NHS (National Health Service) Hospitals in the UK are mandated to publish their waiting list figures by the government. Waiting list data is monitored by various interested parties including Health Authorities, Unions, political parties and the media.
An internal audit at an NHS Hospital revealed that the size of the waiting list for patients had been under-reported.
Any deliberate manipulation of waiting list figures can result in fines from Clinical Commissioning Groups and potentially lead to criminal investigations. As a result of the finding from the audit and the potential risk for causing reputational harm and having financial penalties imposed, the issue was escalated to the Hospital’s Trust Board.
We were asked to establish the true number of people on the waiting list and to develop a dashboard to help monitor and manage the position.
Upon visiting the team responsible for recording the position, we discovered that there was no process map detailing how patients are added to the waiting list. A patient’s status was mostly determined by entries on the Clinical Information System however, there was a significant cohort where the team would assess if someone was classed as ‘waiting’. As there was no formalised process, there were inconsistent interpretations of how patients should be classified.
Working with appropriate stakeholders, we created a process map, that for the first time, established every permutation of a patient’s position on a pathway to determine if they were to be classed as waiting. Once this process map was agreed and approved it was then possible to use the logic to interrogate the database and establish the true waiting list position.
At that point we held daily meetings with a Hospital Trust Director and Senior Manager to develop a dashboard showing the performance and trends so that the Board could monitor and manage the waiting list position.
The Hospital Trust Board were assured that they now had a true position of their waiting list as well as having a process that would ensure that there would be no repeat in the future. They also had a new dashboard that allowed monitoring through to individual patients.
Patients who were not on the previous waiting list but still required treatment, were identified via the dashboard and fast-tracked for appointments leading to better health outcomes.
Due to the Trust’s candour, prompt and robust response, no sanctions were imposed against the Trust.