05 Culture Change
The Outpatient Programme provided the resources and education to develop capacity and capability for change in outpatient services in the NHS. Resources were provided to encourage and allow locally designed and led change to meet the needs of each service area. The successful implementation of change has been demonstrated in the majority of these local projects and the learning for the NHS and SEHD has been extensive. Examples of the work have been published in "Delivering for Health" (2005) and the Audit Scotland report "Tackling Waiting Times in the NHSScotland" (2006) as good practice and press coverage of the initiatives has been positive. From a programme perspective all deliverables and objectives have been met.
Beyond this, and perhaps most importantly, the Outpatient Programme supported a number of cultural shifts within NHSScotland:
- Previously, only activity data was collected for outpatients and planning was done on the basis of average activity;
- The programme supported and demonstrated that non-acute work should be moved to a primary care setting. This approach is endorsed by "Building a Health Service Fit for the Future" (2005) and the National Waiting Times Unit;
- The programme advocated an understanding of the impact of queuing theory on waiting times and introduced the fundamentals of better waiting list management;
- The programme advocated the role of a range of clinicians in managing chronic illness.
The challenge of implementing such fundamental changes in thinking and planning should not be underestimated. The outpatient team recognise that simply to have outpatient staff thinking in terms of capacity, demand, activity and queue is a huge shift from the previous focus on average activity and that the benefits of this shift will bear fruit over the next few years. The beginning of this culture shift is somewhat anecdotal but the following observations are seen as strong indicators that this has begun.
- Of those surveyed by CCI regarding redesign 92% stated that they would like to be involved in further redesign. 83% and 72% respectively felt that waiting times and access had been improved by redesign.
- The changing language in the NHS to discuss all of the above elements is seen as an initial sign of success.
- 25 newspaper articles have highlighted work being supported by the Outpatient Programme and this helps to improve patient awareness of positive changes taking place in service provision.
- "Building a Health Service Fit for the Future" encourages further spread and development of many of the ideals of the work piloted in the Outpatient Programme.
- "Delivering for Health", the Scottish Executive response to "Building a health service fit for the future" outlines the policy direction for the NHS over the next 5 years. Delivering for Health draws specifically on the projects that have been supported by CCI and embraces the tenets upon which the work was built.
Between June and September 2005, CCI surveyed the views of staff involved in outpatient redesign projects across the specialties of Neurology, Dermatology, Plastic Surgery, Orthopaedics and ENT. Staff who had been involved in the redesign work, either directly or indirectly, were asked for their opinions of the effect of redesign on the patient pathway and on the staff involved in the project. A total of 250 people were invited to fill in an online questionnaire. The response rate was 48%, with 121 staff submitting a completed questionnaire.
- 64% of all staff actively involved in the redesign thought that the work had a positive impact on their working environment;
- 95% of staff whose role changed agreed that they were happy with these changes;
- 92% of staff said they would like to be involved in further redesign;
- 83% felt waiting times had been improved and 72% felt patient access had been improved.
In September 2005 the PFB project ran a staff and a patient satisfaction survey. The staff survey was sent to departments across NHSScotland who were currently implementing PFB. A total of 161 staff responded to the survey with half of those actively involved in the implementation. The headline results were as follows:
- 65% of staff felt PFB had a positive impact on the patient experience of outpatient services;
- 85% of those staff directly involved in the implementation of PFB wanted to be involved in further redesign.
The respondents were also asked what aspects of the service they felt had been improved through the PFB process, with waiting times and communications coming out top.
The patient survey was run in dermatology outpatient clinics over a two-week period and 700 responses were received.
- 98% of respondents felt happy to telephone to arrange an appointment;
- 90% of respondents reported no difficulty in getting through to appointment centres;
- 89% of respondents felt were given a choice of appointments;
- 97% of respondents were happy with the appointment they received.