Using a driver diagram to support reduction in waiting times for Newham Foot Health Service

Authors: Marie Parchment (Clinical Lead Podiatrist), Jo Raphael (Head of Adult Therapies), Sarah Skeels (Deputy Director) and Clarissa Sorlie (Improvement Advisor)

The Newham Foot Health service are using quality improvement methodology to help them capture their theory of change, in their efforts to reduce waiting lists.

Figure 1. Newham Foot Health team

Each month, the Newham Foot Health service sees over 750 people for a variety of different foot problems including diabetic foot ulcers and musculoskeletal conditions, along with providing service users with advice on self-care to enable safe discharge. Yet the team are facing an uphill battle. The are still working through a backlog of appointments from when they were unable to see patients face-to-face during Covid, and they continue to receive a high level of referrals, averaging 538 referrals per month. 16% of the appointments they offer each month are wasted due to non-attendance, and rebooking these appointments further adds to the waiting list. In addition to this demand, there is a national shortage of podiatrists, which makes staffing vacancies difficult to fill.

The team, led by Marie Parchment (clinical lead podiatrist), have been tackling the waiting list with close support from the Performance team. They have generated many change ideas and have significantly reduced their waiting lists.

Using a tool called a driver diagram, the team have captured all their change ideas and turned them into a visual representation of how they believe these ideas will continue to reduce their waiting list (see Figure 2).

Figure 2. Driver diagram showing the team’s initial theory of change

With so many ideas to test, it’s easy to become overwhelmed. The team have found it helpful to organise their thoughts into a driver diagram that they can regularly refer to and refine. Reflecting on this process, Marie said, “When you have a lot of competing priorities it’s difficult to know what to prioritise. Using a driver diagram helps to provide an ordered system to work from”. Sarah Skeels (project sponsor and deputy director for Newham Community Health Services) agrees: “I think that this is the greatest benefit of a driver diagram; when there is a large task ahead of you”.

Having recently joined the Trustwide equity programme to reduce missed appointments for service users who live in the most deprived neighbourhoods, the team’s next steps are to further expand on their driver diagram to include the ideas that emerge from their involvement in the programme.