Managing orthopaedic waiting lists

Waiting lists are often assumed to be natural products of the demand and supply interplay in the hospital treatment ‘market.’ However, they can frequently be highly imperfect markets due to the organisational arrangements which surround them. In fact, when organised poorly, the arrangements for matching waiting list patients with available hospital resources actually contribute to waiting times. The author has spent much time in several orthopaedic departments in one Region and has observed the different ways in which waiting lists are organised. Experience of this has led to the drawing up of a short-list of ‘good practices’ which may ensure that both hospital and patient resources are used as effectively as possible. In addition to these practical measures, the precise definition of a waiting list is also explored which has implications for those seeking to illuminate and interpret their own problems. It is shown how clinicians can ‘vire’ patients between the two main types of waiting list, namely for out-patient appointments and in-patient treatment and the relative advantages of such strategies. Finally, the paper looks at the current information that most orthopaedic departments holds about waiting list patients and shoes how this is inadequate both for patient administration and for planning purposes.