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Abusing Statistics
A total of 76 patients were sent appointments, ten cancelled because they were better, ten did not attend on the day and 56 patients were seen. The breakdown of the conditions was as follows: spinal disorders 20, soft tissue injuries 15, orthopaedics 6, rheumatology 13, others 2.
management Waiting List Problems? Have a Blitz! DEBORAH SUFFIELD MCSP Formerly Senior Physiotherapist Hinchingbrooke Hospital, Huntingdon
Introduction MANY physiotherapy departments are currently stretched to the limit, and long waiting lists appear commonplace. Recently, this was the situation at Hinchingbrooke Hospital and we decided to attack the problem through the idea of a 'blitz' day, a strategy that I'd heard via the grapevine had been tried in other departments. For us this proved very successful and it may be useful to share our experience.
to wait more than four weeks to be seen. As a result the patients were unhappy, the GPs were unhappy, and there was a drop in staff morale. It was felt that as the situation was static, if we could only get the waiting list down, we would be able to keep it low. Our strategy was to set aside a day, when all the staff were working, to see only new patients. They were booked in at half-hourly intervals, with 'scream breaks' in the morning and afternoon for coffee and biscuits. Appointments were sent ten days in advance to allow time for reallocation following cancellation.
Innovative Management Good ideas are made for sharing and they are particularly important now in management. If you have tried out or heard of any innovative management practices please let us know about them, for publication in this column. There is no special format or structure for items in this part of the Journal, so jot down your thoughts and send them in - that is all there is to it!
The Problem Our out-patient department employs 5 % whole-time-equivalent staff with mainly orthopaedic, rheumatology, accident and emergency and acute GP referrals. The waiting list, which we are normally able to maintain at around two weeks, had crept up to six weeks with 143 patients on it, owing to a period of staff shortage and increased referral. Despite the staff situation being resolved, the size of the waiting list had remained static, with 61% of patients having
personal view ~
Abusing Statistics IAN S MAXWELL BSC DipEd ~
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PHYSIOTHERAPISTS would be upset if statisticians studied physiotherapy texts and then proceeded to treat patients. Yet many physiotherapists read about statistical methods and then proceed to use them. This is playing dangerously with the subject. Most of these therapists do not understand what they are doing. Many try to obscure their lack of knowledge by using 'Statspeak'. They talk of 'random variables', 'two-tailed tests' and 'levels of significance' to all who are prepared to listen. Most are bluffing. If they were asked for the formal
physiotherapy, February 1990. vol76, no 2
definitions of the commonly used tests, they would be unable to give them. And they would find it impossible to discuss the mathematical theory of their development. Even to understand the theory of the commonly used 't-test' an understanding of mathematics to A-level is required. But physiotherapists do not need to study statistical methods in detail. They should seek advice from professional statisticians! Many are loath to try this. Most have no more than an 0-level in mathematics. They are frightened of exposing their weaknesses. Just as there are university degrees in physiotherapy, there are degrees in statistics. Each is a discipline in its own right. Universities and polytechnics have statistics departments; most offer statistical advice to those undertaking research. Part of a statistician's training is communicating and working with people from other disciplines. The statistician accepts that he knows nothing about his client's subject but he is prepared to listen and help.
Results More than 8 4 % of patients were discharged within two weeks. The average number of treatments was 5.5. Of the 76 patients on the waiting list who were sent appointments for the blitz day, 75% were off the waiting list and discharged within one week. This was a great boost to staff morale. The waiting list had been reduced by 53% in one day, and interestingly, once the 76 appointments had been sent, the waiting list continued to shrink even before the blitz day arrived. This trend continued until the waiting time was back to around two weeks, and this reduction is still being maintained six months later.
Discussion We were delighted with the results and obviously feel the exercise was well worth while. However, it does raise some questions. A long waiting list appears to have different characteristics; a higher incidence of patients do not attend, presumably because they are better. Also conditions either become more chronic and therefore require more treatment, or else they improve spontaneously so that minimal treatment or perhaps just advice is necessary. After waiting for six weeks, 25% of patients did not require treatment. Are we over-treating, or will they reappear with a similar problem, having not had the benefit of prophylactic advice? By working closely, physiotherapists and statisticians should be able' to design an experiment which will make a significant contribution to research. Too frequently, statistical help is sought after measurements have been taken. 'Researchers' often approach statisticians with a list of data and ask: 'Which test can I apply?' At that stage it is nearly always too late. Admittedly, a test can nearly always be applied. But it will not be the best test for the problem under consideration; results which are mathematically correct, but misleading to the therapist, may be produced. Nowadays it is possible to purchase statistics packages for microcomputers. These save a lot of number crunching. But it is far too easy to apply the wrong test to a set of data. The computer will always do exactly what it has been asked and produce a result. Whether this can be justified from the scientific point of view is often debatable. Even when proper methods have been employed, it requires physiotherapists and statisticians to interpret the result. Further tests can then be designed to verify the findings. While it is unnecessary for therapists to become familiar with the details of experimental design, it is essential for them to seek professional advice before using these methods in their research.
107
management Waiting List Problems? Have a Blitz! DEBORAH SUFFIELD MCSP Formerly Senior Physiotherapist Hinchingbrooke Hospital, Huntingdon
Introduction MANY physiotherapy departments are currently stretched to the limit, and long waiting lists appear commonplace. Recently, this was the situation at Hinchingbrooke Hospital and we decided to attack the problem through the idea of a 'blitz' day, a strategy that I'd heard via the grapevine had been tried in other departments. For us this proved very successful and it may be useful to share our experience.
to wait more than four weeks to be seen. As a result the patients were unhappy, the GPs were unhappy, and there was a drop in staff morale. It was felt that as the situation was static, if we could only get the waiting list down, we would be able to keep it low. Our strategy was to set aside a day, when all the staff were working, to see only new patients. They were booked in at half-hourly intervals, with 'scream breaks' in the morning and afternoon for coffee and biscuits. Appointments were sent ten days in advance to allow time for reallocation following cancellation.
Innovative Management Good ideas are made for sharing and they are particularly important now in management. If you have tried out or heard of any innovative management practices please let us know about them, for publication in this column. There is no special format or structure for items in this part of the Journal, so jot down your thoughts and send them in - that is all there is to it!
The Problem Our out-patient department employs 5 % whole-time-equivalent staff with mainly orthopaedic, rheumatology, accident and emergency and acute GP referrals. The waiting list, which we are normally able to maintain at around two weeks, had crept up to six weeks with 143 patients on it, owing to a period of staff shortage and increased referral. Despite the staff situation being resolved, the size of the waiting list had remained static, with 61% of patients having
personal view ~
Abusing Statistics IAN S MAXWELL BSC DipEd ~
~
~
~~~
PHYSIOTHERAPISTS would be upset if statisticians studied physiotherapy texts and then proceeded to treat patients. Yet many physiotherapists read about statistical methods and then proceed to use them. This is playing dangerously with the subject. Most of these therapists do not understand what they are doing. Many try to obscure their lack of knowledge by using 'Statspeak'. They talk of 'random variables', 'two-tailed tests' and 'levels of significance' to all who are prepared to listen. Most are bluffing. If they were asked for the formal
physiotherapy, February 1990. vol76, no 2
definitions of the commonly used tests, they would be unable to give them. And they would find it impossible to discuss the mathematical theory of their development. Even to understand the theory of the commonly used 't-test' an understanding of mathematics to A-level is required. But physiotherapists do not need to study statistical methods in detail. They should seek advice from professional statisticians! Many are loath to try this. Most have no more than an 0-level in mathematics. They are frightened of exposing their weaknesses. Just as there are university degrees in physiotherapy, there are degrees in statistics. Each is a discipline in its own right. Universities and polytechnics have statistics departments; most offer statistical advice to those undertaking research. Part of a statistician's training is communicating and working with people from other disciplines. The statistician accepts that he knows nothing about his client's subject but he is prepared to listen and help.
Results More than 8 4 % of patients were discharged within two weeks. The average number of treatments was 5.5. Of the 76 patients on the waiting list who were sent appointments for the blitz day, 75% were off the waiting list and discharged within one week. This was a great boost to staff morale. The waiting list had been reduced by 53% in one day, and interestingly, once the 76 appointments had been sent, the waiting list continued to shrink even before the blitz day arrived. This trend continued until the waiting time was back to around two weeks, and this reduction is still being maintained six months later.
Discussion We were delighted with the results and obviously feel the exercise was well worth while. However, it does raise some questions. A long waiting list appears to have different characteristics; a higher incidence of patients do not attend, presumably because they are better. Also conditions either become more chronic and therefore require more treatment, or else they improve spontaneously so that minimal treatment or perhaps just advice is necessary. After waiting for six weeks, 25% of patients did not require treatment. Are we over-treating, or will they reappear with a similar problem, having not had the benefit of prophylactic advice? By working closely, physiotherapists and statisticians should be able' to design an experiment which will make a significant contribution to research. Too frequently, statistical help is sought after measurements have been taken. 'Researchers' often approach statisticians with a list of data and ask: 'Which test can I apply?' At that stage it is nearly always too late. Admittedly, a test can nearly always be applied. But it will not be the best test for the problem under consideration; results which are mathematically correct, but misleading to the therapist, may be produced. Nowadays it is possible to purchase statistics packages for microcomputers. These save a lot of number crunching. But it is far too easy to apply the wrong test to a set of data. The computer will always do exactly what it has been asked and produce a result. Whether this can be justified from the scientific point of view is often debatable. Even when proper methods have been employed, it requires physiotherapists and statisticians to interpret the result. Further tests can then be designed to verify the findings. While it is unnecessary for therapists to become familiar with the details of experimental design, it is essential for them to seek professional advice before using these methods in their research.
107