1. Reduction of DNA's in new obstetric appointments.

2. Identification of areas for priority attention. Review of performance – Service line obstetrics underperforming with negative margins. A change project that would benefit patients, staff and the organisation.

3. Reason for the change project. Patient experience – impact on waiting times for appointments. Organisational pressures. Staff impact – communication, follow up DNA policy. High risk patients – need to access the service early into the pregnancy.

4. Directorate performance. Obstetric DNA’s constantly highlighted red as underachieving. Rate to achieve <5.56%. ACTUAL % ACHIEVED OVER LAST YEAR 22-26%.

5. High risk, harder to reach women. To ensure effective, safe utilisation of the service – Consultant / Midwife time.

6. Root Cause Analysis. Review of where we have come from…and where we are going. Internal audit. Patient participation. Staff participation, all members of the multidisciplinary team. Review performance to identify any trend pattern across the year. Open communication to staff.

7. Explore change management tools available.

8. Action Plan. PHASE 1 Patients to be reminded of the clinic appointment via text message. MA’s to remind the patient of the clinic visit during screening. DNA – follow up, patients to be asked why the failed to attend.

9. Monitor the service change impact – support staff – admin. Ensure effective communication. Close monitoring of monthly performance.

10. PHASE 2. Introduction of direct referral at booking one/one – increase in positive patient experience, convenient time and date. Effective communication regarding the change in practice. Monthly monitoring of performance. Monitor the effects of the change on other services.

11. Impact Analysis. Initial drop in DNA’s with the implementation of phase 1 – from 23.95% - 13%. (gradual increase to 17% over the following four months). Direct referral booking to commence 16.01.2012. Monitoring of monthly performance review.