USING YOUR WAITLIST TO MEASURE DEMAND FOR YOUR SERVICE? THINK AGAIN: REMOVE IT!
How long have you been waiting to hear those words? Most outpatient physiotherapists in publicly funded healthcare have been waiting a long time. Let me tell you our story…
Here’s what you need to know about being Timely
Eastern Health is a regional health authority in Newfoundland and Labrador. We have eight ambulatory sites with 20 physiotherapists that deliver adult musculoskeletal services.
Our biggest problem, the energy sucker, was the waitlist for routine clients. The bulk of our work in this service – people with urgent problems – getan appointment within two weeks. It is the people who have problems we classify as “routine” that often waited eight months to a year. Additionally, the number of people waiting was large; often in the hundreds.
Common challenges associated with not using timeliness
At one of our smallest sites, the staff saw an opportunity to improve efficiency and their own satisfaction with their work.
A new process would help with:
- Maximizing our resources in these budget-restrained times;
- Improve staff morale: they just couldn’t get out in front of this issueand morale was low;
- Improve efficiency: we spent significant time “managing” this waitlist by calling patients, leaving messages, sending letters, scheduling and rescheduling. All of this wasn’t addressing the problem – notto mention staff frustration with clients not showing up for appointments.
There was nothing left to do but to imagine a future without this problem, and bring that reality to life.
Lead by senior frontline physiotherapists and assistants who knew this work the best, a suggestion. Create a system that allowed people to come to us when they were ready.
Let them choose the time, date, or even if they wanted to come at all.
No more calling people with appointments that they may or may not show up for.
It sounded impossible, but it wasn’t.
We removed the waitlist by sending all those referrals back to the client (not the referral source – the client) with a letter of instruction; when you are ready to come to physiotherapy, call us the week before at a dedicated time to get an appointment.
We put in a phone line for this purpose to make sure this was the only “work” happening on that line. If you’re familiar with Lean, we used the concept of “client pull”, or the client triggering or pulling the service to them at a time that works for them.
Here’s why using timeliness is important
What happened was pretty amazing and challenged all the assumptions we had about those routine people sitting on the waitlist: only 40% of the people out there with referrals returned.
Most people were able to get an appointment with one or two calls to the appointment line, and the wait time (defined as the time you first tried to contact us to when we saw you) was less than15 days.
I know what you’re thinking – what about all those people that did not come back? What about them? Well, we were worried about those people as well, so we called them all.
- We found 52% of that sample did not want to come to physiotherapy and had no intention of making an appointment,even though their primary provider had sent a referral.
- We found that 11% had tried to make an appointment and couldn’t get through, and 10% were confused by the process.
Our big worries were reduced: were the majority of people trying to call for appointments and couldn’t get through? No.
Were people confused by this process? No.
Could the people who wanted our service get to us? Yes.
Significantly, our time “managing waitlists” went from four hours a week to one hour, which allowedfor more service recipient time.
The number of “no shows” for first assessment was reduced from 15% to 3%, which made it easier for the service to meet performance targets.
Everyone that was scheduled for an appointment actually showed up.
A time sensitive service
Our lessons were powerful – half of those people on the old waitlist did not want to come to physiotherapy.
Using the waitlist as a measure of demand was artificial and inaccurate; most who called for an appointment did it within six weeks of getting a referral from their primary care provider. If a person didn’t return by then, the likelihood of ever reaching out for physiotherapy was miniscule.
We know physiotherapy is a time sensitive service; intervention close to the time of injury increases the likelihood of higher value outcomes. What we may not have appreciated is the interpretation of timeliness from a client’s perspective – people want this service when their problem is urgent to them, and the service needs to be available to fit their life to make it possible.
When we have a system that allows access at a time that is right for a person, we become a more valued part of managing a client’s health.
What you can do right now to incorporate timeliness in your practice
Our story continues – we’ve removed waitlists in four other sites since this pilot, and the data is holding true to the trend we first saw. Better access and higher efficiency in the service.
We have more work to do, and more lessons to learn. We look forward to sharing that story with you as we go along, but, what can you do right now?
Two significant things:
- Understand what a true client orientation, or client pull, would look like for you. Anything that makes your service more accessible to the client at a time that works for them will move you in the direction of client orientation.
It can be hard for people to give up their bias towards a service that is set-up around the clinician, but the results are worth it for everyone.
- Understand your waste. Specifically, how much time to you spend per week managing your waitlist? What is the rate of no-shows? This lost time can be converted back into service recipient time when you change your access process, and you have a baseline to measure against.
I presented a full webinar on this topic for the Canadian College of Health Leaders in January 2016. If you’d like a copy of that, please contact the College at firstname.lastname@example.org
Thanks for reading this blog. I’m happy to discuss further or hear your feedback…we are always looking to improve. Please comment below and I’ll be happy to respond to you.
Cathy Hoyles BScPT, MHM, CHE
Regional Professional Practice Consultant, Physiotherapy
Newfoundland and Labrador