NB I HAVE PUT A TOPIC HEADER ON THIS, THERE WAS NONE ON THE ORIGINAL
POSTING
Alan Midgley has proposed a system for managing waiting lists.
His system relies on assigning relative priorities WITHIN a single
source of patients who join a waiting list, and the use of this
priority centrally.
This problem is very akin to that of scheduling services in a
multi-tasking computing environment, and it might be well worth
looking at the literature there to see if it is relavant. One of the
most succesful schemes was devised by John Larmouth in about 1970;
Larmouth's scheme even included a methid by which someomne seeking
service could crank up what he was prepared to pay to get it.
Mike Wells
> From: [log in to unmask]
> This arises from an idea which occurred to me during a commissioning group
> meeting.
>
> While discussing waiting list management the usual problems popped up:-
> -hospital admissions department telling patients that their GP could get
> them advanced by writing a letter to the consultant;
> -delay in general
>
> A solution which was floated was that individual GPs or practices could
> acquire the right to manipulate their own waiting lists, by swapping one of
> their patients (say) who is 20th on Mr Cuttem's waiting list with the more
> urgent or strident patient who is 50th on the same surgeon's list.
>
> This clearly fails, even if extended to medium sized practices because the
> numbers of patients available to an individual GP/practice on the WL for
> one consultant in one specialty is too few to permit useful manipulation -
> typically it would be one or two/GP.
> It was also unwelcome on the grounds that a patient being told that they
> had not been called for surgery yet because their GP had moved them down
> the WL might be dissatisfied. Not an absolute reaction there, but a clearly
> functional system would have to be delivering benefits to overcome this
> objection.
>
> Further objections or problems included the lack of comparability between
> different GPs patients (for urgency) and between the different consultants
> who the different GPs refer to.
>
> A SOLUTION
> -THe theoretical form of a solution occurred to me at this point:-
>
> -In practical terms the manouvre demanded of GPs would be that taking the
> list of every patient of their practice, (or perhaps done by individual GP)
> they rank all these patients in order from most urgent to least urgent.
> Note that this means including medical and surgical, orthopaedic and
> gastrointestinal, rheumatological and dermatological etc all in the SAME
> list.
>
> -It is not conceptually difficult to imagine facing a list of all your
> waiting patients, a useful idea in itself, and taking them two at a time
> deciding to place on above or below the other. One might do it with a
> stack of paper cards, or with a program, the concept remains the same.
> -A question I have not resolved is whether to allow equal choices,or
> toforce a decision. On the whole I prefer to force the decision while
> accepting that the differences between adjacent patients in the list may be
> small or trivial (indeed the difference in urgency between 49percent down
> the list and 50% down the list must be small.
> -Note that nowhere here am I trying to set out how one decides, doctors
> always have, and the GP looking at it is agreed to know more about the
> patient than the doctor who hitherto has decided, but less about anyone
> elses' pateints.
>
> CORE CLEVER CONCEPT (?)
> -THe vaguely clever bit comes in here.
> -THe rank order is reported to the central clearing house (almost certainly
> in the hospital Admissions Dept but perhaps owned by the HA or the
> Commissioning Group. (method of reporting unimportant, ranges from fax or
> printout to a tailored EDIFACT message - unimportant in form)
> THe report must specify the position of each patient relative to the whole
> of the list at that practice/GP, and do so by giving the proportion of the
> way down the list they come.
> -The assumption I have made is that on average, the patient who comes 37%
> down your list in a practice of 6 GPs will be as urgent as the patient who
> comes 37% down my list in my practice with one GP.
> -I specifically reject reporting them in order as number 1 - 2 - 97 as the
> different sizes of practice and list and the random variations in numbers
> of patients on the waiting list would render this unworkable.
>
> -I would welcome a statistical view on that - I think it is a proper
> assumption.
>
> One number is therefore reported for each patient. (eg 37%)
>
> COMBINING
> At the hospital the software (or a shuffler with a really big stack of
> cards a rubber and a pencil) combines the numbers reported.
>
> Each consultant's waiting list is then sorted out of it and the relative
> urgency compared to other patients at the practice of origin for each
> patient is available to inform the consultant's decision on where in their
> waiting list the patient should be.
>
> -THis can also be used to approach the age old pleading "patients referred
> to my specialty are more urgent than patients referred to his specialty"
> although clearly not to actually resolve it<g>
>
> SUMMARY
> I describe a method of combining the consultant's knowledge of resources,
> and of other GPs' patients' urgency with the GP's knowledge of the
> individual patient's urgency.
> The advantages are to offer a more accurate or at least informed appraisal,
> tooffer it automatically to every pateint rather than to those who complain
> or are fortunate in having a more active GP or a personal relationship
> withtheir GP, to automate* the process so it is repeatedly and accurately
> carried out; to remove a proportion of telephone pleading and second letter
> writing from GPs, and reading them from consultants.
>
> --------------
> *even if it is done with a deck of cards.
>
>
>
>
>
>
>
>
>
>
> --- OffRoad 1.9n registered to Adrian Midgley
>
>
> ----------------------
> Dr Adrian Midgley GP Exeter
> [log in to unmask]
> Fax 01392-436105
> ----------------------
>
>
==========================================================
Professor Mike Wells
Department of Physics, The University of Leeds
Leeds LS2 9JT, United Kingdom
Phone: 0113-233-2339 E-Mail [log in to unmask]
==========================================================
%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
|
