Headlines: July 21st, 2000

A review of hospital outpatient management systems found that many are archaic with practices dating back to the 1950s. There were few long term improvement plans and rarely did Executive Directors have a direct responsibility for their management. Guidance issued by the Department of Health now requires NHS Trusts to introduce a new booking system model which has shown in trials that it is possible to reduce waiting time for outpatient first appointments by 40%. They are also required to set up a Clinical Management System, which initial use suggests will find surplus capacity in about one third of clinics.The findings of the review are relevant to any public service developing strategies for productivity and quality improvement. Services will not perform well without active leadership and dedicated senior management time. Where there is no senior management involvement, functional groups will operate in watertight compartments with no sharing of resources. Historical patterns of provision can quickly become out of date and there is a need to challenge patterns and track changing need. Most of the information needed to operate the Clinical Management System was already collected by clinics, but it was used for accounting and other purposes, consequently there was no overview of how the system was performing from a management perspective. Moving the focus away from the clinic and on to the patient not only improved the service, but also increased efficiency.