Reducing waiting times associated with an integrated child health service

Abstract

Following an increase in average waiting times associated with a child health service in East London, an initiative to rapidly reduce the numbers of children waiting long periods following a referral was undertaken over the period May to June 1999. A multidisciplinary cooperative approach was adopted operating within the existing available resources and involved medical, nursing, managerial and administrative staff. The initiative involved a review of the accuracy of the waiting list, followed by an invitation to remaining patients to provide an option of continuing to wait to be seen or offering attendance at a rapid response clinic associated with reduced waiting and consultation times. Half-hourly appointments were routinely offered instead of hourly appointments and proformas were adopted for history taking and onward referrals to save time spent on administration. A total of 162 patients were seen over the course of a month and a satisfaction questionnaire completed by relatives indicated a preference for the new service. The mean waiting time was reduced to under a quarter of the time at the start of the initiative to a mean of less than two months. The purpose of the study was to see if the waiting list could be reduced by using existing staff. We wanted to ascertain the parents' views whether shorter waits and shorter consultation periods were acceptable, and to ascertain if the waiting list could be kept down or whether the waiting list would rapidly recur after the rapid response clinics stopped. The findings are discussed in relation to initiatives elsewhere and the need to maintain a high quality service.

Reorganizing pediatric rehabilitation services to improve accessibility: do we sacrifice quality?

“…Examples include Clow & al. proposing 30-minute rather than 60-minute sessions to children with disabilities [6] and Sorel, Bouchard, Kalubi & Maltais who proposed evaluating children on the waiting lists, counseling their families and offering them information group sessions to foster family well-being while awaiting treatments [5]. Although interesting, these authors did not evaluate the impact of their temporary solutions on the overall quality of service provision (nor on patient outcomes).…”

SWOT analysis of a pediatric rehabilitation programme: A participatory evaluation fostering quality improvement

“…For instance, temporary services have been offered to children on a waiting list [8], new interventions thought to be more cost effective are being explored [9], and there is anecdotal evidence that programmes are scrutinizing their current model of service delivery and reorganising their services, partially or completely. Kotter believes that service providers, as well as people with some power of authority to lead the change, should be involved in service reorganization because the chances of success are greater in participatory approaches where people concerned by an organizational transformation work together [10].…”

Waiting for child developmental and rehabilitation services: an overview of issues and needs

“…The literature recognizes that health and related services are organized and delivered in complex ways, with interplay between various aspects of the service system’s performance, such as accessibility, appropriateness, effectiveness, and sustainability 24,25 . The extent to which improvements in accessibility occur at the expense of other components (such as effectiveness) is unknown, although some reports suggest that such a trade‐off does not necessarily occur 6 . Nevertheless, the implication remains that measuring wait times for service in isolation from other measures or indicators may create a distorted and incomplete picture of service quality overall 26 .…”