Jonas Knudsen
Research Director, Health Insights
Capacity planning while making sure the patient attend the scheduled appointment could be the low hanging fruit to improve efficiency, increase productivity and patient satisfaction.
The healthcare system in most countries is under tremendous stress. Quality of the care delivered by hospitals has improved, life expectancy has been extended and patients are more knowledgeable about their conditions; they are eager to participate in managing their health to live longer and healthier lives. But longer life expectancy and the increasing prevalence of chronic conditions, are driving an increase in the cost of pharmaceuticals, testing and disease- and care management; that is particularly true for certain patient groups like the elderly and frail. The increase in cost is threatening the financial sustainability of the traditional healthcare delivery model in many countries. New models of care and new imbursement models emerge as a solution to the burning platform of increased cost.
However, what if alternative solutions are just in front of you? How about truly educating the patient into taking a more active role in the treatment. What if they actually just showed up on the day and time of their schedule and what if the hospital didn’t have to cancel procedures due to the lack of medical supplies, staff, assets or even beds?
First, let’s have a closer look at the case where patients do not show up. The 2nd of September a Danish patient shared a picture (has been reposted almost 6000 times) on Facebook from the allergy center at Odense University Hospital. It shows two tubes, one for each month of August and September. The staff uses red balls in each tube to mark every time a patient does not show up to a scheduled appointment. In August that number was 105! Now, the allergy center is small compared to other departments in the hospital, and one could argue that the amount of no shows in departments with more severe illnesses probably is smaller. The allergy center has around 30 patients visiting each day, so it is roughly 10 pct. A quick phone call to another department in the hospital: Department L: Urinary Tract Surgery clarifies that they have 10 patients in average missing their scheduled appointment each day, which is also about 10 pct. Feel free to calculate the operational and financial impact on an entire hospital of your choosing.
The trend is not isolated to Denmark. BBC in the UK refers to several statistics regarding cancellation of procedures. One of the main findings is that the amount of cancellations due to patients not showing up, is increasing. In fact, the proportion of planned operations cancelled for non-medical reasons such as patients cancelling or not turning up to their appointment has risen to 41,031 (48.6%) (Welsh Government, September 2016).
Another huge cause of cancellations is the lack of proper capacity management within the hospital. BBC refers to a case study from Aneurin Bevan Health Board which includes the Royal Gwent Hospital in Newport and the Nevill Hall Hospital in Abergavenny. The case shows that more than 3,500 operations were cancelled by the hospitals within three days of the appointment in 2015/16, including more than 2,000 on the day of the procedure itself. 30 pct. were cancelled because ward beds or intensive care beds were unavailable, 18% were cancelled because staff were not available and just under 12 pct. because the equipment was unavailable. When looking at operations cancelled because of the patients, 28 pct. were due to the patient not showing up.
So, to say it quite bluntly, there is a huge potential in actually performing the procedures that have been scheduled and not canceling them. So how does IT fit into this? One efficient initiative taken by several Danish hospitals is to kindly remind the patient of their appointment by text messaging. The region of Central Denmark did a pilot in 2012 and it resulted in 34 pct. fewer cancellations due to patients not showing. To handle that efficiently, the hospital must implement a scheduling/booking system and have access to updated patient information, e.g. mobile number. The hospital must also be aware of not sending any patient classified information in an unsecured way, it could be the department or type of procedure, due to legislation around patient privacy.
To improve capacity management, digital initiatives can be implemented to prevent cancellation. There are great synergies in thinking Hospital Operation Management in a more integrated context, where both planning/scheduling, service logistics (bed management, cleaning, transportation etc.) and clinical logistics (patient flow management) are seen as interconnected. Only when the hospital knows what to do, when to do it, who’s going to do it and with what, the cancellations due to lack of beds, assets and staff can be prevented. Processes before, during and after the patient visit must be aligned and coordinated in order to deliver the right amount of service, at the right time, and in the right place. To be able to do that, digital systems must be integrated and data must be shared, in order to pass information between the process and organizational units involved in and around the patient flow. To handle service logistics disconnected from the clinical logistics process doesn’t make sense in an optimized and quality driven hospital.