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Here at DrDoctor, we decided to look at the maths behind clinic utilisation to gain an insight into the different variables that could be controlled to reach a perfectly run clinic. We wanted to dissect the theory behind how clinics could ensure that 100% capacity could be reached. Part of the definition of a successful clinic is surely one where all potential slots become attended appointments. Traditionally clinic utilisation is defined by the booking efficiency of a hospital, as well as the number of DNAs taking place, and is calculated as:
We wanted to take this equation further as we feel there’s no point in knowing your clinic utilisation without understanding the different parts it actually consists of. Identifying the different components is the first step in understanding how they can be manipulated to increase clinic utilisation.
Booking efficiency is a metric that describes the amount of appointment slots that are booked at the time of the clinic. For example, if a clinic has 10 potential slots available, and only 8 of these were booked, your booking efficiency is 80%. The DNA rate of a clinic is traditionally heavily associated to the financial performance of a clinic. We say this all the time; although the DNA rate is naturally important, it should by no means be the sole focus of a hospital when looking at clinics and if they are being run in the best possible way. In this situation, let’s say every one of those 8 patients turned up for their appointment and the DNA rate is therefore 0. No financial benefit can be associated to this, as two appointment slots went empty and the full potential of the clinic was therefore wasted.
Breaking down a higher level metric into separate constituents allows for more accurately targeting the areas that contribute to clinic utilisation and to further gain control over these changes. We already know that DNA rate as well as booking efficiency contribute to clinic utilisation. However, these two variables aren’t enough to explain clinic utilisation, simply because the maths doesn’t add up. Working backwards (with GCSE algebra) you can work out the missing part.
The missing part
The booking teams working in the NHS are under immense pressure to report clinic attendance outcomes in a timely manner, otherwise the hospital will not be paid for the attended appointments in a clinic. Naturally greater emphasis is put in reporting attended vs not attended appointment slots. Equal emphasis isn’t always put in explaining the different types of missed slots, i.e. defining between DNA & late cancellations, or reporting why a patient did not attend. The uncategorised appointment types are often marked as ‘other’ for reporting purposes and are not accurately monitored. This is why clinic utilisation is most often not correctly explained.
Utilising the ‘other’ category for appointment types saves time and allows for efficient reporting of a clinic’s outcomes. We have taken this into account in our equation by identifying a variable called the confidence rate. The confidence rate describes how accurately each appointment outcome has been reported i.e. how confident you are in your data and that the ‘other’ category has been cashed out in reporting.
If a slot isn’t booked it won’t be attended, if a person DNAs the slot won’t be attended, but the sum of these two does not equal clinic utilisation. The missing part of the equation is the confidence rate and appears as the complex part, but actually is self-explanatory.
The equation
This gives us an equation with three parts; booking efficiency, DNA rate and confidence rate. Due to mathematical correctness, instead of using the actual DNA rate we use the inverse of it, i.e. the attended rate. When you mathematically work that out through a long and complex rearranging of letters and numbers, you end up with:
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“That looks impressive”- you say.
What this actually means is that if you want to achieve 100% clinic utilisation, the overall aim should be to make the number of bookings the same as the number of slots at the time of appointment. In a nutshell, you want to increase booking efficiency, reduce DNAs and decrease the variables affecting the confidence rate (such as late cancellations).
Mathematically speaking this would end up leading to 1/1 which equals 100% i.e. a clinic that has its potential perfectly utilised.
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If you want to discuss our thoughts further, brainstorm other factors that make up a perfectly running clinic, or fancy an algebra refresher- please get in touch! We love to hear from you!
