Publicly funded outpatient physiotherapy services are a primary care service i.e. clients can access this service by referring themselves, however most are referred from another primary care provider. In the past all clients were called and given an appointment as per traditional booking practices. Clients are categorized in two ways: “urgent” referrals are typically post surgical problems with high potential to deteriorate functionally if not seen right away, thus are booked for an initial visit within two weeks. “Routine” referrals are all other categories of movement dysfunction (such as low back pain, chronic neck and shoulder pain, moderate osteoarthritis of the knee and hip ). Wait lists and subsequent wait times for problems that are “routine” ranged from 3 moths to two years. By changing to a “client triggered” system for routine referrals i.e. the client determines when they are coming or even if they want this service at all, wait lists were removed and wait times shifted to less than 30 days for “routine” clients. The process included sending the referral back to the client with instruction to call a dedicated “appointment line” one to two weeks before the service was required. As a result, the rate of “no-shows” for the first appointment decreased significantly, and those clients that did trigger an appointment were motivated to self-manage their condition, many of which are chronic conditions; a key feature of success and value in this primary service. This leading practice for access in a primary service demonstrates the value of aligning process to be based on self-selecting the right client ( those that are motivated or ready to change) at a time that is right for them, instead of allowing access by date of referral( chronological). This orientation to better customer service results in higher value for the client as the service is available when needed, better efficiency in the service due to less waste, as well as higher staff engagement as the specter of an ever-growing wait-list is removed.

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