North West Tasmanian paediatric outpatient clinical redesign

Mrs Gaylene Bassett1,2, Mrs Vanessa Vernham1,2

1North West Regional Hospital, Burnie , Australia, 2University of Tasmania , , Australia


Outpatient waiting lists influence quality service delivery and impact patient and staff satisfaction.

During a diagnostic phase of clinical redesign, outpatient waiting list data from the Tasmanian health services patient management system (iPM), has been analysed. Staff have been involved in a root cause analysis considering why the system is affecting their satisfaction and the voice of the family has been reflected upon to understand how this influences their satisfaction and health outcomes. Waiting lists in hospitals are a worthy cause for quality improvement (1).

The key diagnostic finding reveals that reasons for extensive outpatient waiting lists include:

  1. Unmanaged waiting lists
  2. Demand verses capacity
  3. New to review ratio disproportion (Low discharge rate)

Following the diagnostic phase with a team of stakeholders, supported by executive sponsors we have explored the paediatric outpatient journey. Using LEAN, Six Sigma and Theory of Constraints methodologies our team has designed six solutions.

The goals for the North West Paediatric outpatients are:

To decrease over boundary new appointments from a median of 60% to 30% by December 2021 and to decrease the number of patients waiting over boundary for their planned appointments by 50%. The aim of these goals is to improve patient and staff satisfaction.

These six solutions include collaborative working relationships, service delivery initiatives and new models of care.


1              Johannessen KA, Alexandersen N. Improving accessibility for outpatients in specialist clinics: Reducing long waiting times and waiting lists with a simple analytic approach. BMC Health Serv Res. 2018;18(1):1–13.


Vanessa is an experienced paediatric acute care nurse who has recently undertaken a certificate in Healthcare clinical redesign accessed through a Tasmanian Health Service (THS) Scholarship at the University of Tasmania. Vanessa is employed in conjoint positions between the paediatric inpatient and outpatient units.

Gaylene is a paediatric Nurse Practitioner who has also recently undertaken the Utas certificate in healthcare redesign made available through a THS scholarship. Gaylene works across the North West region between the two larger hospitals and in an outreach capacity to the smaller hospitals and Aboriginal Health Centres.