RESUMO
INTRODUCTION: A capacity and demand improvement initiative commenced in January 2019 with the goal of reducing the growing outpatient waiting list for magnetic resonance imaging (MRI) at Counties Manukau District Health Board (CMDHB). Initial work showed that the capacity (MRI machines and staff) actually outstripped demand, which challenged pre-existing assumptions. This became the basis for interventions to improve efficiency in the department. Interventions undertaken can be split into three distinct categories: (1) matching capacity to demand, (2) waiting list segmentation and (3) redesigning operational systems. METHODS: A capacity and demand time series during 2019 and 2020 was used as the basis for improving waiting list and operational systems. A combination of the Model for Improvement and Lean principles were used to embed operational improvements. Multiple small tests of change were implemented to various aspects of the MRI waiting list process. Staff engagement was central to the success of the quality improvement (QI) initiatives. The radiological information system (RIS) provided the bulk of the data, and this was supplemented with manual data collection. RESULTS: The number of people waiting for an MRI scan decreased from 1,954 at the start of the project to 413 at its conclusion-an overall reduction of 75%. Moreover, the average waiting time reduced from 96.4 days to 23.1. Achieving the Ministry of Health's (MoH) Priority 2 (P2) target increased from 23% to 87.5%. CONCLUSION: A partnership between Ko Awatea and the radiology department at CMDHB, examining capacity and demand for MRI and using multiple QI techniques, successfully and sustainably reduced the MRI waiting list over a two-year period. The innovative solutions to match capacity to demand may be instructive for other radiology departments, and other waiting list scenarios.
