Why is it so difficult to organise an outpatient clinic?
OBJECTIVE
The shift from inpatient to outpatient care in the UK is drawing attention to the role of the outpatient clinic. Yet, outpatient clinics have received less attention than other elements of hospital work. This study sought to identify key problems perceived by staff in the functioning of outpatient clinics and to understand their responses to these problems.


METHODS
Interviews were conducted with 57 hospital staff in two hospitals (one teaching, one district general) in South-East England. Staff were selected through snowball sampling to provide a cross-section of those working in, and interacting with, the outpatient department. Constant comparison was used to generate hypotheses from the data collected in the first hospital, which were then tested in the second hospital.


RESULTS
Four main themes emerged. These were the role of the individual consultant, pressure on time, weaknesses in communication and problems with training. The personality of the consultant--in particular, his or her attitude to risk--was often central to the functioning of the clinic. The actions arising from differing personalities were remarkably resilient to managerial action. Most clinics operated in the face of pervasive pressures on time, which created a service that was seen as meeting no-one's needs adequately. Communication was almost universally poor in all directions and through all media. Training of medical staff was haphazard.


CONCLUSIONS
Despite its growing importance, the hospital outpatient clinic is often ill-equipped to respond to the new challenges it faces. Overall, there is a need for the system to be managed, rather than simply to respond to whatever comes its way, and to ensure that the growing literature on individual and organisational change is understood and applied.
McKee
M
M
Health Services Research Unit, London School of Hygiene and Tropical Medicine, London, UK.
Waghorn
A
A
D001291:Attitude of Health Personnel; D003430:Cross-Sectional Studies; D004739:England; D006769:Hospitals, General / Q000458:organization & administration; D006784:Hospitals, Teaching / Q000458:organization & administration; D006801:Humans; D007318:Inservice Training / Q000458:organization & administration; D007400:Interprofessional Relations; D007407:Interviews as Topic; D010044:Outpatient Clinics, Hospital / Q000458:organization & administration*; D010564:Personnel, Hospital / Q000523:psychology; D011369:Professional-Patient Relations