Sally Child is the project Manager of Leeds Hospitals Trust wide Appointment Reminder implementation. Sally recently presented at our Out patients event inspiring the audience with her experience of leading change from objectives to results.
1. Before the Appointment Manager pilot, how did Leeds Teaching Hospitals remind patients of their appointments and what were Did Not Attends (DNA’s) sitting at?
We didn’t have a formal process to remind patients of their forthcoming appointments. The DNA rate was on average 12%, 4% above peer average. It was clear we needed to trial appointment reminder technology to measure impact on attendance and DNA rates.
We worked with Healthcare Communications to introduce SMS reminders and Interactive Voice Messaging (IVM) across 19 Clinical Service Units. We also gave patients the opportunity to respond with REBOOK or CANCEL rather than one way messaging, where patients need to phone the hospital to reschedule.
2. What impact did these channels have on DNA and attendance rates with the CSU’s involved in the pilot?
In the pilot areas it reduced DNAs to around 10%, increasing attendance rates to around 88%! This confirmed proof of concept and supported Trust wide roll out.
3. What challenges did you face with a project of this size?
Firstly, adhering to strict Information Governance regulations and increasing the number of patient phone numbers was integral to project success.
We were also dealing with multiple specialist services where patients are managed differently. So the sensitivity of the clinic and what the message should contain was complex.
Roll out of partial centralised booking processes needed to be managed differently and we had to consider the integration with multiple operational and clinical systems including PAS, Radiology and Symphony.
We were also working to extremely tight delivery deadlines, so we needed to work collaboratively with all CSU management teams and Healthcare Communications to achieve the best outcomes for the service.
4. How did you overcome these challenges?
Due to the complexity of the organisation and the timescales, it was clear that we needed dedicated resource to deliver the full service. A Project Manager was employed to focus solely on implementation and work with the Healthcare Communications team.
It was important to communicate the financial benefit of introducing the service against attendances so all stakeholders understood the project purpose. We maintained regular communication with all parties and continually worked with CSU’s to improve their DNA rate.
Healthcare Communications software, Envoy Messenger integrated smoothly with our existing systems so information sharing was secure and automatic.
5. What strategies did you use to encourage staff and patient buy in?
This was led by the Trust Board and formed a large part of the Cost Improvement Programme to deliver Trust savings. We also communicated to staff how this will improve clinic productivity and the real time outcomes will enhance patient care.
Patients were notified and given the option to opt out of the service at any time and we encouraged feedback of concerns or suggestions.
6. Your DNA rates reached 7.5% – lower than the national average! What about savings efficiencies?
We reached 7.5% one week and we’re averaging 8% which is our peer average. We estimate that over the next 12 months, Envoy Messenger Appointment Manager will generate income for the Trust of approximately £1 million!
We have also conducted some internal analysis, which has shown that of the patients that receive a reminder the Trust average DNA rate is approximately 6.5%. This highlights that there are further efficiency savings to be made over the course of the next few months. Our aim is to optimise the system even further and to highlight the benefits to patients in order for us to achieve this target.
7. What are the projected benefits for 2015/2016 and what are your future roll out plans for introducing Reminders elsewhere in the Trust?
We’ll continue to adapt the reminder service to suit the needs of every individual specialty and make sure we reach 7.5% across all specialties not just as a Trust total.
8. What other areas do you envisage Envoy Messenger will be able to support you in delivering further income gains?
We’ve already implemented another pilot with Healthcare Communications for inpatients within 4 specialties. If this proves to be a success we will continue with this roll out to all suitable inpatient services. This will again provide greater Trust efficiencies, as well as providing great access for patients.
As we continue to improve the services where the reminder service appears to be less effective, we are undertaking focused pieces of work in conjunction with Healthcare Communications. As an example, what we’re looking at for fracture clinics is to send a message when the appointment is booked. This will make sure the patient informed and reassured that their referral reached us.
In addition, we would like to use this service to validate follow up patients and may introduce this with clinical systems not purely on our main administration system. For example, cardiology tests, A&E clinic attendances and Radiology x-ray.
There’s the opportunity to expand on offering appointments and then asking the patient to ring to agree on the slot time.
The next big development we would like to explore is the possibility of a secure mobile phone app that would enable us to collect home test results. I.e. Blood pressures, heart monitor downloads and place the information into our electronic patient medical record.
As well as using the secure internet portal functionality to deliver electronic letters to aid faster patient communication with regard to their patient appointments.