health appointments Archives - Clinic Appointments

Cold weather alerts

From the winter vomiting virus to spring hay fever, summer heat strokes to autumn seasonal affective disorders (SAD); every season has its peak illnesses. Of course, any of these can occur at any time, but health professionals are aware that as the seasons turn so too do differing conditions come to the fore.

With that in mind, as health professionals just how do you prepare to meet the differing challenges which the changing of the seasons throws up? It’s not always easy. Whilst some conditions, such as SAD which is triggered by shortening day length, are fairly easy to predict; others may depend on more variable factors.

For example, whilst summer rains might initially help allergy sufferers by washing pollen out of the air, a couple of days later with plant growth having been triggered by the rain you may well find an increase in pollen or mould levels, leading to an increase in allergy presentations. Or to look at another scenario, winter slips and falls are far more likely to occur in icy conditions than on comparatively milder days.

What this adds up to is a need for weather to be taken into account in resource planning. Local forecasts may be of help here, especially when viewed alongside national resources such as the Met Office’s cold weather alert service.

Operating from 1 November to 31 March each year in conjunction with the UK Health Security Agency (UKHSA), the cold weather alert service aims to reduce the impact of severe cold weather on people’s health. It does so by not only predicting weather severity but also providing advice to individuals, communities and agency on how they should prepare and manage differing scenarios.

Building on an alert level 0 which looks towards all year round planning, four other levels look towards steps required to manage anything from mild winter conditions (Level 1) to a major weather incident (Level 4.) So, for instance, Level 2 looks for social and healthcare services to work to ensure that they are prepared to take swift action to reduce the risk of harm from a period of cold weather whilst Level 3 requires those agencies to take specific actions in order to protect high-risk groups.

At the time of writing we are facing alert level 1 in the three northernmost regions of England with alert level 2 across the rest of the country. The level 2 alert specifically warns of a “70% probability of severe cold weather between 1800 on Thursday 13 Jan and 0900 on Monday 17 Jan in parts of England. This weather could increase the health risks to vulnerable patients and disrupt the delivery of services.”

Information such as this helps health providers to create flexible solutions which can be triggered depending on need. Even something as simple as being able to transfer phone calls to a virtual assistant service when demand is high could help with resource management. When the pressure is on to treat as many individuals as possible, the ability to outsource some routine administration matters such as phone answering or even the booking of appointments could just tip the balance towards effective care when it is most needed.

Paying by card?

£58 billion!

That’s the total spend on all credit and debit cards in the UK in April 2017, the most recent figures available at the time of writing. Credit cards accounted for just short of £17 billion, whilst the debit card spend was boosted by the growing acceptance of contactless payments.

Overall our growing love affair with the card as a form of payment has resulted in a 6.8% year-on-year rise in card spending. Partially thanks to the contactless element, this translates into a 12% increase in transaction numbers.

What does this mean for business? Well for a start it makes it far easier for businesses to move away from cheques and cash and towards card payments. The old arguments about cards and businesses which accept cards being the preserve of the few now simply don’t hold sway. So much so, that this writer was surprised recently to be asked for a cheque in payment. Luckily the request came in advance, saving a round-trip to retrieve the cheque book from its secure drawer.

Quite simply, card payments are convenient for both customers and businesses. More importantly, they speed up the receipt of funds for the business. Particularly so in businesses which have traditionally relied on the service/ invoice/ cheque payment route. Simply sending out the invoice and waiting for the cheque to arrive in return could easily take up a couple of weeks; and by the time bank clearing has taken place and funds are available for use the original service is a distant memory. Secure card processing generally delivers cleared funds approximately one week after the appointment.

The growing acceptance of cards as a means of payment has also brought further benefits, particularly for those businesses such as health providers which rely on an appointment system. Taking card details at the time of booking, whether on the phone or online, tends to concentrate the mind and that means that clients are far more likely to turn up for their appointments. Particularly so if the health practice operates a ‘no-show fee’ system, charging clients who fail to turn up a percentage of the overall fee.

Adding a further service such as sending out SMS text messaging or email to remind clients of the appointment also helps to ensure that clients either turn up to their appointment or cancel well in advance. It can be all too easy in a busy life to forget the date or time of an appointment so scheduling reminders acts as a handy aid memoire.

When it comes to health services, anything which can boost attendance numbers is welcome. Both in the public and private sectors time is of the essence and resources are stretched. Those who fail to turn up to appointments not only jeopardise their own treatment plan, they also block or delay the chances of treatment for others. So the hidden cost is far higher than simply having a team of health professionals sitting and waiting for a client who has either forgotten or has no intention of turning up.

Reducing Missed Appointments

The recent junior doctors’ strike has highlighted the cost of cancelling or delaying treatment both to the NHS and to patients. Whilst emergency cover continued to be provided, the inevitable cancellation of some operations has added to waiting lists and left patients having to manage their conditions for an extended period of time.

Whilst these delays have been occasioned by strike action, on a day-to-day basis the NHS and other health providers are forced to delay or reschedule treatments simply because patients fail to turn up for booked appointments. These ‘space blockers’ not only cost health services in terms of wasted appointment times, they also prevent other patients being treated in their place.

The problem is so acute that many health providers have resorted to adopting systems such as SMS text reminders or telephone reminders in a bid to cut down on missed appointments. Even with these measures in place a department of health report published at the beginning of this year estimates that one in 10 hospital appointments (5.6million) are missed. At an average cost of £160 per missed appointment this equates to a significant amount of wastage, something the NHS can little afford.

In an effort to reduce missed appointments still further, the Department of Health has carried out a research trial looking at the wording used when reminders are sent out. The trial, which was conducted in conjunction with Barts NHS Trust, compared various forms of text message. All started with a reminder of the appointment time and date with subsequent variations including:

To cancel or rearrange call xxx.
9 out of 10 people attend. Call xxx if you need to cancel or rearrange.
Not attending costs NHS £160 approx. Call xxx if you need to cancel or rearrange.
Not attending wastes money. Call xxx if you need to cancel or rearrange.
Please be fair to others and call xxx if you need to cancel or rearrange.
Please attend or call xxx cancel/rearrange or we will record as a missed apt.

Whilst all of the variations produced a slight reduction on the original SMS which merely asked people to call the number on their appointment letter to cancel or rearrange; the message which specified the cost of not attending was shown to reduce missed appointments to 8.2%, equivalent to a 23% reduction in no-shows. Whilst an 8.2% no-show rate is still not ideal, the reduction in missed appointments still represents a considerable saving to the NHS.

Although this experiment purely related to hospital appointments, it does demonstrate the way in which a careful choice of words can make a difference to the way in which SMS text messages are perceived and actioned. Health professionals may therefore wish to choose a form of wording which best suits their client base, perhaps by undertaking their own trial with a variety of phrases which they feel may resonate with their clients.

Of course, those health professionals who charge for appointments have another option which they can use to encourage clients to attend. Taking credit card details at the point of booking enables health professionals to charge a no-show fee in the event that the appointment is missed. Adding a comment about this no-show fee to an SMS appointment reminder may well encourage patients to either attend the appointment or telephone to rebook.

At the end of the day reducing missed appointments benefits everyone from patients to health professionals as well as the country as a whole. The more timely the treatment, the better the outcome; so it therefore pays for patients to be treated at the earliest opportunity to reduce the chance of the condition escalating thereby requiring additional treatments. If a simple change of words on the SMS text reminder can reduce no-shows by 23% then it is something which all health professionals would do well to consider.

Patient Confidentiality

98.9% of doctors and 95.1% of nurses own a smartphone. There’s nothing particularly surprising in that, although it is ahead of the UK average; but what is perhaps surprising is that 92.6% of doctors and 53.2% of nurses find their smartphone to be useful or very useful in helping them to carry out their clinical duties.

That was the finding of a multicentre cross-sectional study which was recently published in BMJ Innovations. Whilst a proportion of smartphone use related to using the phone in place a more traditional ‘bleep’ the study also revealed that health professionals were routinely using apps, picture and text messages to send patient information to colleagues.

Whilst there is nothing intrinsically wrong in using smartphones to speed up communications, the study does raise concerns over the security of information which is being shared over unsecured media. In their conclusion, the study’s authors comment that “healthcare organisations need to develop policies to support the safe and secure use of digital technologies in the workplace.”

In truth, organisations which have yet to draw up policies relating to the safe use of technology are behind the times but it also has to be acknowledged that the speed of technological change may have caught out some healthcare practices. When the industry as a whole is talking about overarching concerns such as the safe storage and sharing of digital patient records on a countrywide basis, it is perhaps easy to overlook the fact that individual health professionals are using day-to-day communications to speed up treatment.

It certainly has to be acknowledged that the digital storage of patient records, the maintenance of electronic diaries, or even the sending out of appointment reminders by text have helped to smooth out patient communication and treatment pathways. But whether the data is being managed on a national level or within a specific health practice the importance of respecting patient confidentiality cannot be underestimated. That’s why our systems are set up to respect the privacy of your clients.

However securely data is maintained, at the end of the day security is a state of mind and it is up to every health professional to ensure that when they share information they do so with confidentiality and security in mind. As an NHS spokesperson, commenting on the survey, said “Apps and other online services offer powerful benefits to clinical practice but it’s vital that doctors and nurses know which ones are safe to use.”

When this article was originally written in 2015, the concern was over the safe use of digital records but the safeguarding of physical records should also not be ignored. Reviewing this article in February 2017, reports have come to light of the ‘misplacing’ of some 500,000 NHS patient documents. Early indications are that these were stored in a warehouse rather than being filed in patient records or sent to GPs. There is no indication at present whether these records would have had a material impact on patient care but it does highlight the importance not only of patient confidentiality but also of ensuring that records are complete and up to date.

One Step Too Far

In our last article we commented on the way in which exercise regimes have moved on; with the emphasis now being on providing exercise and mobility training which not only suits individual pursuits but also the individual athlete. With the Rugby World Cup being very much in evidence at the moment, it’s a theme which we thought we would return to.

Aside from the numerous injuries which seem to have befallen the Welsh team, opening skirmishes have led to injury worries for numerous players. Some will be rested before being brought back into the fray later on in the campaign whilst for others their World Cup dream is already at an end.

The neutral observer may question why there are so many injuries when it comes to the big tournaments. Admittedly rugby is a game which begets injuries but it has to be asked whether there is an underlying reason for so many key players to become injured at the same time. Again the neutral observer may wonder whether it is simply that in rugby injuries are rife, but we only hear about them thanks to the increased publicity which world cups bring.

But there has to be more to it than that and whilst some injuries are simply down to the run of the game or bad luck, it has to be wondered whether others may be as a result of a desire to field the best team possible. This can lead to circumstances such as players who are carrying a minor injury being selected in the hope that they will be fit in time for the tournament, players ignoring slight niggles as they don’t want to miss out on the tournament, or even a bit of overtraining in a bid to be as ready as possible for a key match.

Whatever the reason, players who entered the tournament in hope are leaving it in pain; being forced to swap the field of glory for the physiotherapy table. As they depart they bring a lesson for all of us. It’s one thing to push yourself to the limits of your ability but take one step too far, be unrealistic in your expectations, and you will run the risk of harm. We all like to think we can cope under pressure, we all like to think that we can just do one bit more and one bit more again but even those at the top of their game have their limitations.

In other words, sooner or later we will reach the limits of our abilities and when that happens we have to call on others for help. And that is not an admission of failure; it is simply an acknowledgement that when we are open to calling others on to our team, we can stretch just that bit further and do just that bit more.

For injured players, it will be the help of physiotherapists and other health and fitness professionals. For those same health professionals, it may be the help of administrators or assistants in areas such as booking and keeping track of appointments, maintaining virtual client records or simply in answering the telephone to avoid interruptions to client treatments.

Sportsperson or not, sooner or later we all come up against our limits. Getting the right help at the right time might just prevent us taking one step too far.

Stretching Therapies

Looking back at old newsreels of athletes training it is striking how little variety there is in the exercises shown. Admittedly this may be down to the personal preference of those who made the films but whether looking at footballers in training or holidaymakers limbering up at summer camp, there seems to be little variation from the sit ups, press ups and touch your toes type of exercise.

But times have moved on and now the emphasis is very much upon providing bespoke exercise and mobility training which not only suits individual pursuits but also the individual athlete. The old favourites are still there but they are supplemented by other activities.

Cross-training is also very much in evidence. For example, athletes may look to yoga training to enhance posture and core control, or take up dance or gymnastics to improve overall mobility and rhythm. Swimmers too no longer spend 100% of their training time ploughing up and down a pool but look to other forms of strength and conditioning work to supplement their water work. And this idea of choosing the right type of exercise to help the individual is not simply confined to athletes. Mainstream healthcare too is exploring the way in which a range of different platforms can lead to faster recovery times and increased mobility.

For example, according to the Chartered Society of Physiotherapy website a group of physiotherapists from Edinburgh are exploring the benefits of tai chi. More than 50 physiotherapists have signed up to the event and it is hoped that more will be planned in future. Commenting on the event occupational health physiotherapist Jo Gordon said that they were “interested in options for exercise to recommend to our patients and contacted the centre to ask if they would consider hosting a class or introductory session so we could find out more.”

This idea of moving away from the traditional and exploring other options is not just confined to physiotherapy. Right across the health service we are seeing practices embrace new treatments and new ways of operation in a bid to maximise the service which is being provided to patients. So tai chi and reflexology are coming in but so too are a raft of simple exercises which people can carry out in their own homes. This health professional/patient partnership in which the patient is responsible for some of their rehabilitation not only provides a more consistent recovery regime, patients also take more of a stake in the success of their care plan.

And for health professionals themselves, technology has brought a new range of options including electronic diary management, automated SMS appointment reminders and electronic storage of patient information. In fact anything which can cut down on day-to-day administration and maximise patient focus is being looked at in a bid to increase the time spent with patients and provide as swift a response service as possible.

Today’s health service is looking towards having a relationship with patients which optimises treatment on an individual basis whilst maximising efficiencies. Sit-ups and old-fashioned courtesy may still be part of the package but those who look to maximise patient care are constantly broadening their horizons, looking for alternative treatments and operational efficiencies.

Suffering from Compartment Syndrome

Sometimes it is amazing to see just what people will go through simply to look good. We are used to seeing stories in the papers on a virtually daily basis about how this foodstuff or that drink will completely transform our energy, complexion, body shape or mood; but similar stories about what we wear are not as prevalent.

It was interesting therefore this week to see two stories about clothing hit the headlines. The first story was from a journalist in Los Angeles who set out to wear high heels for an entire day. By early evening, he had called off the experiment as he was in so much pain.

The second story related to the wearing of skinny jeans. Researchers in Australia reported that a 35-year-old woman had suffered from bleeding and swelling of her leg muscles, caused by spending an extensive period squatting to clean out cupboards whilst wearing skinny jeans. The condition experienced by the Australian woman has been named as compartment syndrome but tight fitting trousers have also been blamed for a number of conditions including heartburn and twisted testicles.

Whilst these examples may seem isolated, the fact is that physiotherapists and other health practitioners are regularly called on to relieve the symptoms of those who have damaged muscles and ligaments thanks to their choice of clothing. The Los Angeles journalist may have been in so much pain because he had come to high heel wearing without proper preparations but according to the American Osteopathic Association high heels are one of the biggest factors leading to foot problems in women, with one in three high heel wearers suffering permanent damage. If skinny jeans are now to be added to the list of potentially harmful clothing, particularly if compartment syndrome starts to become a regular problem for fashion-conscious home cleaners, then osteopaths physiotherapists and others are in for a busy time.

And that’s just the start of the clothing-damage story. In recent times we’ve also heard tales of people setting out to climb steep hillsides whilst wearing flip flops, tripping over long skirts, and even wrenching necks whilst putting on tight tops. It seems as though when it comes to looking good, practicality goes out of the window. Perhaps it’s not surprising therefore that our health professionals, particularly physiotherapists and chiropractors, are increasingly under time pressure.

As a result, whilst health practitioners are relieving the symptoms of clothing related injuries including compartment syndrome, they need to do something to ensure that their time is spent as productively as possible. So they in turn looking towards virtual assistant services to relieve the time pressure caused by full client books. Even something as simple as a call answering and appointment booking service can make a measurable difference to daily pressures

With calls being answered in a prompt and professional manner in the name of the health practice, clients are reassured that they are dealing with a professional practice. Other benefits include never having to miss a call or interrupt a consultation to take a call. With unwanted sales calls also being screened, health practitioners can concentrate on patient treatments.

Exercising Choice for a Fitter Health Practice

It’s January and that means only one thing; a host of fitness and diet related stories have hit the headlines. In a bid to either persuade us to keep those New Year resolutions, or to even make some belated ones, news media are leaping on any health related story they can find and putting it out there for our consideration.

Are we swayed by the headlines? Well perhaps some of us will use the research conclusions to kick start an improved lifestyle, but for others the exhortation to improve diet or fitness levels will merely be of passing interest and will have no effect on ingrained lifestyle patterns.

Actually when you stop to analyse some of these stories, the advice given generally only amounts to common sense. The study which concludes that a brisk daily walk, even if just 20 minutes, can add years to life expectancy is hardly surprising; although it was interesting to see that the research concluded that twice as many deaths a year are attributable to inactivity than to obesity. Similarly, a report which concluded that working as part of a team, either with a partner or with others, can help people to stick to lifestyle changes makes sense when you consider that a self-supporting team is less isolated than an individual.

But if some of the conclusions are simple common sense and may well lead to lifestyle changes, others may have varying measures of success. A report which suggests a correlation between wearing high heels and the chance of developing osteoarthritis may be unlikely to sway the majority of those who enjoy wearing shoes with high heels. On the other hand, a report which suggests that moderate alcohol consumption is linked to reduced heart failure risk may well be seized on by those who enjoy the odd drink but were feeling guilty about its affects on health.

In essence this is the beauty of having free will, and not just on health related issues. We can look at all of the advice and choose that which seems best to us. That’s why some businesses interrupt client conversations to answer the phone whilst others have set up a system which diverts phone calls to a virtual assistant. That’s why some businesses still file records by hand whilst others have embraced digital filing methods. And that’s why some health practices offer online booking and card pre-payment methods whilst others stick to phone bookings and collect the payment later.

Whatever the business, whether you offer one-to-one health consultations or regular pre-booked fitness classes, the key to success is to know your customer and offer a business model which will best meet their needs. Special offers and discounts are all very well in attracting new custom, but people won’t stay unless you offer them a level of service which encourages them to return time and time again and to recommend you to friends. So going back to one of our earlier examples, if your clients tend to have busy lives then online booking is a quick and simple way for them to make an appointment. On the other hand, if your client base is more elderly then they may feel more comfortable making telephone bookings.

No matter how seemingly strong the research, whatever the ‘experts’ tell us, at the end of the day all research and all ‘best practice’ advice is there to act as a guide. What we do with it, how we turn advice into great customer service and a strong and fit health practice is up to us.

Redesigning Your Therapy Service

A discharge team working out of two West Midlands’ hospitals has been recognised with a national award for creating an integrated discharge process which includes a focus on early identification of appropriate therapy. The idea behind the scheme is simple but it has already reduced patient hospital stays by over 13% and saved the Trust around £2.5m.

Simply by giving therapists ‘trusted assessor’ status, patient assessments can start earlier, even before the patient has left hospital. Not only does this lead to the provision of a care plan which starts even before the patient has left the hospital, it also this means that seamless ongoing care can be provided. With therapy plans already in place, patients can be discharged into home care far earlier than before. This in turn means that treatment is more focused, not only meeting the immediate needs of the patient but also their long term rehabilitation needs.

Prior to the inception of the integrated discharge process, patients would have to stay longer in hospital to ensure that they had recovered sufficiently well to enable them to be discharged into a home or other environment. Moreover, once they had been discharged they would have a period without treatment arguably at a time when treatment is most effective; having to wait for community assessment at home and potentially facing a relapse of their condition in the meantime. So not only do the new procedures save bed space they also help to speed up rehabilitation.

The idea of creating seamless and integrated processes is not just one which is confined to hospital discharge. When reports reveal that generally the health system is under some strain, anything which can speed up patient treatment and therefore recovery times is welcome. Health practitioners across the board are therefore looking for ways to cut down on administration and maximise treatment time.

Quite frankly, anything which can reduce the time spent on routine administration, and therefore non-treatment, time is to be welcomed. That is why practices such as SMS text messaging to remind patients of appointments, online booking and digitising patient records are becoming more widespread as health practitioners look to automate the non-treatment elements of their daily round.

For health practitioners who need to charge for their services secure card processing helps not only to smooth out cashflow but also saves time in sending invoices and chasing unpaid accounts. And using the services of a virtual health receptionist means that patient treatments can run without interruption from multiple phone calls, leaving the health practitioner to provide therapy whilst others take the administration strain.

Thinking outside the box, thinking smart; whatever you call it the result is the same. As health practitioners find new ways to leverage the advantages to be gained from technology and look anew at routine processes, they can make a measurable difference to ongoing patient treatments. As Physio Karen Lewis, one of the award winning West Midlands team said, receiving national recognition “really shows the value of physiotherapists leading innovative service redesign for the benefit of patients.”

Secure Card Processing

Black Friday, Cyber Monday; whichever day you have earmarked as the time to break the back of your Christmas Shopping the chances are that both shops and internet will be working to capacity. In fact, as a speech by the Managing Director of the Payment Systems Regulator, Hannah Nixon, revealed recently our love of automated transactions is growing apace. And the more we use our cards the more important it is for the payments industry to ensure that secure card processing happens as a matter of course.

According to Hannah Nixon, in the UK in 2014 some 40,000 transactions are made every minute on average. With early reports that spending on the two ‘major’ Christmas shopping days so far this year was well up on 2013 it is easy to believe that transaction volumes also were far higher than average.

One of the reasons for Hannah Nixon’s speech was to highlight the way in which the PSR is working to improve payment systems in order to provide new options for consumers and to make existing options better and easier to use. Much of what she said was more directly relevant to those who provide the systems rather than end users but if the PSR vision is realised then we will have “world class payment systems operating in the best interests of service users and the wider UK economy.”

Over the last few years we have already seen a huge development taking placed in the payment card sector. Contactless payments, online payments, swift transfers between accounts; all have improved payment options for businesses and consumers alike. We now expect to be able to use our cards as a prime payment method. And with that expectation comes the acknowledgement that ease of payment for consumers and swifter receipt of funds for retailers delivers a win-win result.

Take booking health appointments for example. By allying a secure card payment processing service to online booking, health practitioners can take a pre-authorised payment at the time of booking. Once the appointment has taken place, payment can be confirmed, helping to smooth out cashflow. Another advantage of secure card processing is that it tends to reduce the number of ‘no-shows’, particularly if clients know that they will be faced with an automatic cancellation fee if they fail to turn up for their appointment. Should clients decide to pay by an alternate means then the pre-authorisation can simply be cancelled.

Secure card processing is just one way in which the health practitioner can reduce administration time whilst at the same time helping to ensure that appointment slots are filled as much as practicable. SMS text reminders also help to reduce no-shows and can be pre-scheduled to be sent out at a set time before the appointment. Health practitioners may only account for a small proportion of the billions of transactions which already take place every year but if secure card processing can help to cut workflow and smooth cashflow then the more developments in card payment options which the PSR can encourage the better.

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Tag: health appointments