How to achieve your 18-Week Pathways from GP Consultation to Theatre?

In order to achieve the 18-Week GP to Treatment target, you may well need to make some fundamental changes to existing procedures for Administration, Diagnosis and Care Provision. This might cause you some concern.

Of course, prudence dictates that you use well tried and tested ways of working, but the problem is that these will be totally new and they've never been done before - A Paradox!

This is precisely the situation in which computerised PatientFlow planning and good Simulation modelling can be used to help you design, test and deliver new and cost-effective processes. Moreover, you will be confident in the sustainability of your Strategic Choices.

Regardless of an 18-Week target, in reality you'll be much more concerned that each Patient is delighted with the promptness of their treatment and care. Also, the unfortunate reality is that if you don't want to breach the 18-Week target, then you should be aiming for a 13-15 Week Target for the majority of Patients.

An Example

Let's look at an illustrative example in which a GP makes urgent referrals for 5 different Case-types and the different Patients flow through their designated processes which will include some or all of C&B Appointment, Diagnostics, Review, Decision to Treat, Ward, Theatre and Discharge. Although each Patient is individual, each Case-type has a statistically predictable set of timings, based on the Clinician's experience.

As you plan your strategy you may well be asked very sensible questions such as :

"What if we try to do all of the initial Diagnostics on the same day - Bloods & Pathology samples, X-rays / MRI and possible Ultra-sound?"

Because of the psychological, physiological and social variation of Patients with each Case-type, planning on a basis of 'Averages' is bound to be a disaster. (If 'Averages' were reliable, we could all be multiBillionaires from the Stock Exchange!). Also, our processes are disjointed and mutually interactive (e.g. MRI Scanners are not continuously available and have a finite capacity). The processes also typically use resources which are loaded at 85%+ capacity.

Running the preceeding Percept FlowModel many times to investigate the inherent levels of variation the model may produce spreadsheets as below:

For each Case-type, this particular simulation model takes account of their different Priorities, Costs and PbR Tariffs. It estimates the Opt-out via C&B if Queues are too long at any point. 18-Week Financials

From the above table it can be seen that there is a clear case for 24 Beds rather than 18 being available. The difference between 24 Hospital Beds with/without 1 Day Diagnostics is less significant financially but extremely important in terms of 18-Week "Breaches" and also the enhanced Patient experience.

Note that we have not increased Diagnostic resources to get these outcomes. We have simply changed our process to offer as many Patients as possible the extra convenience of having multiple tests done on the same day, thereby removing artificial administrative delays.

Extending the hours when our Resources are available for these Patients
Increasing the number of Staff/Facilites either by in-house expansion or use of 3rd-party capacity
Removing other process delays, especially those introduced by adherence to tradition or by bureaucracy. We need to get the process working as swiftly as possible within the limits of Resource Capacity and Sensible Utilisation
Referral management and better use of Primary Care services.

To see what we mean by 'Sensible Utilisation' you could read our comments on Lean Thinking :

How do FlowModels support the 18-Week Target?

An Example