1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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The Wait Is Over – Part I
Implementation of Interventions to Reduce the Electromyography Waiting List
Student Number: MSc. Healthcare Management
Abstract
The current waiting list to have Carpal Tunnel Syndrome (CTS) screening performed within the Department of Clinical Neurophysiology of a large university teaching hospital is 255 days. This delay in access to the service causes increased stress amongst staff and anxiety of patients as they are spending increased amounts of time in the symptomatic state and their condition can deteriorate. The aim of this organisational development project is to reduce the wait time to have CTS screening performed. The project involved the redesign of the Electromyography service’s process with demand shifted by the addition of waiting list validation and redirection of referrals inappropriately sent to the department. The new process involved the introduction of an extra clinic to increase throughput along with the application of lean methodologies to remove waste and improve the efficiency of the bottleneck. These demand and capacity measures caused a significant (35%) reduction in the wait time for CTS screening to 166 days, increased efficiency as seen by a reduction in ‘fail to attend’ rate resulting in cost savings for the organisation but also increased equity of access. This enabled a greater understanding of the service on a micro level with acknowledgment that demand and capacity variation and its management is a vital part of waiting list management along with the appropriate use of the constraint, which is the bottleneck.

2. Introduction & Background Organisational Impact
The Wait is Over – Part I
Implementation of Interventions to Reduce the Electromyography Waiting List
Student Number: MSc in Healthcare Management
Introduction & Background
Methodology
Evaluation
Objectives implemented using the guidance of the HSE change model3.
1) O’Neill J.K., Laina V. & Wilson S. (2008) Referrals between consultants. The wait to be seen in a specialist plastic surgery hand clinic. Clinical Governance: An International Journal 13(4)
2) Meekings A. & Briault S. (2013) The “control tower” approach to optimising complex service delivery performance. Measuring Business Excellence 17(3)
3) HSE (2008) Improving our services: A users guide to managing change in the Health Service Executive. Dublin.
This OD project was introduced in the Department of Clinical Neurophysiology in a large university teaching hospital. The Electromyography (EMG) service provides diagnostic testing for neuromuscular disorders such as carpal tunnel syndrome (CTS). The current waiting time for CTS screening is 255 days. The longer a patient must wait for CTS treatment the more likely the condition can progress to motor symptoms and make treatment more onerous1 but also increased propensity of the patient failing to attend which increases costs and is inefficient.2 Departmental demand and capacity was analysed pre change (Figure 1).
Figure 1 : Pre Change Demand and Capacity
Figure 2: Demand Output
Figure 3: Average Demand and Capacity Outputs
Figure 4: Outcome
Initiation
Insight into the environment in which change is to occur gained using a number of tools such as PESTLE, TOWS and cultural analysis .
Planning
Team presented with data portraying failures in current system and this data used to create urgency of change. Appropriate influencing tactics used to gain ‘buy in’. Communication key to the understanding of everyone’s roles within change.
Implementation
Waiting list validated and patients who did not want test removed. Referrals vetted and redirected to appropriate organisation. Extra technologist lead clinic commenced in October Testing time analysed using t test with resources capable of adding one extra patient into one of the technologist clinics.
Aims & Objectives
The aim of this project is to reduce the waiting list for CTS screening using the following objectives:
Demand Measures:
Validate the waiting list of patients waiting longer than three months by February 2015.
Redirect inappropriate referrals to appropriate organisation throughout the course of project.
Capacity Measures:
Introduction of an extra clinic each week, increasing capacity by 3-5 patients per week to commence on October 1st 2014.
Analysis of value added time in each clinic with the addition of an extra patient per clinic to commence in January 2015 if resources permit.
Organisational Impact
Reduced waiting time for testing
Reduced ‘failed to attend’ rate from 20% to 8% resulting in greater efficiency
Increased equity of access
Mainstreaming
Validation office to take over validation. Continue exclusion criteria. Waiting time reduced, so continue extra clinic and extra patient until list cleared.
Conclusion
The key to reduction in waiting lists is to ensure that the bottlenecks are working efficiently and effectively and near maximum usage. Once the waiting list is reduced it needs to be maintained by continuous monitoring of variation in demand and capacity with flexibility in capacity to meet change in demand. Part II, once the list is cleared, will involve advanced access “one stop shop” clinic enabling continuous quality improvement.
References