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Step in Time

Central Coast Local Health District
Project Added:
30 November 2015
Last updated:
3 December 2015

Step in Time


This project made changes to its staffing and administrative processes, to deliver a more timely and efficient orthopaedic service to patients at Gosford and Wyong Hospitals.

View a poster from the Centre for Healthcare Redesign graduation, December 2015.

Step on time poster


To increase the flow of the patients through the orthopaedic clinic and decrease the waiting time for appointments and clinic review.


  • Delivers a more streamlined and efficient process that maximises available resources.
  • Reduces costs and inefficiencies in maintaining outdated processes.
  • Improves the patient experience and increases access to services.
  • Decreases the time required for patients to spend in outpatient clinics.

Project Status

Key dates

Project start:  25 February 2015


Implementation - the initiative is ready for implementation, is currently being implemented, piloted or tested.


An audit of records at the orthopaedic clinic at Wyong Hospital found that since 2013, 45.7% of clinics ran longer than the time allocated (four hours). At Gosford Hospital, clinics ran an average of 1-2 hours late but it was not uncommon for patients to wait 3-6 hours. This late finish had a significant impact on patient outcomes, staffing management and staff morale.

These results highlight many systemic issues facing outpatient clinics at Gosford and Wyong Hospitals. On 2 July 2014, one clinic was due to finish at 4.30pm but ran four hours late. This event became a catalyst for senior management at CCLHD to investigate the processes and systems that were in place.

Previous strategies implemented to improve the system included the creation of a central booking line, which aimed to streamline the appointment process by allocating new patients evenly between both sites and processing follow-up appointments after consultations.

These solutions were introduced in 2006 and since then, presentations to CCLHD orthopaedic clinic has increased by 144%. In February 2015, the nurse employed to manage this booking process received 833 messages that required return phone calls to patients. From the 833 messages, a sample of 520 messages were audited and it was found that 111 messages required multiple phone calls by the booking nurse back to the patients. This occurred when patients did not having voicemail on their phone, or the phone was engaged or not answered. 

It was clear that the current processes were not sustainable and the cause of both patient and staff dissatisfaction.

Graph showing patient satisfation pre-project results



  • Clinic clerical shift times were staggered to ensure that staff were available to make follow-up appointments.
  • The order the patients were seen at orthopaedic clinics was changed to prioritise kids, followed by new patients, follow-up patients and postoperative patients. This was to provide a more streamlined and efficient process, to stop the consultants taking patients out of order and get the most challenging patients seen by the visiting medical officer (VMO) while they are in the clinic.
  • The clinical process was changed so that patients could receive their x-ray prior to attending the clinic.
  • Ward clerks were instructed to make post-operative appointments at the time of discharge.
  • Additional solutions are still in the process of development, including the improvement of orthopaedic VMO clinic attendance times and pre-ordering of x-rays.

Implementation sites

  • Wyong Outpatient Clinic
  • Gosford Outpatient Clinic


The following data will be captured to measure the results of the project:

  • clinic finish times, staff overtime and time in lieu
  • number and type of return calls made by the central booking nurse
  • time log of orthopaedic VMO clinic attendance
  • patient and staff satisfaction surveys.


Since the project implementation, there has been an 18% increase in patients making new appointments within one day. 90% of patients now rate the service as good or excellent, compared to 71% pre-implementation. 

Lessons Learnt

  • Specialist medical involvement is paramount to achieving sustainable and accountable change, however it is sometimes difficult to engage with specialists.
  • It is important to be specific with requests to sponsors when help is needed and not assume they are aware of the problems.
  • It is a good idea to keep the scope small and achieve the outcomes required. 


Steven Nolan
Nursing Unit Manager
Ambulatory Care, Outpatients Clinics and Vascular Access
Wyong Hospital
Central Coast Local Health District
Phone: 0455 067 815

Lisa Absalom
Administrative Officer, Wyong Outpatients Clinic
Central Coast Local Health District
Phone: 02 4394 8150

Elizabeth Selby
Nursing Unit Manager, Gosford Hospital Outpatients Clinic
Central Coast Local Health District
Phone: 02 4320 3391 

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