Service re-designs: Waiting Room
A General Hospital radiology department provides x-rays and procedures to diagnose and treat variety of patients. The daily schedule of the X-ray department is 7 days a week and with on-call radiographer. Furthermore, the department provides services to: inpatient, outpatient, clinics, accident and emergency daily, however, services are provided for theatre and General Practitioner (GP) patients who need no appointment only between 9am-7pm on weekdays. Also being a busy hospital, the number of patients attending the department varies. Patients are dissatisfaction with healthcare services provided by the department especially those (elderly in pain) whose medical condition cannot permit them to stand for a longer period of time (See appendix…) because the current X-ray waiting room is too small and have the capacity to accommodate eighteen patients and all the seats are occupied during peak hours especially during the week. Therefore, to have a seat, patients may have to wait for 15 minutes or more (see appendix…). Furthermore, radiology staff has attested to the challenges they have to face to manage the flow of traffic in the department as a result of the small waiting room (see appendix…).
The Department of Health (DoH, 2010) states that clinical governance is a quality assurance process to ensure that standard of care is improved and NHS is accountable to the public. The According to Hawkers (2011), NHS is responsible to delivering of a clean, harmless to patients and also continuous evaluation its services and implement change.
The only way to achieve this is service redesign. Hayman, Cioffi & Wilkes (2006) argued that service redesign is an efficient tool to improve patients’ standard of care, provide opportunity to staff, optimise productivity and support development into new clinical areas. Saxon et al (2013) emphasis that waiting time is a major concern in most NHS hospitals, but if the waiting is improved, it will generate patient satisfaction as treatment will not be postponed. Marcinowicz, Chlabicz & Grebowski, (2009); Sherwin, et al, (2013) argued that waiting room has virtually been neglected, however, a well structure layout and the design of the waiting room including seating, lighting and sound is an important driver of patient satisfaction. This is supported by Elfenbein (2011) defines waiting room as learning place and transitional area which plays a valuable role in educating and monitoring of patient satisfaction. Oermann (2003) reported a primary care survey which shows that patients' perception about the healthcare system is determined by the time spent in the waiting room before be examined.
Biddis et al (2013) describes service redesign as evaluation tool that is used to improve support expansion and enhance the efficiency of service and patient care. This is supported by Greaves, et al (2013) who ascertain that service redesign can improve waiting times and reduce patients’ traffic with a very low financial cost.
This report will evaluates the current waiting room of an X-ray department in a District Hospital, and identifies the most achievable redesign option which will deliver efficient care to patient (NHS institute for innovation and improvement, 2010; NICE, 2014).
Evaluation.
The evaluation of previous service is important in order to identify the current problems. To achieve this a demand and capacity tool will be use to illustrate the discrepancy between service and capacity in order to identify the problem facing this service (see Appendix….).
Furthermore, SWOT is a framework which is used to carry out a comprehensive analysis which could impact on planning and management decisions as well as future finance. According to Morrison (2011) SWOT tool is used in service redesign to prompts managers, clinical leads, or staff involved in planning and analysis as to what is effective or ineffective in the department. The opportunity to extend the waiting area is demonstrated in (Appendix…). For a successful service redesign, stakeholders’ interest must be addressed. Low power stakeholders such as staff and patients push for change, however, the major obstacle in this service redesign is being able to persuasive high power stakeholders such NHS Executive, building managers who oppose construction project due to cost can impede implementation (Olander & Landin, 2005). This resulted in carrying out stakeholder analysis (Appendix…) in order to evaluate the project situation and identify every individual interest in the project (NHS Institute for innovation and improvement, 2010).
A four weeks qualitative survey of patient satisfaction about the x- ray department was carried out and patients were asked about the feelings of the waiting area (see appendix…). The result shows that patients were dissatisfied with current service and wanted the waiting area to be changed (see appendix…). Similarly, a survey of effectiveness was carried out on staff, if reported that they were also dissatisfied and majority of them called for improvement of the waiting area (Garret, 1999) (see appendix…).
CRITERIA OPTION 1
OPTION 2
OPTION 3
Description of Option
Do nothing Extension of the waiting room to the adjacent changing room B (Appendix…) Join the waiting room and reception together to form a bigger waiting room. (Appendix…).
Reception is transform into digital room
In the waiting area, patient can self-log into system and a number given.
When patient’s number is displayed he goes to the X-ray room
ADVANTAGES (data to support option and ‘best practice’ evidence if applicable).
Do nothing Patient is empowered to initiate changes.
Reduction in the number of complaints
Staff morale is increased (Rashid, 2009)
Seat capacity increases from 18 – 35 after the extension of the waiting area. (Appendix…)
Leaving without be x-rayed is reduced.
Patient care is improved (NICE, 2013).
Patient satisfaction is increased.
Overcrowding is reduced
Patient knows how long they wait and can plan other activities around it.
Patients, carers, and families could have more available seats (See Appendix…).
Effect of redesign on patient experience
Service remain the same Reduced patient’s stressed
Complaints are few
Patient satisfaction is increased
Patient’s care is improved
Improved hospital reputation.
Patients can be accompanying by loved ones.
Less patients leave too early Patient unhappiness due receptionist being replaced by machine and leading to limitation of information.
Increase in delays and waiting time due to the difficulty to use the self-log-in system especially by elderly and non-English speaking patients.
Cost of service re-design
Impact of costs on staffing, furniture and buildings etc. Are one off cost? Do nothing Only one payment for pulling down walls and procurement of furniture. Additional cost for staff member to assist patients.
Only one off payment for pulling down walls, procurement of furniture, computerised login system and screen display
Delivery and sustainability of service re-design change
Do nothing Pre-audit survey to be conducted to analyse what impact the change will have on service users.
Redesign cost to be analysed to check for feasibility.
Stakeholders are involved in change.
Cost to be analysis will be for feasibility purposes.
Stakeholders are involved in change
Pre-audit survey to be carried out to analyse what impact of change on patients and service
Difficulties of acquiring information as there is no receptionist.
Unsustainable as some patients especially the elderly who are unfamiliar with computer system.
Using the digital log-in and booking system might result in long queues and delays
Identification of potential risks of the options
How can the risk be minimised
Remain the same Potential risks:
Impact on service as re-design requires longer time to be executed
Resources are available to execute redesign
Minimising risk:
Redesign affordable
Meantime patients can use Mammography waiting area while working on redesign
Potential risks:
Redesign requires longer time to be executed and this may impact on services.
Resources are available to execute redesign.
Elderly patients and those seriously ill who might not be able to use the digital log-in system.
Reception or log-in service unavailable, as redesign is under progress
Minimising risk:
Redesign affordable assessment is conducted
Patients can in the meantime use Mammography waiting area while working on redesign
Outcome measures / Evaluation:
How will you evaluate the changes you make?
No changes made. Carry out audits
Use of suggestion box
Form focus group forum.
Conduct post redesign survey to measure patient’s satisfaction.
Handout feedback forms
Carry out audits
Conduct post redesign survey to measure patient’s satisfaction
Form focus group forum.
Use of suggestion box.
Handout feedback forms
Justification and Action plan
The important of improving of standard of care delivered to patients in the healthcare environment and this will be done by evaluating practice in order to ensure that high quality care is delivered to service users (NICE guidelines on quality standards, 2013)
Therefore, the importance of the redesign is to improving the structure or environment in which healthcare is delivered, by engaging in innovative planning and design (Berwick, 2013). The outcome service improvement in an establishment is that patient experience is enhanced and staffs are motivated to deliver quality service (Meena, 2012). According to Francis report (2013) if guidelines and recommendations are not adhered to, they may lead in inefficient organisation, poor reputation, low standard of care, and law suits as a neglected of health and safety policies. From the above optional appraised, option 1 involves no cost and is the most cost-effective, but it offers no improvements to the current issue of the waiting room (Berwick, 2013). In option 3, is not a favourable option to patients because it involves the costs of pull down the walls, procuring the new furniture, digital display screen and computerised logging machine as well as employing a receptionist to assist patients who need help (Rashid, 2011). Furthermore, option 3 will increases delays and queues and also more patients such as the elderly and non-English speaking patients might decide to leave without being x-rayed. In addition, these patients might lose self-confident in the organisation if there is no receptionist to assist them (Morrow, McElroy, Scheibe, 2012). In the current NHS financial state, option 2 is the most feasible option. Even though, there are some costs of demolition is involved, but it is just a one-off costs. Therefore, with option 2 patient complaints will reduce, quality of care improved and staff morale enhanced (NICE, 2014)