Robert Burns former Director of Planning and Information at Great Ormond Street Hospital (GOSH) tells us what the hospital did to improve waiting times, which was one of the key issues raised at the Foundation Trust’s membership consultation in March 2015.
What are some of the issues with waiting times at the hospital?
Waiting can mean a couple of things: waiting when your appointment is scheduled at a particular time, but also waiting a long time to have an operation (what we think of in the NHS as a ‘waiting list’). Although we have areas that do have some longer waiting times for operations or outpatient appointments, generally the waiting times are quite short. We would always seek to treat people with clinical urgency first and in the time that’s needed for their condition.
However, there are areas where waiting times are longer than we’d ideally like. We’re trying to tackle this by adding more capacity, for example more theatre lists.
I’ve spoken to the Foundation Trust membership, and the Young People’s Forum in particular is very strong in their message that waiting at outpatient appointments is the biggest area of concern. As one of the patients said: “There’s real time, and there’s GOSH time.”
How do you approach trying to change the current situation?
Patients often need to have a number of tests before their appointment in order for that information to be ready for the doctor. Trying to organise that when information is coming from lots of different clinics simultaneously is a challenge! Also, our doctors have many responsibilities, such as ward rounds and responding to queries from families and other hospitals, so we have to try and balance that across their outpatient sessions.
In terms of prioritisation, we look at areas with the biggest problems and where patients and doctors have raised questions, so we would seek to tackle pinch points in the process. For example, where lots of our patients were waiting for blood tests, we introduced more staff members trained to carry out those tests and adapted rooms so that there are more areas available to perform them.
How will technology help improve waiting times?
To have an electronic system that measures the different stages in the patient’s journey at the hospital will help hugely, which is something we’re looking to develop. It will be introduced in a staged way, because at the same time we’re trying to convert the traditional written patient notes into electronic versions, which will mean they won’t get lost and they can be accessed by several people at the same time.
The first step is to get an electronic data management system where all the patients’ data is held in one place. We can then look to move on to an electronic patient record that assists with many aspects of a patient’s care pathway, for example scheduling tests and monitoring the effectiveness of the treatments we provide.
We’re also looking to bring in digital check-in areas, which immediately tell us when a patient has arrived. These will additionally allow patients to confirm that we have their correct details, which is helpful for our communications with them.
What does GOSH plan to do to assist patients and families with learning disabilities?
The hospital has a dedicated Consultant Nurse for Intellectual (Learning) Disabilities, Jim Blair, who supports children and adults with learning disabilities. In this role, Jim enhances the service we provide by offering specialist advice, linking staff within clinical areas and assessing capacity. He has also introduced an alert system to inform staff of a person with a learning disability, which has helped us to ensure reasonable care adjustments are made.
In addition, GOSH has rolled out a hospital passport, a document that shares information about the patient and their health, and we have launched a learning disability page on our website (www.gosh.nhs.uk/intellectual-learning-disability) to inform those with learning disabilities about what we provide.
Does the hospital plan to do more to care for patients’ siblings who are waiting with them?
We’ve been working with Great Ormond Street Hospital Children’s Charity, who have supported us with the development of more play facilities for siblings as well as patients. Of course, all the toys in our outpatient departments are available to both patients and siblings. We also need to ensure that there are locations for families to get food. I went down to The Lagoon restaurant recently and it was absolutely packed with families, which is great!
What improvements have there been over the past year?
We ran an improvement project in our outpatient clinics where we reviewed every specialty to see how we can improve the timeliness of our service and use our resources better so we can see more patients. This has been extremely effective – we’ve seen thousands more patients than we did a few months ago and with less resources.
We also did an audit of the time that people waited. We compared a couple of days before and after the launch of the project to see how long patients waited, and it showed much improvement.
What are the next steps?
We have a new outpatient facility opening later this year, and we’re trying to provide better waiting areas with a smoother flow of patients. We’ll also be introducing preoperative assessment for all patients prior to surgery. This will ensure that they’re fit for surgery and we’ve got all the information we need, so that things run more efficiently on the day of operation.
We don’t always get things right, and we know that the timeliness of our services can be better, but patients and their families should be assured that we are continuously trying to improve.