Appointment management, NHS

Partial booking outpatient clinics, what are the benefits?

Partial booking is one of the best ways to improve attendance rates in a trust. It also increases flexibility for staff and for patients.

So what is partial booking? In a normal booking process, or ‘full booking’, we book a patient into the next available clinic slot within the relevant time scale. So for example, if we need to see someone for a follow-up in six months, we will book them the next slot we can find 6 months from today.

With partial booking, there are two key processes:

  • Give the patient a target date, place them on a waiting list and arrange the exact date and time later on
  • When arranging the appointment get the patient to contact the hospital and choose a time that suits them

Anything other than this is not partial booking.

These two new ways of working have separate benefits. Trusts that do one or the other will not see the full benefit of partial booking. Partial booking requires a different administrative resource to a full booking process. This means some trusts have moved back to full booking, having struggled with the transition.

So why is partial booking so effective?

Let’s look at why patients don’t attend:

The time didn’t suit me. This is often the root cause of Did Not Attends (DNAs). Rarely though is it given as the reason in clinic. It is certainly a major cause of unnecessary calls and rework in booking centres, as we move currently booked patients to new slots. Getting through to the booking team can often be frustrating. Non attendance because ‘I couldn’t get through to reschedule’ is not unusual.

When we partial book patients we give them choice and control. We give them choice in the near enough future that they know their own availability. Most people know where they will be in four weeks, but do you know where you will be in six months?

Partial booking reduces DNAs by offering better choice. It goes without saying that this choice also improves the patient experience.

I forgot. We all forget things. Particularly if I was last told something six months ago. Our research shows there is a direct relationship between notice given and the likelihood of someone attending. Shortening the time between making and attending the appointment reduces opportunities for forgetfulness. Coupled with reminders this can be powerful!

DNA vs Reminder
Likelihood of non attendance is directly correlated with reminder period

I didn’t know. Partial booking, done right, is a proactive system. This means the patient must chose and confirm they will be attending their appointment. It also means we have to confirm we’ve got the right contact details for a patient. This can be onerous, but means we avoid wasting everyone’s time sending letters to old or non-existent addresses.

Often partial booking processes have a safety net, which ‘force books’ patients who have not chosen a time. Unsurprisingly, these forced bookings run at higher DNA rates than normal appointments.

By asking patients to confirm their attendance, we avoid booking slots for patients who would never turn up.

The appointment wasn’t important to me. Particularly in chronic conditions this can be a common cause of non-attendance. By speaking to patients, we can impress the importance of coming to hospital. Indeed, we can give them the option to move to another care setting if their condition has changed.

A good partial booking process can solve all of the above problems. The benefits don’t end there, they extend to helping us run a better service inside our hospital too.

Flexibility for staff. The most important resources in any hospital are the staff who see patients. In a busy hospital things change – staff move on, clinics change, or holidays get booked. In a full booking system these changes mean clinics have to be cancelled and patients moved – 51% of patients we surveyed had been rescheduled by their hospital at least once. Strict leave polices can help slightly, but rarely act as more than sticking plaster solution. Partial booking leaves clinics empty until a few weeks before, reducing the need for mass cancellations.

Clinical benefits. As a clinician, it is important patients are followed up on the right timescale. If I next see a patient in three months when I requested six, I have doubled my workload. If I want to see them in six months, but they don’t come back for nine, we risk missing important complications. There are enough stories of patients going blind while waiting for treatment.

With a full booking system, we often lose visibility of when we see patients. Clinic cancellations can have a negative effect on clinical timescales. They also create self-reinforcing capacity issues. If I cancel a booked clinic, I either move all those patients back (possibly several months), or I create a spike in demand. Recovery from these spikes is difficult and leads to ongoing capacity issues or the need to run initiative clinics.

So why doesn’t everyone partially book their outpatient clinics?

There is often confusion about processes. A poorly, or partially (excuse the pun) implemented system can increase workload without the benefits above. It’s important to use waiting lists and offer choice if partial booking is achieve its potential.

I will need to cancel and rebook all clinics to transition. This is one of the most commonly held misconceptions. Whilst there are advantages to a clean break, the extra work and risk of losing patients mean it is rarely worthwhile. A process where old fully booked appointments work their way through the system and new partially booked appointments are made in parallel is preferable. This allows a smooth transition and a slow ramp up of the new process.

We can’t cope with the increase in phone calls. Partial booking does require a different sort of resource, and a different approach to customer service. The load on receptionists is often reduced in clinic, which often has a positive effect on queues. There do need to be more trained call handlers, with a good understanding of the process. One solution to this is technology. Allowing patients to partially book by text message or online removes the need for call centres. It will also substantially reduce paper and the associated costs and patients like the flexibility.

Can't cope with the extra calls?
Can’t cope with the extra calls?

See the next in the series for how technology can help implement partial booking!