Broken Hill Health Service (BHHS) hosts an outpatient service which houses a variety of programs and services across multiple areas including medical, mental health and allied health; allied health is made up of dietetics, speech pathology, physiotherapy and occupational therapy. Although the model uses a main reception hub for patients to arrive and check-in, there is no central intake process.
The allied health referral management process at BHHS’ outpatient department has many flaws. Consumers often experience long times with no form of intervention or contact, with processes differing depending on the discipline. Clinicians spend valuable patient time processing referrals and making their own client appointments. There are no governance structures to guide caseload and monitor waitlists, and the service does not collect consumer feedback to help shape services. The referral management process varies greatly between each department. This occurs because of siloed department methods, a lack of specific guidelines or key performance indicators around outpatient clinic bookings, high staff turnover leading to processes being lost or re-invented without consultation, and processes driven by individual clinician or department preferences.
Improving efficiency and governance
A review of the service found a low level of governance, no KPIs and no documented processes that staff could rely on to help them perform within the full scope of their role. Allied health departments reported feeling disconnected from other departments, and patient waitlists for each domain were medium to high, with wait-times often exceeding patient expectations. This project looks to deliver a patient-centered Allied Health Referral Management System (AHRMS) for the four disciplines that make up the BHHS which is both efficient and sustainable and has appropriate governance. These improvements will lead to better access and improved health outcomes for patients. The benefits of the project include:
- improved consumer satisfaction with consumer knowledge of the AHRMS process
- increased clinician time for direct patient care
- one standardised guideline for the referral management process across all allied health disciplines
- improved governance of allied health referral management process by having KPIs related to this process
- improved efficiency of the referral management process
- establishment of real-time feedback from consumers for ongoing quality improvement.
Standardising referral management processes
Each discipline was transitioned over to an administration centralised booking system, in a stepped approach from November 2023 to February 2024. The working party devised Allied Health Outpatient Guidelines based on the NSW Health Management of Outpatient (Non-Admitted) Service Guideline. These guidelines have standardised referral management processes across all four disciplines, particularly about policy around fail to attend (FTA) management and KPIs on processing times.
A clinical support officer (CSO) was recruited to complete bookings for clinicians, ands client reminders about appointments were changed to be delivered by mobile text messages, to improve efficiency and help with the FTA rate. The project team created an automatic database to calculate wait times based on the prioritisation categories so clinicians could manage patients, so they did not exceed prescribed wait times. Further digital solutions to be implemented are modifications to the external website to reflect information about referral management, contact details and further information about the services, so the consumer can be appropriately informed. The project team will collect patient feedback via an online survey daily, so services can respond to consumer needs.
Preliminary Allied Health staff survey data shows 100% of respondents (n=13) have appointments booked by one person compared to 80% of respondents in the pre-implementation survey who self-managed bookings (n=15). The pre-implementation survey asked staff if they would be satisfied with the referral management process if they were a patient or carer of a patient. Pre-implementation data showed 15 respondents would be somewhat satisfied (n=9) to satisfied (n=6). In post-implementation data, staff report high satisfaction (n=2), satisfied (n=9) and somewhat satisfied (n=3).Post-implementation of the CSO position being employed, there were increases in the number of appointments seen by all departments. The project team will collect further evaluation data as they implement each solution and collate all data at the end of June 2024. There is a planned post-implementation consumer and clinician survey.
View this project's poster from the Centre for Healthcare Redesign graduation May 2024.
