P065 Lateral thinking in dermatology led by lean methodology

Abstract Currently, there are nearly 60 000 patients on national dermatology waiting lists in Ireland, representing a growing concern for departments across the country. This study describes the experience of a tertiary adult dermatology department addressing waiting lists utilizing a person-centred research method. Within the hospital, a Lean Six Sigma Academy exists dedicated to improving healthcare processes and patient experiences. Lean Six Sigma is a philosophy that adopts a team-focused approach to improve system performance by eliminating resource waste and defects. Lean Six Sigma methodologies were adopted to inform and drive the improvement process. Lean practitioners led a week-long collaboration between dermatology medical, nursing and administrative staff to identify problem areas and brainstorm solutions to implement change. They visualized real-time processes as they were performed to identify tasks that did not benefit a specific outcome or service. Main problem areas were identified; they included a need to address waiting-list numbers, and subsequent difficulties relating to patient referrals, triage and appointment scheduling. Dedicated outpatient clinics to review patients classified as routine, long waiters were established to clear a backlog of 2000 patients within a timeframe of 6 months. A new referral pathway was established with all referral letters uploaded to a single dermatology worklist. Nationally approved exclusion criteria were applied to inappropriate referrals, which were subsequently returned. Standardized triage criteria were established and referrals were divided according to the clinical commitment of each consultant. A ‘rotating triage consultant’ role was implemented. Furthermore, all appointments were scheduled with letters sent to each patient within 1 week of receipt of referral. As a result of these collaborate efforts, urgent referrals were reduced by 61% (from 118 days to 45 days), semiurgent referrals by 70% (from 517 days to 155 days) and routine referrals by 32% (from 358 days to 241 days). Furthermore, the number of patients waiting > 12 months for an appointment decreased by 60% (from 1615 patients to 634 patients). These changes culminated in a 40% reduction in the total number of patients on the waiting list (from 3736 patients in September 2020, to 2228 in June 2021). In conclusion, this study demonstrates the benefit of adopting a person-centred approach utilizing Lean Six Sigma methodologies to facilitate service improvement initiatives in the healthcare setting. This study can guide other dermatology departments to enhance departmental capacity, increase efficiency and achieve sustainable quality improvement goals to transform service provision in dermatology.