Tuesday, 29 May 2012

There's No Efficiency Without Effectiveness

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  1. What could be even more revealing would be a study of failure demand in the admin services operated by GP practices. My own experience suggests that as much as 80% of patient visits and telephone calls to surgery non-medical staff represent failure demand. The main reason behind this is that my GPs - good as they are on medical matters - have chosen to offload an ever increasing number of 'admin' tasks to a 'back office' of receptionists, secretaries and general administrators who often work part time, only know a little bit of a patient's story and pass only ad-hoc bits of paper between them to track (or often fail to track) progress. Hence endless rounds of failure contacts with a whole back office existing where, often, all that was really needed would have been for the GP to have spent 20 more seconds at the end of a consultation on a referral or documentation task, rather than pass it to his own 'back office' to undertake. And I wonder how many patients give up dealing with their surgery back office and instead ask to see thir GP again, simply because their original consultation did not lead to the result they expected?!

  2. This is a very thought provoking article which goes further than most in discussing the access issue. I think more research is required to really dig deeper into results found at the third practice to see if these can be replicated with other practices with other populations.
    Something else I am interested to learn more about is the concept of the super consultation (i think that's what it's called) been tried in the US - that is consultations for half an hour to allow the patient to talk through as many problems as they wish - these could be ordered by the patient as almost a separate "product" should they feel it necessary. I have heard anecdotally that they are sucessful in improving access but not seen the evidence for myself.
    Melissa Morris

  3. Really interested in your ideas. One of my partners is becoming something of a Vanguard evangelist and is encouraging us all to look at failure demand. I think we are buying in to it but struggling to know where to start.
    One of the biggest stumbling blocks seems to be our patient's reluctance to tell anyone what they want an appointment for. They aren't keen on telling a receptionist as its personal yet is it cost effective for me to take all the calls?
    Last week for example i had a couple of consultations that were - could you print my repeat pill or could you chop off this suspicious looking mole. Both arguably didn't need to see me - more efficient alternatives were available. Yet its difficult to force people to tell us up front what they want so as to signpost them better.
    I believe some say the GP should triage. but I see 18 patients in 3 hours. If i were to take all 18 calls in 3mins each roughly = an hour - I would have to save over a third of the calls to be ahead and up to half to be really ahead - I'm not sure thats going to work.
    So how do we change? I guess its work out what our most frequent 'failure' is and work on a better pathway for that? I have an idea that patients can email in a picture of the lesion they want removing and we will contact them direct ether with an appointment to remove it or a referral or reassurance. The problems going to be making sure everyone knows about that pathway and the pill one and the eczema one and the hay fever one and the etc and doesn't just make an appointment.
    One of the problems in a group practice is I think variation. I might give a years worth of pill, others 6 months others 3. Some want to do a BP every time some once a year, some let the patients monitor it themselves. This variation is going to cause problems whereas a single hander will in theory do the same thing each time. I suspect that we need to work on standardising common tasks like these.

  4. Thanks for your comment Neil. In answer to your question 'How do we change?' you are right to identify the issue of failure demand. The starting point for that is to really understand your demand - the type and frequency of it - first. We have learned that it is important to have people (not service) shaped data. It is here that the greatest lever for change is. If your practice is anything like other systems we have studied you may start to see patterns of consumption emerging which will allow you to focus on designing responses tailored to particular patients, families and even communities. With that knowledge you can really test the notions of value and failure demand. What might currently be seen as prima facie value demand could well turn out to be failure demand when viewed from that perspective. Solutions here may well release capacity to deal with some of the other demands you have right now. Equally as likely, those demands may disappear altogether.

    It's great that you are having a go with the Vanguard Method. I hope it helps your practice. Its quite difficult to put things across in the written word so if you think it would be useful to chat through some of the issues you are facing please do call 01280822255.