Abstract

Background

An increased number of therapeutic options in mRCC have extended median survival beyond 3 years in recent clinical trials. These important clinical advances have led to increased complexity and rising patient numbers within already pressurised NHS outpatient services. The Christie renal team wished to evaluate and improve outpatient processes to cope with this additional patient demand.

Method

This ‘Medical and Educational Goods and Services’ (MEGS) project was conducted in collaboration with Pfizer Ltd and Quintiles . Aims were to improve patient experience, identify inefficiencies in processes, and standardise operational processes. Phase One ‘diagnostic’ involved stakeholder interviews, patient surveys and clinic observations. Phase Two involved identification of key deliverables.

Results

Phase One: Patient Survey results were positive regarding overall patient experience, but confirmed frequent clinic delays (>50% surveyed saw doctor >30 minutes after appointment time). Inefficient processes were identified (25% surveyed sometimes saw doctor more than once during same clinic). Stakeholder interviews and clinic observations identified problems in key areas including: staffing (lack of full-time renal CNS which was “critical to the patients and to the service”); clinic templates (predictable demand was variably managed); availability of scan results; phlebotomy operational policies (problems due to batching of samples); clinic prep and ownership of patient flow during clinic attendance.

Phase Two focused on 3 core deliverables:

1. Suggested improvements in clinic management/performance were fed into existing Christie Outpatient Management Project
2. Drug-specific pathway flowcharts and action charts were developed to standardise renal outpatient processes
3. A ‘case for change’ was developed to support a business case for expansion of CNS role and implementation of dedicated CNS clinic stream

Conclusion

This novel MEGS project has directly benefited mRCC patients at our institution by identifying and improving operational inefficiencies, and through support for a business case to expand the CNS role. This model could be readily adopted at other NHS institutions.