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Children's missed healthcare appointments: professional and organisational responses
Jane Appleton1, Catherine Powell2, Lindsey Coombes1
1Faculty of Health & Life Sciences, Oxford Brookes University, Oxford, UK.
Insights
UK healthcare organisations
Area of Science:
- Child Health
- Healthcare Management
- Public Health Policy
Background:
- Missed healthcare appointments for children present significant challenges within the UK National Health Service (NHS).
- Existing organisational policies and professional responses to these missed appointments require examination to ensure child welfare.
- The NSPCC (National Society for the Prevention of Cruelty to Children) funded this study due to concerns about safeguarding and child-centred care.
Purpose of the Study:
- To investigate how UK healthcare organisations and professionals respond to children missing their scheduled appointments.
- To evaluate the quality of internal policies concerning missed appointments within NHS healthcare organisations.
- To understand the practical management of missed appointments in a hospital setting and identify areas for improvement.
Main Methods:
- Phase I involved a web-based scoping review and systematic analysis of internal policies from UK NHS healthcare organisations regarding missed appointments.
- Phase II employed a case study methodology within a single hospital trust, including staff interviews, organisational data review, and policy analysis.
- The study assessed policies against evidence-based standards and examined the 'systems' in place for managing missed appointments.
Main Results:
- Organisational policies on missed appointments were found to be of variable quality and often failed to meet evidence-based standards.
- A disconnect was observed between national safeguarding requirements and cost-reduction strategies for missed appointments.
- The case study highlighted the continued use of adult-centric terminology like 'did not attend' (DNA) and the need for a more child-centred approach, acknowledging parental challenges and the link to child maltreatment.
Conclusions:
- Current strategies for managing missed appointments in children are often inadequate, with policies of variable quality.
- There is a critical need to shift from cost-focused strategies to a child-centred approach that acknowledges the complexities and safeguarding implications of missed appointments.
- Further exploration of general practitioner responses to missed appointments is warranted, given the association with child maltreatment.
Aim:
This National Society for the Prevention of Cruelty to Children (NSPCC) funded UK study sought to examine organisational and professional responses to children's missed healthcare appointments.
Design/Methods:
The study comprised two parts: phase I was a web-based scoping and systematic analysis of UK National Health Service healthcare organisations' internal policies on missed appointments. Phase II involved a case study of how missed appointments were managed within one hospital trust, including interviews with hospital-based staff, review of organisational data and examination of policies and 'systems' in place.
Results:
Policies accessed were of variable quality when benchmarked against a predetermined set of evidence-based standards. Additional material (eg, board minutes) gleaned through the searches found an apparent disconnect between nationally determined safeguarding requirements and strategies to reduce the cost pressures arising from missed appointments. Findings from the case study included the continuing use of the adult-centric term 'did not attend' (DNA), the challenges that may be inherent in attending appointments (with concomitant sympathy for parents) and a need to further explore general practitioner responses to DNA notifications, particularly given the acknowledged association between missed appointments and child maltreatment.
Conclusions:
The web-based scoping exercise yielded a small number of organisational policies. These were of variable quality when rated against predetermined standards. Other material gathered through the search strategy found evidence that 'missed appointment' strategies aimed at reducing costs did not always acknowledge the discrete needs of children. The case study findings contribute to an understanding of the complexities and challenges of responding to a missed appointment and the importance of taking a child-centred approach.
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