Triage system- featured on Ockham healthcare podcast
We may not have the Harry Potter sorting hat, but we have a clinician in our reception triage team and that comes pretty close!
We can’t have the Harry Potter sorting hat making decisions as to where to put our patients, but the smart use of a triage system using a clinician integrated into your reception team comes pretty close.
I’m David Stokes, aka the Efficient GP, GP partner at St. Lawrence Surgery for 10 years. My practice manager, Jo Wadey and I were interviewed by Ben Gowland on the Ockham Healthcare Podcast where we discussed the merits of our triage system.
If you want to hear the episode it is here:
https://ockham.healthcare/podcast-practice-index-triage/
It’s been so successful in transforming workload, efficiency and relationships in the team that I’ve been asked by many practices how they can do the same. In this article I’ll share how we did it. To help practices beyond my locality to meet their demand, I’ve distilled the ‘how to’ into a course launching next month (May). By signing up to this newsletter, you’ll be the first to hear about it.
What is it?
Put it simply, we have a clinician embedded in our reception team as they take the calls from patients. Members of the team take a brief history of the patient's problem, present it to the clinician and a plan is made as to the best next steps to resolve the patient’s issue.
Two things happen that increase effective capacity:
A significant proportion of calls are dealt with there and then, that would otherwise have taken up an appointment
Patients needing appointments are booked in with the most appropriate clinician first time. - That’s the person with the skill set to resolve their issue most effectively. Many appointments are wasted when patients are booked in with someone who can’t help them, and they get rebooked. Similarly, patients with complex histories can be managed effectively with the fewest touch-points if they are seen by someone who knows the back story. When demand is high, the tendency is to book patients with whoever is free, but this rarely resolves their issue.
These advantages alone more than make up for the clinician being taken out of the appointments for the day. However, over time a number of additional benefits have shown themselves:
Increased job satisfaction and retention of reception staff - they feel better supported, valued and integrated into the wider practice. Less rudeness to reception staff from patients
Significantly increased patient satisfaction.
GPs feel less isolated - it’s quite fun being with a group in an open office rather than alone in a room
The duty GP can give ad-hoc advice to the multidisciplinary team as needed
It helped us meet our CQC requirements and it was stated as the reason we retained our “Outstanding”
As the new QOF focusses on access there couldn’t be a more important time to look at this.
How did we get to this point?
We haven’t always had this system. A few years ago, prior to the pandemic, I was the GP in a small team working to turn around a practice that needed to change following CQC recommendations.
The clinician-in-triage was one of the first things put in place. This was about managing the immediate crisis, a temporary measure to regain control of the workload safely.
The clinician guided the reception team so that the scarce clinical resource (the doctors, nurses, paramedics and HCAs) could be matched to the patients that really needed it, keeping them safely cared for and giving the clinical team some breathing space.
The surgery team were fantastic- bold, brave and up for making the change - and when we saw the initial results they surprised us all. We saw that it worked so well on one of the main challenges in general practice - bringing order to the wave of undifferentiated need that arrives each day.
Now here I was looking around me realising we had a lot to learn on home turf. I could see that we had a problem common to many practices. We were struggling with “call back tomorrow disease” for all the patients who didn’t feel able to say that their problem was “urgent for today” once the day's appointments had been used. I wondered if we could improve our system with the same triage approach.
How did we do it?
To investigate further, we called in the help of Andy Wadey of Premium Primary Care. His background in logistics for big companies such as the Body Shop helped us look at our own data. It confirmed that the same telephone numbers were calling day- after-day, trying and failing to get an appointment. At the same time, other patients were being seen one, two, three and sometimes four times in quick succession as their problem hadn’t been dealt with effectively the first time. We decided to implement the model we’d seen at the turnaround practice to see if it could work for us too.
Now was the moment to pause. Changing something as big as the appointment, triage and duty system is a big undertaking. It’s the route into the practice and involves a lot of staff. We were careful to plan it properly and worked with our colleagues as we wanted the change to be positive, something people could get behind, rather than a disruption.
I drew on change management templates I’d learned about to involve the team in the solution so the process looked something like this:
Identify the problem >> Communicate!!
Engage the key team members >> Communicate!!
Develop the solution >> Communicate!!
Engage the team in the design of the solution >> Communicate!!
Communicate the solution >> Communicate!!
Launch >> Communicate!!
Regular review and improve >> Communicate!!
In case it isn't becoming apparent from the above, communication cannot be overdone! The data we’d generated on how people were actually using appointments was really fundamental for at least 1-5 above.
A word about making the change….
At the heart of any successful change is the ability to bring the people involved along on the journey. Without that, it’s unlikely to work, or continue for long before being undone.
If your head of reception hates the idea, without winning them over you are going to struggle to make a change like this a success.
If your GPs are not happy about the idea similarly you are not going to get it off the ground.
We convinced our team with the results seen at the turnaround practice (now rated Good) and the data we had worked on from our own practice with Andy. It’s hard to argue with such clear data. Having this expertise was invaluable and allowed us to show both the problem as well as the potential solution.
We then brought the various teams together to consider the implications of the change on their work and to design the system so that it would work for everyone. They got comfortable with it before the change.
We spent a lot of time preparing all the teams. In particular, we supported the reception team with extra communication training and resources for the duty team to make the day run smoothly. We also had to let the patients know what to expect as reception staff would now be asking about their medical conditions.
In the beginning, daily debriefs reviewed learning from the day which fed into changes to refine it as we went along.
How did it go?
The system worked beautifully and, as predicted having looked at our data, things got easier and more satisfying in a few short weeks.
We have not stopped learning, developing and improving the model. The joy is the techniques we used in developing the model have allowed us to remain flexible and adapt the system as we need. Especially during the pandemic and subsequent massive changes in demand for general practice.
A number of local practices have come and used this model successfully to help their demand, and there has been great interest from around the country since the podcast in how this may be used in other practices.
If you are interested in finding out more, subscribe to my newsletter. I am developing a course that is designed to take you through this step by step in your own practice. I will also be sharing lots of other Efficient GP tips and tricks - remember it is efficiency that gets you home on time!
I look forward to hearing your thoughts and questions
David
Exciting news, the Clinician-led total triage course is now live if you want to get support in rolling out something similar at your practice