length of the queue will be reflected in the waiting time.

Access targets are often set around the length of the queue and the

Outpatient Programme was set up to support the achievement of a

26-week maximum waiting time by December 2005. ISD collect and

collate retrospective waiting times by specialty and by NHS Board.

The queue, whilst often measured has not routinely been managed in

outpatients. Queuing theory gives us several management ideas that

would help us decrease the length of the queue:

Minimise the number of queues, i.e. pooling;

See patients in date order where clinically appropriate;

Minimise carve out, i.e. the type of appointment slots.

PFB helps to ensure that routine patients are seen in date order.

The bars in the graph below represent an outpatient waiting list for

ophthalmology outpatients in September 2004. The line shows how

long patients would have waited had the queue been managed by

booking routine appointments strictly in turn. In effect, the maximum

wait would have been reduced from 44 to 21 weeks.

Graph 4: Effect of in-turn booking on waiting time

QUEUE04

Illustrations

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Wait (weeks)

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Booked in Turn

Ophthalmology Sept 2004: Outpatient Waiting List

vs List for patients booked in turn


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Other projects have changed templates and introduced pooling.

In NHS Forth Valley, a comprehensive redesign of orthopaedic

outpatients was undertaken. As well as introducing multidisciplinary

and community-based services, the orthopaedic surgeons met as a

team to discuss and agree clinic templates that they would all use. They

then agreed to pool their waiting lists, reducing the number of waiting

lists from 36 to 8. Forth Valley clinicians are now going to look at

return patient appointments. Agreement has been reached that

unused return slots will be used for new patients and the current new

to return ratio is 1:1.7.1

Be prepared to be flexible and adaptable. Plans will change and you

need to be able to adjust and develop an alternative approach should

barriers be insurmountable.

There is less potential for confusion introducing PFB specialty by

specialty rather than consultant by consultant. This means that medical

records staff do not have to decide which process a referral has to go

through.

Starting small allows you to get a feel for PFB before extending to all

areas. Most projects in outpatients started with three specialties and

then moved on to others several months later. It also helps to start

where there is the greatest support for PFB as these staff will help to

spread the word as implementation is extended.

As well as providing resource for projects such as those described

above, the Outpatient Programme:

Provided training and raised awareness on queuing theory;

Produced and disseminated a Patient Focussed Booking update;

Produced and disseminated a PFB implementation guide;

Produced and disseminated an Outpatient Toolkit.


Programme Action

1 ISD provisional data 2005


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Whilst savings will be made by implementing PFB, these are difficult

to measure and will not necessarily occur where resources may be

needed, e.g. medical records and information departments. Health

systems need to fund any ongoing resources specifically in these areas;

Whilst PFB ensures that routine patients are invited to phone-in in

turn, patients will respond out of turn. This can cause problems

where waiting times are close to the maximum guarantee and

appointment slots for potential breaches may be given to other

patients. A solution needs to be agreed to manage patients who

choose to delay contacting the booking centre, to discourage health

systems from reverting to traditional booking methods.

QUEUE04Programme LearningPoints


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The Outpatient Programme provided the resources and education to

develop capacity and capability for change in outpatient services in the

NHS. Resources were provided to encourage and allow locally designed

and led change to meet the needs of each service area. The successful

implementation of change has been demonstrated in the majority of these

local projects and the learning for the NHS and SEHD has been extensive.Examples of the work have been published in Delivering for Health

(2005) and the Audit Scotland report Tackling Waiting Times in the

NHSScotland (2006) as good practice and press coverage of the

initiatives has been positive. From a programme perspective all

deliverables and objectives have been met.

Beyond this, and perhaps most importantly, the Outpatient Programme

supported a number of cultural shifts within NHSScotland:

Previously, only activity data was collected for outpatients and

planning was done on the basis of average activity;

The programme supported and demonstrated that non-acute work

should be moved to a primary care setting. This approach is endorsed

by Building a Health Service Fit for the Future (2005) and the

National Waiting Times Unit;

The programme advocated an understanding of the impact of

queuing theory on waiting times and introduced the fundamentals

of better waiting list management;

The programme advocated the role of a range of clinicians in

managing chronic illness.The challenge of implementing such fundamental changes in thinking

and planning should not be underestimated. The outpatient team

recognise that simply to have outpatient staff thinking in terms of

capacity, demand, activity and queue is a huge shift from the previous

focus on average activity and that the benefits of this shift will bear

fruit over the next few years. The beginning of this culture shift is

somewhat anecdotal but the following observations are seen as strong

indicators that this has begun.

Of those surveyed by CCI regarding redesign 92% stated that they

would like to be involved in further redesign. 83% and 72% respectivelyfelt that waiting times and access had been improved by redesign.

The changing language in the NHS to discuss all of the above

elements is seen as an initial sign of success.

05 CULTURE CHANGE


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25 newspaper articles have highlighted work being supported by

the Outpatient Programme and this helps to improve patient

awareness of positive changes taking place in service provision.

Building a Health Service Fit for the Future encourages further

spread and development of many of the ideals of the work piloted

in the Outpatient Programme.

Delivering for Health, the Scottish Executive response to Building

a health service fit for the future outlines the policy direction for the

NHS over the next 5 years. Delivering for Health draws specifically

on the projects that have been supported by CCI and embraces the

tenets upon which the work was built.

Between June and September 2005, CCI surveyed the views of staff

involved in outpatient redesign projects across the specialties of Neurology,Dermatology, Plastic Surgery, Orthopaedics and ENT. Staff who had

been involved in the redesign work, either directly or indirectly, were

asked for their opinions of the effect of redesign on the patient

pathway and on the staff involved in the project. A total of 250 people

were invited to fill in an online questionnaire. The response rate was

48%, with 121 staff submitting a completed questionnaire.

64% of all staff actively involved in the redesign thought that the

work had a positive impact on their working environment;

95% of staff whose role changed agreed that they were happy with

these changes;

92% of staff said they would like to be involved in further redesign;

83% felt waiting times had been improved and 72% felt patient

access had been improved.

CULTURE CHANGE05

Illustrations


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In September 2005 the PFB project ran a staff and a patient satisfaction

survey. The staff survey was sent to departments across NHSScotland

who were currently implementing PFB. A total of 161 staff responded

to the survey with half of those actively involved in the implementation.

The headline results were as follows:

65% of staff felt PFB had a positive impact on the patient

experience of outpatient services;

85% of those staff directly involved in the implementation of PFB

wanted to be involved in further redesign.

The respondents were also asked what aspects of the service they felt

had been improved through the PFB process, with waiting times and

communications coming out top.

The patient survey was run in dermatology outpatient clinics over a

two-week period and 700 responses were received.

98% of respondents felt happy to telephone to arrange an appointment;

90% of respondents reported no difficulty in getting through to

appointment centres;

89% of respondents felt were given a choice of appointments;

97% of respondents were happy with the appointment they received.


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The last word must go to those improving services. This list comprises

their lessons learned and acts as advice for people commencing

service redesign.

Do not underestimate the power of face-to-face interaction

when selling your idea and ensuring that key stakeholders know

and understand what is expected of them!

When crossing new professional boundaries, be prepared to negotiate/

perhaps even compromise/and be patient.

Although you have a project plan be prepared to be flexible so

your project can evolve alongside unforeseen changes and

service developments.

Dont underestimate the time it takes for an ESP to obtain the skills and

confidence to run a clinic and be prepared to start with small numbers

of patients and build up to full capacity over time.

If you will be relying on Patient Group Directives to start newclinics make sure and start them as early as possible as the

process of writing them and getting them signed off is very

lengthy.

Needs adequate infrastructure in place before redesign occurs.

Team effort with all stakeholders signed up to the process is

required.

Expect the unexpected to happen and have contingencies for the

contingencies.

Initial support from Clinical and Support staff requires ongoingmotivation and encouragement in the redesign process.

Project management resource enabled staff to find innovative

solutions and assisted with implementation.

Introducing change takes longer than you expect.

The patient experience and level of care has improved significantly. Care

and treatment is being delivered locally and patients are able to access

services which were previously denied to them because of their geography.

Inclusion of all key stakeholders from the start of the project

ensured relatively smooth implementation of the project.

Process mapping proved very useful in identifying major issues within

the system.

THE LAST WORD


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THE LAST WORD

48,000 outpatient appointments created by

specialist practitioners.

1,000,000 patients booked through

Patient Focussed Booking per annum.

171 Specialist Practitioners.

80 Patient Pathways.

At December 2005, only two patients in Scotland

waited longer than 26 weeks for a first

outpatient appointment.


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THE LAST WORD

The CCI Outpatients team were

Stephen Gallagher (Programme Manager) 2003-2004

Michelle Hughes (Programme Manager) 2004-2006

John Anderson

Max Brown

Bev Dodds

Dr Ali El-Ghorr

Eva Frigola

Peter Gilfoyle

Harriet Hughes

Dan Isaac

Phil James

Dr John Jamieson

Carmen McAteer

Marjorie McGinty

Fiona Watson

Alastair Watt

Further information on all aspects of the Outpatient Programme

can be found at www.cci.scot.nhs.uk under the Outpatient

Programme sections.

An audit of the service improvements developed through the

Outpatient Programme will be conducted in 2007. Details of the

audit will be published on the CCI website.


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Crown copyright 2006

This document is also available on the Scottish Executive website:

www.scotland.gov.uk

Astron B46065 06/06

Further copies are available from

Blackwells Bookshop

53 South Bridge

Edinburgh

EH1 1YS

Telephone orders and enquiries

0131 622 8283 or 0131 622 8258

Fax orders

0131 557 8149

ISBN 0-7559-5048-8

Documents

Out Patient Program