Measuring direction-related failure demand in outpatient services

Failure demand is demand caused by a failure to do something, or do it right, for the patient the first time. In outpatient services, a meaningful share of reception and volunteer time is spent answering "where do I go" — a question that, in principle, should already have been answered by the appointment letter, signage or a member of staff at the entrance.

Measuring this well requires more than a gut feel. We recommend a short, structured baseline: over a defined period, log direction-related contacts at a small number of key points (main reception, one or two busy clinic desks), noting rough handling time. This does not need to be perfect — it needs to be consistent enough to compare against later.

Once you have a baseline, any wayfinding intervention can be evaluated honestly: did direction-related contact fall, stay flat, or move to a different point in the journey. It is also important to track what a reduction is used for — released time only becomes value if it is redeployed, not simply absorbed.

We publish our own evaluation method openly, including the limitations of before/after comparisons in a live clinical environment, because a business case built on a method nobody can inspect is not a business case a board should approve.