MANAGING ELECTIVE CARE

– THE CHALLENGE HAS STEPPED UP A GEAR!

Pre-pandemic, Health providers across the UK were being severely challenged in meeting waiting time targets for both outpatient and admitted patient care. This was despite continued use of waiting list initiatives and external resources. Additional measures were being planned to return elective care waiting times to an acceptable level, for example, in Scotland a national programme of waiting time resource expansion is in play to enhance national elective capacity, but this is specifically aimed at dealing with future growth in demand and not aimed at supporting baseline challenges or accumulated backlog at a local level. This programme is to be delivered through the development of 5 regional centres, however, it will take some time for these to become fully operational.

“The pausing of elective care as a consequence of Covid-19 management creates some new and significant challenges in terms of current and future waiting list management.”  

On the demand side the dual impact of cancelling appointments and operations will result in an immediate increase in the numbers of patients waiting for treatment, however, this is exacerbated by the reduction in people attending for GP appointments.  When the pause button is lifted, this will create a double bulge in future demand to address the backlog and the inevitable rise in referrals as people normalise access to primary care services.  From a supply side perspective, the on-going management of Covid-19, to ensure that care is delivered safely for both patients and staff, will mean that outpatient and inpatient throughput are unlikely to be at levels seen pre-pandemic which will impact on productivity and treatment volumes.

“Outpatient and inpatient throughput are unlikely to be at levels seen pre-pandemic which will impact on productivity and treatment volumes.”

This means that existing waiting time targets and treatment guarantees will not be met for some time, a position which is not sustainable, either politically or in promoting the health and wellbeing of the population.  The need to plan for recovery is therefore paramount even if the trajectory back to normality is variable depending on clinical risk, geography or care setting.

All of the above will create significant short, medium and long term pressures on elective capacity, which cannot be effectively managed through returning to previous arrangements. A way needs to be found to shift the demand and supply curves so that balance can be achieved in the timeliest and most clinically effective manner. Whilst this will require the adoption of a range of new ways of working, the positive message is that many of these already exist but are not yet adopted in a consistent and scaled manner.

All of this creates the need for a structured response which reflects the complexity of the challenge, through a combination of strategic, analytical and operational thinking to support rectification planning nationally, regionally and locally.  

“There is a significant opportunity for redesign, including the accelerated roll-out of alternative delivery models”

It is highly unlikely that effective recovery planning is facilitated through simply enhancing existing arrangements and there is therefore a significant opportunity for redesign, including the accelerated roll out of alternative delivery models such as Active Clinical Referral Triage (ACRT), patient-initiated returns, alternative workforce solutions, delivering care in alternative settings and the wider use of digital technology.

Whilst this is a complex set of circumstances there are four key considerations in supporting organisations to successfully tackle their waiting time challenges:

1. assessing the scale of the challenge

The starting point is to assimilate and present data that sets out the ‘new’ baseline waiting time position and therefore the scale of backlog and on-going deficit in activity and capacity. This needs to be done by individual specialty and care-setting as the measures required to redress the position often require different solutions. 

2. scenario planning

Allowing organisations to translate demand into required capacity through the application of a set of planning and performance assumptions. This establishes the required capacity to address elective waiting time targets across a range of settings including outpatients, admitted patient care settings and theatres and to set this out as part of a phased plan.

3. delivery planning

Working with clinicians and other staff in translating the output of the scenario planning into a set of planning and resourcing measures to support the delivery of the required service enhancements. This underpins the elective care recovery plan and allows organisations to quantify the resource and financial impact of delivering the required enhancements.

4. Implementation and Change management

Often overlooked, this vital step supports frontline staff on the ground in piloting, observing, measuring and refining new ways of working to ensure new approaches are well understood, fully documented, standardised and communicated to relevant staff. This also encompasses staff-training on new process adoption, support through change-management implementation and enabling teams to sustain change through the use of appropriate systems and structures, supported by key leadership behaviours.

Of course, this is not a static set of circumstances and organisations will need to adapt their approach to changing circumstances depending on the progress in the initial pandemic recovery phase.  Recovery planning will require regular review and adaptation of measures for some time to come as we adapt to the ‘new normal’.

Please contact the team for more information.