“Our Trust serves a population in the most deprived decile of the country. Whilst of course reducing Did Not Attend rates and increasing Clinic Booking Utilisation rates are about improving productivity, at its heart they are also about reducing the health inequalities that many members of our community experience.” Ned Hobbs, Chief Operating Officer & Deputy Chief Executive Officer at WHNT
Following on from our previous blog on Understanding the Impact of Health Inequalities in the UK, this article looks at the links between socio-economic status and DNAs, how they impacted Walsall Healthcare NHS Trust (WHNT) and how a patient focus approach was key to addressing issues.
A crucial part of our Outpatient Improvement Programme with WHNT was addressing health inequalities among patients in the region, improving access, and reducing safety risks associated with long waits. To learn more about the full programme of work we undertook at WHNT, click here to read the case study.
Links between socio-economic status and DNAs indicate a higher likelihood of DNA where the patient is from an area of high deprivation. The scale of the problem is vast, nationally, in 2021-2022 there were an average of 650,000 DNAs per month, each reported to cost £120, totalling £936,000,000 for the year.
In WHNT over 44,000 DNAs were recorded in 2020-2021, straining healthcare resources, leading to inefficiencies in clinic utilisation and delaying care for patients. The patient population served by the Trust is characterised by its diversity in terms of socio-economic status, introducing unique challenges related to digital disparities, language barriers, and financial constraints.
A Tailored Approach to Healthcare Access
The Four Eyes Insight (FEI) programme needed to address the challenge of digital inclusion, ensuring that solutions considered the nuances of the diverse patient population. While digital solutions offer benefits, they could inadvertently exclude individuals lacking access to or proficiency with technology. The programme aimed for a dynamic approach that addressed the unique needs of patients who might face ‘digital exclusion.’
In order to maximise clinic utilisation and operational efficiency, innovative solutions to the problem of last-minute appointments and cancellations were required, while engaging patients effectively and ensuring they were informed about their appointments and healthcare options was essential.
Patient Focus and Engagement
“The importance of access to healthcare appointments has never been as relevant. Ensuring the barriers to attending hospital appointments by listening, hearing, and understanding the patient’s voice is crucial to preventing DNAs and reducing health inequality. FEI acknowledged this and supported patient involvement in the task and finish group so that the intended outcomes had the patient at the forefront.” Garry Perry, Associate Director of Patient Relations and Experience at WHNT.
Collaboration with patients and end users was prioritised throughout the process to ensure that the implemented changes were sustainable.
The importance of patient involvement was recognised and several key strategies were employed to ensure the patient views were considered in all interventions. Patient involvement included:
- Patient Focus Groups: The partnership facilitated patient focus groups in the community to gather insights into patients’ challenges related to appointment attendance. These sessions ensured that patients’ voices were heard, and their perspectives considered in designing solutions.
- Surveys and Feedback: Surveys and feedback mechanisms were introduced to capture patient experiences and reasons for missed appointments. This feedback was integral in shaping the programme’s approach.
- Pilot of Transport Changes: Recognising that patient experience extends beyond the clinical encounter, the partnership piloted transport changes aimed at improving accessibility and convenience for patients. The pilot prompted the Trust to actively promote the range of reimbursements and support options available to patients, particularly concerning transport costs.
These insights served as guiding principles, ensuring that the programme was finely tuned to address patient needs and concerns, ultimately resulting in improved patient experiences.
“Working in collaboration with WHNT on the outpatient services programme was a genuine partnership. It was truly inspiring to see how this joint effort enhanced patient care and streamlined clinic operations. Together, we made a meaningful contribution to improving healthcare accessibility, and I’m proud to have played a role in this journey.” Gurpreet Rai, Consultant, FEI.
Improving DNA rates by addressing health inequalities
Actions were taken to improve the DNA rate, focused on process change that ensured hard-to-reach patient groups that may experience health inequalities were not disadvantaged, including:
- Appointment Reminders: rolled out to over 200 previously excluded clinics, voice reminders were introduced for patients without mobile phones and efforts were made to provide reminders in multiple languages.
- Transport Support: Following a pilot project assessing the impact of offering free transport options to patients, a streamlined process for claiming travel costs was introduced. Patients could now be reimbursed on the day of the appointment, eliminating the need for lengthy processing. Information sheets explaining the process and eligibility were included with appointment letters, resulting in increased financial support uptake and reduced DNA rates.
- Letter Enhancement: Letter language was simplified, and patients were encouraged to check in at the outpatient reception desk to receive directions.
- Webpage Translation: A dedicated webpage was created to translate appointment reminders into different languages, ensuring inclusivity for patients with diverse linguistic backgrounds and enabling automatic translation during phone calls with hospital staff.
- Bespoke Processes: Specialty operational and clinical leads collaborated to develop targeted approaches where DNA rates were high. Examples include overbooking slots in some clinics, implementing Patient Initiated Follow-Ups (PIFU), and using bespoke text messages to address specific challenges in various specialties.
- Validation Initiatives: Validation exercises initiated in specific specialties, such as Gynaecology, Trauma and Orthopaedics, expanded across the Trust. FEI drafted Standard Operating Procedures (SOPs) which the Trust rolled out across specialties.
An average decrease of 52 DNAs per week was achieved (19/06/23 – 13/08/23) compared to the same period in 2022. Annually, this will equate to more than 2600 patients who will now be seen who would previously have missed their appointment.
To learn more about how Four Eyes Insight can help your Trust improve DNA rates by addressing health inequalities, contact us today to arrange a call with Outpatient Subject Matter Expert and Delivery Director, Samantha Sullivan.