The Royal North Shore Hospital (RNSH) Ambulatory Care Centre experiences challenges due to complex governance and decentralised management of department-led clinics. Decentralised processes have led to significant clinical risk due to untracked triage processes, waitlist management, patient communication and clinical documentation practices.
The Ambulatory Care Centre's sixteen department-led neurology and neurosurgery clinics offer specialist clinical intervention and multidisciplinary care, providing providing almost 16,000 occasions of service annually. The waiting list for some of these clinics is particularly long, with timeframes for an initial appointment far exceeding the expected timeframes set out by the Ministry of Health Outpatient Framework. The clinics are not transparent with consumers about these lengthy wait times, thus causing significant stress and anxiety.
Prior to commencement of the project, these clinics operated independently with siloed approaches and individual processes. This led to inconsistent data management processes, communication issues, patient care delays and opaque clinic performance data. This lack of performance data also led to an inability to justify resource allocation.
These processes caused a lack of transparency for consumers and their carers/families, resulting in reported stress and frustration. Feedback from staff was the workload of clinics was extreme, with varied processes, and unclear responsibilities and accountabilities for tasks. This led to significant burnout and reduced job satisfaction for administrative staff and clinicians working in these clinics.
Prioritising responsibility and accountability
We established the OUTpatient INsights project to ensure the sixteen neurology and neurosurgery outpatient clinics located within RNSH deliver safe, timely and sustainable care, while achieving high satisfaction among consumers and staff. We aim to enhance strategic governance with clear expectations, responsibility and accountability. We sought to streamline administrative processes in relation to data management, communication and billing, creating processes whereby clinic data was transparent and monitorable. These streamlined processes will reduce unmanageable staff workloads and improve job satisfaction.
By adhering to the Ministry of Health’s guidelines for outpatient services, we seek to increase transparency for consumers, reduce frustration and enhance timely and appropriate care delivery. Addressing these challenges will mitigate risks, improve the hospital’s reputation and support strategic decisions about resource allocation and service planning. The project aims to create sustainable change that could be scaled to all department-led outpatient clinics at RNSH.
A data-driven approach
To address the challenges within the outpatient clinics, we took a structured, data-driven approach, beginning with a comprehensive analysis of visit numbers, triage timelines and clinic processes. Through identifying key issues like delays in triage, incomplete data and inconsistent use of scheduling systems, we mapped clinic workflows and engaged staff in workshops. This revealed gaps in staff knowledge of available tools, leading to inefficient practices in managing patient referrals and waiting lists.
Five key solutions to address these issues emerged as a result of brainstorming sessions and solution design discussions with stakeholders:
- We wrote a brief to establish an Outpatient Governance Committee at RNSH, which will take on the responsibility for overseeing outpatient services. The project sponsor is now responsible for the creation of this committee, and the monitoring of these improvements will be transferred to this group.
- We developed a responsibility matrix to clearly define roles and tasks associated with outpatient clinic operations, reducing confusion and ensuring greater accountability.
- To enhance transparency, we proposed displaying actual clinic wait times to allow patients to make informed decisions about their care; however, this is awaiting Ministry of Health approval.
- In collaboration with the neurosurgery team, we designed and implemented a new referral receipt cover sheet to ensure all necessary data is collected, accompanied by a streamlined workflow.
- We rolled out SMS technology across all clinics to improve efficiency, reduce administrative burden and minimise patient frustration with phone calls.
Significant reduction in administrative burden
While implementation is ongoing, we have achieved some success in the rollout of SMS technology. We estimate that each SMS saves five minutes of time that would have been spent on phone calls, as it only takes one minute to send an SMS. The implementation of SMS has therefore saved a total of 150 hours across the three months, equating to a total of 50 administrative staff hours per month saved. This is reinforced by a consumer experience survey, which showed that 96% of patients preferred SMS to phone calls for appointment reminders, and that 98% of patients found SMS communication helpful.
View this project's poster from the Centre for Healthcare Redesign graduation May 2025.
