Identifying Key Facts
Before implementing Choose and Book System, Britain’s National Health Service suffered losses of up to 225 million GBP annually because of patient no-shows. The system was launched in 2004 as a part of large-scale IT modernization. The idea behind Choose and Book was to provide patients with an opportunity to select a hospital for their further outpatient appointment. It aimed at speeding up the referral process, stemming losses mentioned above, and eliminating costly paperwork.
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However, it turned out to be a failure, so NHS was forced to design the new system to deal with the limitations of Choose and Book. Launched at the end of 2014, e-Referral Service focuses on reducing waiting time for receiving care. The primary ways to achieve the objective are to implement a totally paperless environment, which would minimize the amount of data errors and eliminate costly paperwork and use an open platform and programming interfaces to turn the system into flexible and easy to navigate in. The new system is expected to ensure that all referrals are certain and all appointment slots are available.
Identifying Key Issues
Even though the initiative was promising, it faced the challenge of incompatibility of computer systems of most hospitals and the unwillingness of many doctors to use it. It was a combination of technology and organizational problems because it was vital to invest in computer systems upgrading and personnel training before launching the system to make it successful. Second, its cost was nearly twice as big as NHS’s losses before implementing it and reached 356 million GBP.
This problem has management and organizational background and goes straight to the inability to organize the workflow and book all appointments. Finally, only half of the first-time outpatients had secure and certain referrals. It entailed longer waiting time to receive care, patients arriving at incorrect times, and waiting for the wrong professional. This problem is a combination of all three challenges – technology, management, and organizational – because the hospitals were not ready for the system embodiment and personnel as well as patients did not know how to operate it accurately.
Alternative Courses of Action
It would have been possible to solve all challenges without implementing the new system, but through improving the existing one. The first alternative course of action implies upgrading computer systems and training personnel. The second one is designing an intuitive interface for the system and the referral process with hints at every step to minimize the chance of making a wrong choice of a professional or facility. The third alternative is to introduce the system of rewards and penalties to diminish the risk of not booking an appointment, i.e. create the system of control and responsibility.
Evaluating Alternative Courses of Action
The first alternative would handle technology problems. The drawback of this course of action is its costliness. The second one would make it easier for patients to choose the right physician or facility because they would have clear hints. However, it requires additional resources and professionals to bring the necessary changes to life. As of the last alternative, its only limitation is a moral barrier because change, especially one promising penalty, is always hard to enact. However, it would decrease the time for receiving care, minimize treatment delays, and guarantee that all referrals are listed.
Determining the Best Alternative Course of Action
The best alternative is to develop a system of penalties and rewards because it would serve as motivation to make the workflow smooth. In this case, even if a hospital has some technical problems or working environment is still hybrid, this course of action would improve the performance because employees are not interested in being penalized. Moreover, it does not require additional costs for upgrading the system design.
Answering the Questions
Clarify and describe the problems of the NHS Choose and Books System. What management, organization, and technological factors were responsible for these problems?
Technologically, not all hospitals were ready for the implementation of this system because the computers they operated were incompatible with the system’s requirements. From the organizational perspective, the decision to provide patients with an option to choose physicians and facilities made the process time-consuming because many patients had problems with navigation and confusing choices. As of management problems, they included the inability to make all hospitals use the system because some doctors refused it as well as the long waiting time to receive care because of failing to list all outpatient appointments and last-minute cancellations.
To what extent was Choose and Book a failure? Explain your answer.
To my mind, saying that Choose and Book was a complete failure would be a lie because even though it had numerous problems and maintenance costs were spectacular, the referrals of more than half first-time outpatients were reliable, secure, and certain. For this reason, the system was considered one of the NHS’s most successful initiatives. That is why I believe that its failure could be estimated at the level of approximately 50 percent.
What was the economic and social impact of Choose and Book?
Economically, Choose and Book failed to achieve its primary strategic objective – cut the losses caused by patient no-shows. The cost of the system maintenance was twice as much as the initial losses. Moreover, projected annual savings never materialized as well as the objective of booking up to 90 percent of referrals was never met. As of the system’s social impact, it resulted in even longer waiting times to receive care because the personnel failed to book all outpatient appointments and deal with the challenge of no-shows and last-minute cancellations.
Describe the steps that should have been taken to make Choose and Book more successful.
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Choose and Book might have been more successful if the stress was made on computer systems upgrading and personnel training to make the implementation process flawless. Moreover, the transition to a totally paperless environment, changing the interface so that it would be easier for patients to navigate and make the correct choice of a physician and facility, and introducing the system of penalties and reward would have been beneficial.