Let’s avoid another crisis

  |   MBI Perform

With winter rapidly approaching all NHS bodies predicting and the media are reporting on its latest A&E “crisis”. In June 2013, we published a blog on The Domino Effect.  We believe it is time again to reiterate some of our thinking and introduce something new. Already the waiting list in England is at its highest in 5 years, but more worrying than that, is the collective drop in priority that hospital waiting times have experienced.


Many of the hospitals we advise have significant issues with RTT and Cancer. They often suffer from a lack of understanding of the rules, high turnover of clinical administrative staff and a consistent inability to manage clinical variation and behaviour.


A reminder-the key to achieving RTT performance. Ruthless Simplicity.

  1. Pathways with ‘hand-offs’ to other departments need to be concentrated on first: particularly diagnostic tests, prosthetics, orthotics and consultant to consultant referrals in other specialties.
  2. Information reports need to be aligned to operations: we often find information departments who do not understand RTT or Cancer and produce meaningless reports of little value to operational teams and clinicians.
  3. Pay attention to clinic outcomes: this is often the most critical stage of recording in RTT and Cancer. Failure to record properly results in increased unnecessary validation being required.
  4. Identify ways to reduce the number of outpatient appointments required with consultants in secondary care by ensuring patients access care at the most appropriate place: we live in the 21st century with a raft of technology available to us, phone consultations, online consultations and reducing the need for patients to actually come to the hospital should be the norm.
  5. Adherence to RTT rules:  regular audits and formal training programs for all clinical administration staff need to be seen as a priority in managing pathways. The recent example of Cancer waiting times not being recorded accurately at Colchester University FT proved the value of scrutinising how things are being recorded and staff trained.
  6. Understand your Clinical administration functions: We find this to be the first area to be cut when an organisation is in financial difficulty yet this is the key to managing patients through the hospital – this is a clear diseconomy.
  7. Work to minimise cancellations: We often find operations which require HDU and ITU input being scheduled on the same day when they could have been spaced a day apart – the lack of scheduled theatre planning results in unnecessary cancellations which the system cannot cope with during winter.


Delivering RTT is not about having more managers or enhanced top-down performance controls. It is about having essential building blocks that enable understanding of the issues – building clinical, administrative and IT resilience.


Nudge Nudge Wink Wink – A ruthlessly simple idea.


Decision making is vital. At MBI Health Group we are developing “Choice Architecture” for RTT and Cancer performance. These are interventions where a system actively encourages its teams to make better choices. Nudging staff and users alters people’s behaviours in a predictable way. However the nudging needs to be easy and cost effective to implement. In supermarkets, having promotional products at eye level encourages more people to see and buy.


We want our clients to improve RTT performance. We want clinical management teams to make the right decisions.

  • Put patients first
  • Book in Date Order
  • Record Clinic Outcomes Properly
  • Offer Patients Two Appointment Dates


Behavioural change is often the hardest thing to influence in hospital operations. MBI don’t think this is achieved by a 100 page slide deck of analysis, followed by a workshop chaired by one of our Partners and a Clinical Subject Matter Expert.


It is behaviour related so investment and interventions need to change just that.


Want to work with us on the Seven Rules or develop Choice Architecture or even hear more about MBI Health Group ideas?  Then please connect with us.