Using Vision reports and a demand tool to test a new appointment system
Arbroath Medical Centre
The Practice Manager and practice administrative team from Arbroath Medical Centre in NHS Tayside were about to implement a new appointment and patient triage system for incoming calls. The team felt that demand had accelerated significantly since the start of the COVID-19 pandemic, resulting in an increase of approximate 30% more work. The previous appointment system was based on offering same day appointments with a small number of pre-bookable slots each day. Patients were asked to call the practice before 9:30am to secure an appointment that day. The practice felt that this approach did not allow them to meet demand and made it more difficult to offer same-day appointments to patients with urgent concerns who called later in the day.
With the new appointment booking system, the team planned to have clinical staff triage patients and give them same day or pre-booked appointments according to medical need. They predicted that putting more pre-booked slots in the timetable and giving away fewer same day slots would make it easier to see patients with urgent concerns. They also hoped the change would spread demand out over the rest of the day as patients realised they no longer needed to call at 8am to get an appointment.
Developing a data collection tool
The practice team decided that the best way to measure the effectiveness of the new appointment system would be to take a daily count of how many same day appointment slots remained at a particular time of day. For example, if they were currently ending up with zero same-day appointment slots left by 11:00am, even an increase to three or four same-day slots left at 11:00am would show an improvement. It would mean that some patients still had a chance of getting an appointment after 11:00am. The practice team used Vision appointment software and wanted to avoid manually counting slots on the appointment book if possible, as this can be time-consuming.
It was possible to run a report through Vision that would give a the number of same-day appointment slots left at a particular time, the practice administrative team informed us that it only took about five minutes to generate the report. The practice team chose to look at the number of same-day GP and advanced nurse practitioner (ANP) appointments left at three set times throughout the day: at 9:30am, at 12:00pm once triage had finished, and at 6:00pm. GP and ANP appointments were the practice team’s top priority because they knew they has the highest demand, and looking at three different time points would help highlight any issues at particular times of the work day. Once the reports were generated, the practice team entered the data into a run chart tool designed in Excel.
Collecting the data
The run chart has a separate worksheet for each time point and allows the practice team to track the change in number of appointments at each time point. In order to get a small amount of baseline data, they began running reports one week before implementation of the new appointment system. The run chart tool allowed them to easily add annotations to the charts identifying the beginning of the new timetable and the day communications went out to patients about the change, helping to visualise the impact of each event on the appointment count.
Analysing the data
The practice team reported that they occasionally found it difficult to run the report because of how busy the practice can be, but overall felt that data collection went well and the run chart tool did what they needed it to do. They found it beneficial to continue running reports daily over a longer period to get a fuller picture of how demand responded to the new system.
[The tool] is useful for seeing the different trends and things like that… It’ll be good for trying to establish where we could maybe add more appointments or change the type of appointments." Practice Administrative Staff
Overall, after reviewing several weeks of data in the run chart tool, they concluded that the new appointment system is having the desired positive impact. They had been reasonably sure the new system would be a success, but collecting data and using the tool confirmed this.
It’s early days, but it [the new appointment system] has made quite a drastic change I think." Practice Manager
If we didn’t have the tool, we wouldn’t know if our appointment system was working or not." Practice Administrative Staff
The Practice Manager identified that Vision users can easily count any appointment type, not necessarily just GP and ANP appointments, and the run chart tool can be adjusted accordingly to explore other issues as well. The practice team do not currently feel the need to continue collecting data, but do plan to repeat this exercise in the future to check that the new appointment system is still functioning well.
We probably want to do spot checks, just for checking that the changes are still working or to revisit things. You might not want to revisit every week but maybe on a monthly basis. If everything’s going fine you don’t need to do it as much, but if you’re going through a difficult period you might want to monitor more to see if there’s a bigger trend." Practice Manager
We’re quite happy with what we’ve got out of it… The doctors are getting so much more time to do stuff, they’re actually finishing at a more reasonable hour of the day, and the patients are happier too." Practice Administrative Staff