Outpatients and Clinics

Our work in Healthcare is targeted at more effective planning and communications methods to the benefit of the patient and to safeguard the future employment of the workforce of our clients. Managing the appointments and consultations with Outpatients is a hugely important contact point with the public as it is a major element in the patients' perception of their Hospital's efficiency.

Better planning and improved communication translates as fewer cancellations, increased clinic utilisation and staff rosters that are balanced against patient footfall and the levels of activity required.

Over several years, and working directly with clinicians in all Outpatient Clinic disciplines, we have developed a complete list of all basic planning times for consultations and treatments. These simply need to be tailored for each local situation which we do by working with local clinical staff. We can then rapidly reach a point when patients can be planned more effectively and rosters designed to match patient footfall rates - peaks, troughs and normal activity levels. This reduces waste and reduces wasted cost. It also improves the Patient Experience and the local perception of the service provided by the Trust.


Study Findings

We carried out a three week study of a Trust’s OPD, evaluating three key areas:

    Clinic utilisation by speciality
    Nurse resource planning
    Patient journey and supporting processes and workflow

The findings of the study identified that the OPD management team did not have the tools or techniques to plan clinics and resources to meet patient demand.  Clinic utilisation was approx 73% of available and staffed sessions.  Excessive overruns combined with late starts were a common feature.  The study also highlighted that management were not forecasting the clinics required by speciality and therefore the required PA’s and related costs.

Project Overview and Objective (20 calendar weeks)

The Trust planned to move towards 100% “Choose and Book”, thus being able to control clinic wait times through the flexing of clinic capacity by speciality. This was seen as a major part of the Trust’s competitive advantage and strategic objective of generating on-going and sustainable growth.  The project was designed with this in mind.

The key objective of the project was to design and implement:

Demand driven capacity planning system:

The system was to be designed to enable management to plan and flex OPD capacity to the real demand.  This capability would give management the tools to sustain short & tightly controlled wait times. 

Weekly management reporting by clinic to agreed targets and KPI’s:

    Agree start and finish times
    Agree patients slot times
    Agree patient ratio’s (new to return)

Resource planning tool linked to planned clinics by skill type.

Project Approach

OPD project improvement teams were set up from week one of the project.  These teams included management, clinicians, OPD nursing and members from support services departments.  All OPD improvement teams evaluated their own clinic requirements and potential improvements to the patient journey, within their own specialities.   

Project Results

A Demand Driven Capacity Planning System which analysed the varying demand as evidenced by the variations in referral input on a weekly basis was designed for each speciality.  The system used the previous year’s historic referral input and, by applying an agreed growth / shrinkage factor, generated the requirement for OPD clinic slots on a weekly basis. 

This system is now being used by each of the speciality teams to manage their clinic requirement on a rolling monthly basis.  This in turn is forming the basis for contractual discussions by speciality i.e. how many clinic hours are required to deliver the patient demand on a weekly / monthly / annual basis and therefore the required PA’s by speciality.  In some specialities it is anticipated that the overall PA’s will reduce.

Clinic start and finish times with patient targets were agreed by all consultants and a weekly management report of the key indicators is reviewed on a weekly basis by the OPD management team

As a result of this targeted review / preview management style, late starts reduced dramatically and clinic sessions slots are now booked to the appropriate patients numbers.  This has had a 2 fold effect of improving patient waiting times and increasing throughput by approx 8%.

A 6 week rolling view of planned clinics was made available for nursing.  Combined with an agreed nursing skill level per clinic type (agreed at clinician level) this led to a more efficient and effective rostering of nurses with the net effective of requiring no bank or agency staff.


The chart below shows an average of several days of the staffing level relative to patients through the waiting room in a Dermatology Clinic. The blue pattern of staffing was the same every day but the purple bars, indicating patients seen, was highly variable for each of the departmental open hours.  At different points during the working day there were no patients waiting but the trend analysis indicates that patients were all asked to arrive at one specific time, together, and then wait to be seen. The resulting wait times for some patients was a source of frustration, especially as several patients in the sample said their appointments had been cancelled twice previously at late notice.

Better scheduling of the booking process was able to deliver a much smoother pattern of patient throughput after staggering the appointment times. As a result of an improved List Planning procedures, the Clinical Team on this piece of work was able to reassign one full time member of staff despite a net increase in the number of patients through the department.. The savings, taking account of the productivity increase from the additional patient flow, along with the reduction in staff hours, was over 12% and was expected to grow as the planning process became increasingly accurate.

The major benefit was to the patients. Waiting times were significantly reduced, both for appointment bookings and time in the waiting room. Clinical staff reported an increase in patient satisfaction levels and fewer complaints and cancellations coming from patients over an 8 month period following the implementation of the new planning procedures.



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