NHS Highland roll out Waiting List Validation across all Outpatient specialties to validate patients leading to shorter waiting time for those who need clinical appointments
The challenge
NHS Highland is one of the largest and most sparsely populated Health Boards in the UK, and they are committed to putting quality first, to deliver better health, better care and better value.
In 2021, with waiting lists having increased exponentially during COVID and a higher conversion rate of routine to urgent appointments (due to the routine pathway disruption during the pandemic), NHS Highland were keen to implement a way to validate patients on their waiting lists and prioritise patients in order of urgency.
They wanted to supplement ‘patient focused booking’, where patients were sent letters asking them to contact the Board to make an appointment, followed by a reminder letter – a laborious and often slow approach. This was helping to reduce DNAs, but NHS Highland knew there was room for improvement in administration, DNA reduction and patient experience.
They also knew that validating patients would create more accurate – and shorter – waiting lists, at a time when the urgency to reduce waiting lists has never been greater. This would also reduce incoming calls as patients had previously called in to say they no longer needed their appointment, adding to the administrative burden on the Board.
A waiting list validation solution
As Netcall customers for more than 20 years, NHS Highland approached us to help them with this challenge. They selected Waiting List Validation, a module of Patient Hub, our patient engagement portal, because it delivers high response rates, typically leading to significant numbers of patients opting to be discharged from waiting lists.
“We now have an average discharge rate of 9%, in some areas up to 15%. Crucially, by keeping our waiting list tidy and validated, patients are seen in priority order where applicable. It helps reduce DNAs and short notice cancellations, allowing us to utilise clinical and administrative time better. Each of these metrics have a knock-on effect on the quality of care for patients across the whole system.”
Jamie Forrester
Head of Health Records, NHS Highland
The solution
Once built in 2021, the Waiting List Validation application was trialled with the Dermatology department. After a very successful pilot, the NHS Highland team began to roll out to other departments, which meant that they were able to get ahead of the curve as waiting lists grew around the country.
The application engages with patients by assessing their wait time and enquiring about their treatment preferences, providing specialty-based, customisable responses. NHS Highland has seen high responses rates, which have led to significant numbers of patients opting to be discharged from waiting lists.
Utilising the Waiting List Validation module, NHS Highland has achieved an 81% response rate as an average across all Outpatient departments. Of these, an average of 9% of patients opted to discharge, or remove themselves, from the list. Some, such as Ophthalmology, are achieving 15%.
As a patient-friendly, web-based portal that fully automates the patient contact workflow, our Waiting List Validation module enables reviews and actions. NHS Highland found they didn’t need so many staff to administer the processes, meaning they could focus on other tasks. Also, their clinical teams were empowered in being able to manage the responses much more efficiently.
When a patient responds to discharge themselves, the administration to remove that patient from the list is minimal, taking staff very little time to process.
As the data is fed to the system in near to real-time information streams are optimised for efficient administrative processing of patient responses. This reduced administrative burden frees capacity in the NHS Highland booking team, enabling them to work on other tasks.
The Waiting List Validation application gives NHS Highland the ability to control the precise cohorts of patients they include within each Waiting List Validation communication. This means that they can exclude patients with urgent suspected conditions, such as cancer.
As Patient Hub’s Waiting List Validation uses a real-time feed of data, it’s very accurate as well as scalable. NHS Highland can ensure they don’t contact patients who have already been treated at one of the Board’s hospitals, already discharged themselves from the list, or already recently been contacted.
By engaging with their departments to identify the types of exceptions that should be made for their specialty, the specific questions to ask patients, using Plain English and training the clinical teams to deal with the responses, they have developed an accurate, streamlined, straightforward operation.
“It works well. Once the data feeds are going in, the administration and support is minimal and the reporting functionality enables us to measure the impact. Each incremental improvement makes a big difference to reducing our waiting lists, making savings, streamlining our processes and ultimately improves our service to patients.“
Jamie Forrester
Head of Health Records, NHS Highland
The result
An average discharge rate across all specialities of 9.2%, with some areas, like Ophthalmology achieving 15% and Dermatology averaging 11%
Flexibility and control – enabling language and options to be fully adaptable to allow patients to reply with a ‘delay response’ – providing details on when they could/couldn’t remain on the list, which crucially enables prioritisation of patients in order of urgency and prevents patients going back through the system on appointments that were not suitable
Tailoring, reconfiguring the language of communications, taking on patient feedback and extending the notification thresholds to five days has enabled NHS Highland to drive continually improving responses
Management intelligence and reporting on improvements – NHS Highland have seen the advantages of tailoring the communication to learn why a patient wants to be discharged, which enables them to make future adjustments to have even better impacts in the future
Reduced administration, taking much less time for staff which enables them to work on other tasks
All acute specialties, where clinically appropriate, are now using the Waiting List Validation module
Clinical time related to validation is optimised
Access for all – patients have full ability to receive communication by SMS or email (patient preference may be influenced by phone/internet signal in remote locations in the Highlands) and to alter the display with pinch to zoom, colour changes etc to improve visibility, particularly useful for Ophthalmology patients
Up to £1 million of appointment costs avoided by discharging people from the list that no longer need clinical time.
What’s next for the Waiting List Validation application?
Generating GP discharge letters, HAB homecare support and patient contact letters through the Waiting List Validation application. NHS Highland is also keen to introduce chatbots to cut down on calls into the contact centre.
Impact
15% Discharge Rate
in key specialities
81% Response Rate
from patients
c. £1m
costs avoided
Instantly reduce waiting list size
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