Open All Hours

Apr 14
[av_textblock size=” font_color=” color=”] I can order a pizza to be delivered at 2am but I can’t see my GP to talk about my growing weight problem. In the week GP’s are told to ‘open all hours’ we look at the NHS problem from a systems viewpoint.

This will not be a blog about the NHS being rubbish.

So I am a patient. I have worked alongside NHS partners in delivering front line services. I ran a county wide GP engagement programme. So when it comes to thinking about the NHS and its massive operations (excuse the pun) I have some experience above the average Joe.

The media will tell you the NHS is broken. I don’t think they are broken just not as efficient as they could be. There are not enough nurses or doctors. But that’s a funding problem in the main. So where do you find more money? From more efficient systems.

This is my systems story, as it involves the NHS is could well be your systems story too;

A little while ago I visited my GP (thank-you I’m fine it’s nothing serious). I was referred for two different things, one of which would be carried out by a private company another by the hospital in Lincoln.

The private company…..

They rang me. Booked an appointment. I went to the appointment. All within 2 weeks of seeing my GP. Everything was fine. That cost them about £2.50 in administration costs to make the phone call.

The hospital appointment…..

They wrote me a letter. The letter said they would ring me to book an appointment on a specific day at a specific time. They rang to book my actual appointment. They followed up with two letters in separate envelopes. One was a print out with the appointment time and date. In the other envelop were two letters, the first to say this letter contains a letter (I kid you not) and then the letter detailing the appointment time and date.
That cost them about £8.12

So What?

To me the system for the hospital was floored. There were too many steps in the process and it created duplication and a waste of resources.

The hospital have spent £5.62 more achieving the same outcome.

Does that matter, after all I am just one patient. From March 2012 to February 2013 there were 74.9 million outpatient appointments across the NHS hospitals. If they all follow this same system for each that’s a whopping £420 million pounds wasted. Actually wasted, remember the outcome for the patient is exactly the same in both systems. How many nurses does £420 million buy?

System Design

System design doesn’t have to mean spending money on an IT system, or doing anything new. Sometimes it can just mean doing things differently and getting the same outcome, or a better one. Imagine finding £420 million down the back of the sofa, that really would be like winning the lottery.

My rational

For both I have assumed administrators cost £8 per hour and phone calls cost 50 pence.

For the private company appointment I estimate the following direct costs were involved;
15 minutes for the administrators time both on the call and updating their systems
The cost of a phone call
Total direct cost of £2.50

For the hospital appointment I estimate the direct costs as;
Initial Letter
10 minutes of administration time
3 sheets of A4
An envelope
2nd Class stamp

Phone call
15 minutes for the administrators time both on the call and updating their systems
The cost of a phone call

Appointment Confirmation Letter
10 minutes of administration time
3 sheets of A4
An envelope
2nd Class stamp

Duplicate letter
10 minutes of administration time
2 sheets of A4
An envelope
2nd Class stamp
Total direct cost £8.12

So by changing the system, getting the same outcome for the patient but being more efficient has massive implications. And this is just one tiny part of what the NHS do. Systems can help build or break a business.
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