Long NHS waiting times the biggest UK health care burden
Delays and waiting times waste the time of both patients and medical staff, as well as squandering money and resources, says Steve Williams, Managing Director of Qmatic UK
A few weeks ago the King’s Fund once again painted an unflattering picture of the NHS, with a report revealing that waiting times in A&E had hit a nine-year high. I saw much press attention given to call handling and resource deployment, but nowhere did I read about NHS trusts tackling the problem of physical queuing and waiting. Yet, poor signage and administrative burdens are holding back the NHS.
According to our very own report, “Waiting and Queuing in the NHS”, high administrative overheads, patients frequently getting lost, and systematic under-utilisation of resources are the primary structural challenges facing the NHS today.
We commissioned the survey to highlight the structural and systematic causes of delays and bottlenecks within the NHS, which waste the precious time of trained medical staff, taxpayers’ money, and repeatedly let patients down. It looks at the three fundamental issues faced by the NHS today:
1. Improving the patient’s journey between departments
2. Improving the management of patient queuing and waiting within departments
3. Making better use of patient journey information to improve the overall patient experience.
By better understanding the underlying causes of these issues, we can improve the way the NHS handles the flow of patients throughout the organisation so that bottlenecks can be reduced and the delivery of care can be improved.
The Navigational Challenges
• Of those interviewed, 59% of hospital staff claim that patients do not read signs (and 44% have received complaints from patients about getting lost), resulting in missed or delayed appointments, frustrated patients and additional strain on departmental reception desks.
• In contrast to those patients getting lost, 38% of respondents said that patients often arrive very early for their appointments, clogging up the limited seating available. This is especially problematic during peak times when capacity is at a premium.
The Burden of Administration
• On average, 18% of a nurse's time is spent arranging follow-up appointments, while 14% is spent explaining to patients about waiting times and 10% is spent helping lost patients.
• An average total of 42% of a nurse's time is therefore spent on activities other than nursing.
Under-utilisation of resources
• The average percentage utilisation of NHS clinics is cited at 66%, meaning around a third of NHS clinics sit unused during the day.
• 63% of respondents believe they do not have adequate seating in all their departments throughout the day.
Queuing Influences Patient Behaviour
Beyond the bottlenecks and inefficiencies of the physical flow of patients through hospitals and trusts, 97% of NHS staff firmly believes that improving patient flow will have a positive influence on a patient’s behaviour.
Just under half of NHS departments admit they are unsatisfied with the way patients are matched to the most appropriate person or department during the course of their treatment. 62% admit that improving it is a priority for them, reflecting the desire to implement queue management solutions such as self check-in systems. 41% have already done so in some or all areas.
Managing the flow of patients is the core engine of the NHS – it is the one function that touches every single patient at every stage of their treatment. If just one cog stops turning, then the whole machine starts to stall, undermining the ability of the NHS to deliver the high quality of healthcare that it is known for.
Of the dissatisfied NHS departments, the following top benefits were expected from improving patient flow:
• Reduced wait times for patients 79%
• Reduced aggression in A&E 60%
• Less demand at the main reception 52%
• Fewer failed appointments 48%
• Increased resource utilisation (clinic rooms etc.) 46%
• Increased staff productivity (e.g. nurses not directing patients) 44%
• Increased seating area utilisation 44%
According to the National Audit Office, the 57,000 physical assaults on medical staff each year costs the NHS £69 million a year in staff absence, loss of productivity and additional security.
Cutting aggression has become a real target for the NHS, as outlined in its Reducing Violence and Aggression in A&E by Design (2011) report for the Department of Health. With the benefits outlined by the NHS staff surveyed, the research suggests that improving patient flow could yield significant cost savings to the NHS, while at the same time improving the health and safety of NHS staff.
Queue management systems are proving their worth in the NHS, with 41% of NHS departments having now already installed self check-in systems to improve the patient queuing experience, with a further 25% currently considering or implementing such a solution.
Reception Bears the Brunt
For most patients, the reception desk is the first port of call when they check into a hospital department. It is also the first place a patient tends to go when faced with an obstacle or grievance so is an excellent barometer of patient satisfaction and the effectiveness of patient flow. At present; general enquiries (64%), patients asking for directions (63%) and patients being in the wrong department/building (52%) are the most commonly observed behaviours at reception, reinforcing the point that patient flow is an issue for many departments within the NHS.
Hurdles to Patient Flow
When asked specifically about the hurdles faced when trying to improve how patients are linked up with the most appropriate person or department, NHS staff ranked the layout of the building top (46%), followed by the high volume of public visits (37%) and the complexity of the task itself (35%). While the layout of the hospital is not something that can be changed overnight, improvements to signs and the information given to patients before they arrive can certainly help. The high volume of public visits and the complexity of the task of matching patients to the most appropriate resource can be better managed with patient flow management tools.
With the backdrop of competing priorities, administrative pressures and finite resources, it can be difficult to see how the patient experience can be a priority. Yet managing the flow of patients from one department or service is the one function that touches every single patient at every stage of their treatment.
Healthcare facilities are under enormous pressure to provide an improved quality of care to more and more patients, all the while coping with a limited set of resources. As the largest healthcare organisation in the world with an annual budget of over £100 billion, these challenges are amplified considerably at the NHS. The sheer scale and complexity of the NHS means that even the smallest of inefficiencies can be very costly indeed.
The “Queuing and Waiting in the NHS” report is the result of interviews with 100 senior IT decision makers and department heads within the NHS conducted by the independent market research agency Vanson Bourne between December 2012 and January 2013. If you would like to receive copy of the report, please register your interest here.
As Qmatic’s UK Managing Director, Steve Williams is responsible for developing clients in the retail, finance & public sectors. His knowledge in Customer Flow Management (CFM) positions him well to help retailers, retail banks and public sector sites manage the entire customer journey.
The views and opinions expressed in this article are those of the author(s) and do not necessarily reflect the official policy or position of The Information Daily, its parent company or any associated businesses.
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