New ‘choice booking’ process on track to help transform outpatient administration
A new approach to booking outpatient appointments has seen hospital-initiated cancellations fall by over 11 percentage points, patient-initiated cancellations drop almost four percentage points and the proportion of patients who do not attend their appointment also fall by over four percentage points.The ‘choice booking’ approach, which has so far been piloted for over 2,000 ‘follow-up’ appointments since January in clinics across five services (colorectal, gastroenterology, gynaecology, rheumatology and vascular surgery), is one of the key workstreams in our outpatient improvement programme.
It involves offering patients a choice of dates and times, only six to eight weeks in advance of their appointment. Giving patients a choice of slots, relatively close to their appointment time, means they are less likely to have clashes or forget to attend. And for clinical teams, it means that holidays and other scheduling factors are considered before appointments are offered.
With two thirds of appointment bookings currently cancelled or not attended, the new approach has huge potential to improve patient and staff experience while also reducing wasted resource and costs.
The pilot has been designed carefully to make sure we communicate with patients in the way that suits them best, and that no one gets lost in the system. Our patient service centre oversees the whole process, first sending text messages to patients to check they still need their appointment and, if they do, following up with (up to three) phone calls to ask them to choose their preferred date. Patients who do not respond to the text message or phone call are sent a hard copy letter asking them to call to choose an appointment.
Clinical records and referral requests for patients who say they don’t need an appointment – or are not sure if they need one – are reviewed by senior clinicians to make sure it is safe for them to be discharged. If it is not considered safe, they will be followed up directly. A similar approach is taken for patients who do not respond to any of the communications, with further attempts to make contact. Call times have also been scheduled for when patients are most likely to be available to answer, generally in the early evening.
Work is already underway to introduce a digital ‘self-serve’ option – instead of the telephone call – for patients to book a suitable appointment time themselves. The digital platform will also be able to be used by patients who want to rearrange or cancel their appointment. Some of the savings in admin time that this releases will be reinvested to provide support to patients who aren’t easily able to use digital platforms or who have additional needs. There is also a wide range of patient and staff feedback and wider learning from the pilot that we are analysing to improve the choice booking process further.
Outpatient care is the most widely used service we offer, with over 800,000 appointments taking place each year. The improvement programme is focused on redesigning our models of care as well as the booking and wider administrative processes. We are looking at how best to extend and widen out the choice booking approach, including to first appointments.
Other work currently underway as part of the programme includes simplifying and standardising appointment and outcome letters, aligning new signage with information in appointment letters, giving patients, especially those with long term conditions, more control over when they have follow-up appointments, and creating more ‘diagnostics first’ care pathways.
If you are waiting for an outpatient follow-up appointment, you will be told if you are part of this new pilot. To stay up to date with the programme, sign up to our monthly e-newsletter.
