It always amazes me, the number of times we overlook the past. Repeat something that doesn’t work.
Organisational amnesia.
So often we fail to take the lessons of the past onboard. Maybe because the people with the memory have moved on. New leaders and teams come in, unaware of what’s gone before them.
If the past isn’t remembered and brought into today, we risk losing the purpose of history, which is to stop us repeating the mistakes we’ve made before and to ensure we have a better future.
It’s called cultural denial or ‘path dependency’, repeating things because of inertia or being too invested in past strategies.
In 2000, a report by the then, chief medical officer, Sir Liam Donaldson, titled, ‘An organisation with a memory’ he…
‘… encouraged us to learn from the past, pointing out errors were often attributable to systems and not people. We should actively learn from them and ‘near-misses’ with a systematic approach to analysing failures to prevent future accidents.’
For the first time, the ‘bleeding-obvious’ was spelled out in an official report. Highlighting the importance of analysing data.
As a result, some systems were standardised and protocols introduced to minimise variation.
Interestingly, 2.35 million patient safety incidents were reported between April 2021 and March 2022. An 11.2% increase on the year.
What’s going on?
Maybe the increase is partly attributed to pandemic recovery and an improved reporting culture but…
… the numbers are confusing; most incidents cause no harm (70.6%) or low harm (26.0%). Fewer than 4% of incidents reported serious harm.
The learning from that? Reporting does not equal harm so don’t panic? No, we need to take it all seriously. Low harm, no harm can easily become very harmful. Is the NHS any safer? If we’re learning… certainly.
In today’s environment, history is being redefined. We call it data. History as fresh as yesterday. Data, redefining problem-solving, in the here and now.
For example, something we seem to have difficulty fixing… what is lost in terms of money, resource and time when people don’t turn up for appointments.
Did-Not-Attends have been a persistent problem and there have been umpteen ideas to solve it including the usual trope… charge people for an appointment or fine them, for not turning up.
If charges were based on the usual exemptions (prescription charges being waived) that would mean about 89% of people wouldn’t pay. Collecting the other 11% wouldn’t be worth it.
More sensible… leverage the data, use the past to figure out why people DNA and fix the reasons.
Is it a big deal? Yes… DNAs costs about £2.6 million a day. There are 46 missed hospital appointments every minute in the UK. In 2023/24, eight million patients missed a scheduled appointment.
I’ll pause… let that sink-in!
If you want to know what the problem’s like in yer-own-backyard, click here for an interactive map that will show you. It’s brilliant!
The 7 biggest drivers of no-shows;
- Travel related challenges (50%)
- including a referral to a hospital located too far away or requiring multiple modes of transport,
- not being able to afford the bus or train fare.
- Workplace commitments and the fear of loss of income (27%),
- cultural reasons such as fasting or joining community prayers (17%),
- being sent the wrong appointment date/time or
- the appointment time being changed (18%)
How do I know this? From a really interesting survey by DrDoctor. They have a patient engagement platform used by over 70 NHS trusts and they asked patients.
They tell us one of the biggest problems is the difficulty patients have in rebooking an appointment they know they can’t attend.
So make it easy… simples!
If we are to get close sorting the extra demand this type of failure causes aka failure-demand, with it’s costs, confusion and duplication, look at the history, aka the data…
… DNA rates are varied by factors such as age, location and the type of healthcare service to be provided.
One other study reported 40% ‘forgetfulness’ was an issue… so remind people! No rocket science required.
Building-in to the appointment-systems ways of learning from DNAs, considering travel and other social and financial issues can be done. Do it, get it right and DrDoctor’s survey claims DNAs could fall by a third.
Learning from what has happened, it seems so simple. If history isn’t our friend, who is? What works what doesn’t.
Look at the data, don’t do it again.
Look at the data, do it again.
History tells us what works, what creates risks, what keeps people safe, what keeps them turning up for outpatient appointments.
History is more than legacy. It is our friend. Use it to write tomorrow’s history by learning from it, today.
News and Comment from Roy Lilley
Contact Roy – please use this e-address roy.lilley@nhsmanagers.net
Reproduced at thetrainingnet.com by kind permission of Roy Lilley.
