Where are we waiting?
A strategic approach to waiting list management
It’s all too common for RTT waiting list management to be short term and tactical. The 18 week target tends to be met not so much by good planning but by last minute action. This is encouraged by things like PTL lists (Patient Tracking Lists): very helpful for skidding under the bar but as often as not an expensive and stressful solution.
What does a more strategic approach consist of? The key is to understand the bottlenecks.
So where are the bottlenecks? Generically there are three stages: the New Outpatient appointment, the Diagnostic phase and the Admitted stage and it is possible to have a bottleneck at any of these points. Nevertheless the biggest and most difficult bottlenecks are nearly always going to be at the Admitted stage. You are not going to be able to resolve these problems quickly, easily or inexpensively; someone would have done that a long time ago if it were simple. For example, there are fluctuations in demand on theatre time from emergency work and urgent electives which the best planning in the world cannot smooth out.
So how do we respond strategically to the problem of bottlenecks at the Admitted stage? The answer is: “Give yourself as much time as possible”. In practical terms what this means is shortening the wait for the outpatient appointment and the diagnostic phase to the absolute minimum. So if you can get all patients through the first two stages within, say, 5 weeks, you give yourself 3 months to admit all the patients who need an operation. That maximises the extent to which you can use your bed and theatre capacity flexibly and you’ve got a much better chance of riding the waves.
To do this means good ‘in-turn’ list management and smaller outpatient and diagnostic lists. That may require a one-off increase in activity which will increase the size of the admitted list but that doesn’t matter so much because you’ve now got longer to treat those patients.
More often than not, what works best for managers tends to be at odds with what gives patients the best experience. In this case the two are in perfect harmony. Managing the RTT list in this strategically advantageous way is not only good for operational managers, it is also good for patients because from a patient perspective having the outpatient appointment and getting the diagnosis quickly is by far the best way to reduce anxiety. It’s a win, win.
BY: Anthony Thompson