Patient Access – Appointments


imagesCAUP3U1D“Improving patient access” is all something that we hear about on a daily basis. It constantly being discussed at all levels, Partner meetings, Reception Team Meetings and Multidisciplinary Meetings. There is no one working within the NHS who is not aware of this.

As Managers we all strive to make patient access the best we possibly can. Often systems are changed to try to accommodate patients, yet still we hear people complaining that they are unable to access appointments for days at a time.

Not having appointments can often cause frustration not only from the patients, but from the Receptionist Team too, they often feel that are unable to do their jobs and often having to deal with difficult situations because some patients can become aggressive.

I decided to be proactive and look at the amount of DNA’s we had at the surgeries I managed. We had over 30,000 patients and I was shocked when I realised just how many hours were being wasted on a daily / weekly / monthly basis by patients for whatever reason not attending their appointments.

Patients are often the cause of the lack of appointments. It is not acceptable to just “not turn up”.

But what can we do to improve DNA’s? What does your surgery do to try and keep on top the wasted appointments?

Some surgeries (and hospitals) display in the waiting room the number of DNA’s each month, and this can be pretty horrifying when you see just how many appointments are wasted in this way. But of course the people who did not turn up for their appointment do not see these statistics.

Some hospitals will send out a text message a few days before an appointment, thus giving the opportunity to cancel if the appointment is no longer needed (also a good reminder if the patient has forgotten) This system will only be helpful for those with mobile phones, perhaps not so good for some of the elderly that may not use mobiles.

Some hospitals are now sending out reminder letters a week before the appointment, again helpful when the initial appointment might have been made some months before.

Adding something to a Surgery website is another way to encourage patients to cancel unwanted appointments, you could also display the DNA’s for the previous month.

Practice Newsletters is also another way of encouraging people to cancel rather than just not turning up.

We did a trail at one of our surgeries. When a patient DNA their appointment a letter was sent to them pointing out that they missed their last appointment, and the practice would appreciate if they could not attend a future appointment could they please phoned and cancel the appointment. The letter would go on to explain the amount of DNA’s the surgery was experiencing and that patients were having problems booking appointments.

Another surgery I know of has a system in place, that they feel works extremely well and have been getting positive feedback from patients and the Receptionists. They have over 25,000 patients, and have their fair share of DNA’s. They found the amount of DNA’s they were experiencing each day was getting increasingly frustrating for the staff. The Reception Team Leader started getting the Reception Team on the late shift to phone the patients who had DNA that day to ask the reason why they had not attended their appointment. They make the call as friendly as possible; the call is not made with “all guns blazing” or “pointing a finger” at the patient for not attending. The Receptionist simply asks the patient did they realise they missed an appointment today, and would they require another appointment. They found that most patients were extremely sorry for missing their appointments, and some genuinely did forget, but more important it made the patients aware that the Surgery was monitoring the appointments. Since starting this system they have found that their DNA has fallen.

The most important thing when doing this is when a patient cancels an appointment that IT IS CANCELLED. Often for whatever reason if appointment stays on the screen, despite the patient cancelling the appointment it could result in a letter or a phones call going to the patient.

This unfortunately happened at our surgery, a patient was sent a letter when she had in fact cancelled her appointment, and understandably was quite upset when she received a letter. If this system was to work it is essential that every single Receptionist understand the importance of cancelling appointments on the screen – in not doing so could result in the surgery receiving a complaint.

By highlighting the amount of DNA’s in these ways it lets your patients know that you are monitoring your appointments system – especially for those patients that just have not “bothered” to cancel their appointment.

It could also flag up that patients are perhaps cancelling, but for whatever reason they are not being cancelled on the system – which could indicate a training need.

Are appointments being booked too far in advance (i.e 6 monthly BP checks, diabetics checks etc) if so how can you best deal with this? Could you use the texting system to remind patients a few days before their appointment?

I am always in favour of giving out appointment cards especially to the elderly. Always remember to put the day as well as the date on the card along with the time.

Monitoring DNA’s will flag up those that repeatedly fail to attend.

Always approach patients about DNA’s in a positive way. Explain that the Surgery is trying to look as the amount of DNA’s and at ways of decreasing these and feedback on why they DNA would help with the exercise.

Explain if patients cancel their unwanted appointments then this will free up more for other patients – which could be them.

And when a patient does take the time to call the surgery to cancel an appointment, the Receptionist should always thank them for taking the time to do so.

Patients have to be made aware that by not cancelling their appointments it just adds more pressure to the already busy system.

© 2011-2017 Reception Training all rights reserved

 

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2. DNA – The Reception Team Member


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Referring back to my blog on DNA appointments I received a lovely reply from a Reception Team Member who works for a surgery that has approx 25,000 patients.

She too spoke of the frustration that DNA appointments can cause on a daily basis. She now had a system in place at the end of the day where she gets her team to first checks who made the appointment, and whether the patient has already booked. The team approach the patient in a positive manner (ie not guns blazing) as she agreed there could be an error on the surgery in not cancelling the appointment. People will also respond better when someone is approaching them in a positive manner.

The team asks the patients why they DNA their appointment, and in many cases they are extremely sorry for missing their appointments.

I think this is an excellent exercise as it can flag up several issues

  • It can let the patient know you are monitoring the appointments system – especially for those patients that just have not “bothered” to cancel their appointment.
  • It could flag up that patients perhaps are cancelling their appointments and they are not being cancelled on the system
  • Are appointments being booked too far in advance (ie 6 monthly BP checks, or diabetics checks – if so how could your surgery best deal with this.
  • Could highlight the importance of giving out appointment cards whenever possible.
  • Could highlight those few that are constantly not turning up for appointments.

When speaking to the patients regarding their DNA try to get the reasons why in a positive way and look at ways of improving the amount of DNA’s that your surgery has.

What would be helpful would be when you are talking to the patients if it is the first time you speak to them about their DNA you could explain that you are trying to look at the amount of DNA’s and at ways of decreasing these and their feedback on why they DNA would help with this exercise. Explain if patients cancel their unwanted appointments then this will free up appointments for other patients – which could be them. This was it will turn the telephone conversation into a positive one instead of a negative one.

But I am sure by getting a phone call regarding a DNA will certainly get a patient thinking more carefully next time if they simply do not want the appointment and hopefully they will phone to cancel the appointment.

Thank you for your feedback and hopefully this will help other surgeries in dealing with their DNA’s.

3. DNA and the Patient’s Experience


I have had several people contacting me regarding my posts on DNA’s.

The first blog I did was the impact DNA appointments have on Hospitals and Surgeries.

The second blog was in response to a comment made by a Reception Team Leader and how her surgery is proactive in dealing with this problem, which I might add I think is a great system.

This the 3rd blog on DNA’s is from a patients point of view.

Someone contacted my regarding DNA’s and how this impacts on the health service resulting in people having longer waiting times for appointments.

This lady had a hospital appointment a couple of weeks ago, she realised the week before that due to unforeseen circumstances she was unable to keep the appointment the following Monday afternoon, and working in the healthcare sector knew how important it was to cancel the appointment and give someone else the chance of the appointment.

On the Wednesday the week before her appointment she tried to call the consultants secretary to cancel the appointment.

She was greeted with a recorded message saying that the secretary was on holiday and the secretary actually said in the recorded message there was no facility to leave a message. She asked that people call back on her return in 10 days time.

Obviously this would be too late to cancel the appointment. So this lady phoned the hospital and asked for outpatients department, the switchboard put her through and it rang and rang and no one answered. So she had to phone the main switchboard back again. She explained that no one was answering in outpatients, but she was put through again anyway – and again no one answered. So, she had to phone back yet again, she explained about wanting to cancel her appointment, before she could say much more she found she was put through to the “secretary” again, and heard the message she originally heard – and the fact she couldn’t leave a message!

She gave up at this point and left it until the next day when she tried again. She said that she was put through to several different departments, no one wanting to take responsibility for the call she was even told to phone the secretary on her return in 10 days time. She explained that the appointment was in fact in 4 days time and wanted to cancel it and not have a DNA against her name.

She got nowhere – so tried again on the Friday – the same run around.

Monday morning the day of the appointment she phoned the hospital and finally got put through to someone – she explained that she was unable to attend her appointment that afternoon and could they cancel it and ask the secretary to send her out a new appointment.  After taking the woman’s name said she would.

Two weeks went by and this lady had heard nothing so she telephoned the consultants secretary who was not back from her holidays – and to no surprise she found that they appointment had NOT been cancelled, she in fact had a DNA against her name, and the secretary did not get the message about her wanting another appointment made.

To say she was fuming was an understatement.

So, in order to get the DNA rates reduced it takes time and effort from all involved.

Patients have to be more responsible for cancelling appointments and this needs to be dealt with in a delicate manner.

Surgeries and Hospitals need to ensure that if a patient does cancel their appointment that it is recorded and cancelled and the patients does not received a DNA against their name.

Hospitals and Surgeries cannot moan about the amount of DNA’s they have unless they have a policy in order that will actually deal with this when the patients requests to.

And systems have to be in place that these messages are getting through to the right people.

The lady involved felt that no one wanted to listen to her – the operator just didn’t listen to what she was saying which resulted in her being put through to departments that if she had been listened to could have been avoided.

I would suspect that most patients after the first 2 or 3 phone calls would have simply given up trying to cancel the appointment.

2. DNA – The Reception Team Member


imagesCA3PIWKC

Referring back to my blog on DNA appointments I received a lovely reply from a Reception Team Member who works for a surgery that has approx 25,000 patients.

She too spoke of the frustration that DNA appointments can cause on a daily basis. She now had a system in place at the end of the day where she gets her team to first checks who made the appointment, and whether the patient has already booked. The team approach the patient in a positive manner (ie not guns blazing) as she agreed there could be an error on the surgery in not cancelling the appointment. People will also respond better when someone is approaching them in a positive manner.

The team asks the patients why they DNA their appointment, and in many cases they are extremely sorry for missing their appointments.

I think this is an excellent exercise as it can flag up several issues

  • It can let the patient know you are monitoring the appointments system – especially for those patients that just have not “bothered” to cancel their appointment.
  • It could flag up that patients perhaps are cancelling their appointments and they are not being cancelled on the system
  • Are appointments being booked too far in advance (ie 6 monthly BP checks, or diabetics checks – if so how could your surgery best deal with this.
  • Could highlight the importance of giving out appointment cards whenever possible.
  • Could highlight those few that are constantly not turning up for appointments.

When speaking to the patients regarding their DNA try to get the reasons why in a positive way and look at ways of improving the amount of DNA’s that your surgery has.

What would be helpful would be when you are talking to the patients if it is the first time you speak to them about their DNA you could explain that you are trying to look at the amount of DNA’s and at ways of decreasing these and their feedback on why they DNA would help with this exercise. Explain if patients cancel their unwanted appointments then this will free up appointments for other patients – which could be them. This was it will turn the telephone conversation into a positive one instead of a negative one.

But I am sure getting a phone call regarding a DNA will certainly get a patient thinking more carefully next time if they simply do not want the appointment and hopefully they will phone to cancel the appointment.

Thank you for your feedback and hopefully this will help other surgeries in dealing with their DNA’s.