Data quality and validation of RTT PTL to support recovery of Elective Care performance

Feb 2023 – Dec 2023

Background

Like many other systems, our client’s challenges had been exasperated by the impact of Covid 19, continual workforce capacity gaps and more recently, strikes
At the beginning of 2023, there were over 44,000 patients on the incomplete PTL – twice as many as expected
As a result, the Trust was placed in “Tier one” by NHS England – the most at-risk category for achieving both Elective and Cancer care performance targets
There were significant capacity issues, especially not having dedicated support to consistently validate the PTL to keep up with demand
There were also IT infrastructure challenges such as an antiquated PAS system and a lack of standardised process across the organisation
It was extremely difficult for our client to manage the incomplete PTL whilst also pro-actively reducing it to the expected levels

Problem

After carrying out an initial investigation some of our key findings included:

Significant cancellations due to appointments being booked for patients who had already been discharged / no longer needed them
Inflated PTL due to non-application of Clock Stop when patients had already been treated or discharged in some cases
Duplicate pathways being created causing inflated figures
Turnaround time of investigations were challenged due to the service being overwhelmed, thus causing patients to wait longer on the PTL
Non-action of IPT out pathway meaning the pathway on the PTL was longer than it should be
Non-action of Clock Stop from administrative process

Action

Following the discovery phase, it was agreed that we would deliver an in-depth validation and data quality exercise of the incomplete PTL across all elective pathways. We sought to determine the accuracy of the backlog as well as reducing it as quickly and safely as possible. We were also able to recommend areas for sustainable improvement across three key areas; process, systems and workforce. Steps taken include:

Identified duplicate pathways and removed them from the PTL
Improved the system of managing ‘long waiters’ to ensure that appointments were needed before booking
Identified the IPT Out pathway and treated the pathway accordingly as per the RTT rule
Validated pathways and applied appropriate Stop Clock when required
Identified and fixed pathways that were incorrectly stopped
By focusing on the forward look and not just on the backlog PTL, the team were able to implement practices to ensure where possible they were working towards specific milestones and the number of patients adding to the backlog was reduced
Advising the Trust on how to manage patient pathway correctly in line with national guidance

Impact

In 11 months, our team have validated a total of 28,758 records with an average clock stop of 42%
Significant contribution to the rapid reduction of the PTL as well as maintaining a stable position whilst the Trust goes through a challenging period
Assisted our client in mitigating reputational damage across the system and nationally as well as providing the capacity and resilience to deliver business as usual
Reduced the number of pathways in the incomplete PTL
Implemented sustainable change in pathway management via the nominated Elective Care Manager
Developed key milestones for adequate escalation and advised the Trust on implementing nationally recognised best practice
Our client’s validation record is currently over 80% on target for all >12 week waits. The table below shows the figures for 2023:
Below is a graph of our client’s RTT PTL between Jan – Dec 23 showing a 23% reduction:

COLLABORATE • CONNECT • CREATE • CO-DELIVER

COLLABORATE
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CONNECT
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CREATE
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CO-DELIVER

COLLABORATE • CONNECT • CREATE • CO-DELIVER

Collaborate for Success Connect for Growth Create for the Future Co Deliver for Impact

Collaborate

Collaborate to discover the problem

Connect

Connect to design the solution

Create

Create the action to move forward

Co-Deliver

Co-deliver to design the solution