Time Driven Activity-Based Costing To Understand Personnel Costs In A Real World Clinic Setting

Staffing represents the most significant cost to the National Health Service (NHS) and the way these costs relate to the various activities undertaken to deliver specialist services within the NHS, is not well understood. Ophthalmology is the United Kingdom’s largest outpatient specialty and patient time must be managed efficiently. This has led to a number of innovative solutions manifesting in a paradigm shift towards shared care and “virtual” clinic services. The aim of this study was to estimate the personnel cost per patient for a typical virtual glaucoma clinic. 

Department of Ophthalmology, Queen Mary's Hospital Sidcup, King's College Hospital NHS Foundation Trust

Stakeholder analysis was undertaken to process map the virtual glaucoma clinic. Real-world timings were then audited and time-driven activity based costing (TDABC) was used to calculate the personnel cost per patient using the principles of Integrated Practice Units (IPUs) and Value Based Healthcare.

Data was captured from 24 consecutive patients. The ophthalmic technician capacity cost rate was £0.23 per minute while that for the ophthalmology consultants was £1.11. The average time taken to acquire clinical data was 39 minutes (95% CI 36-43 minutes, range 27-61 minutes) per patient with 14 minutes (95% CI 13-14 minutes, range 12-20 minutes) for their remote consultant review. The estimated personnel costs associated with a single virtual glaucoma clinic visit involving three technicians and a senior remote review came to £24.45.

Managers and clinical leads can use these principles to investigate how differing staffing arrangements, in any clinical setting involving highly repeatable steps, can influence costs making this a versatile tool to quantify the costs of much of what we do in medicine. Caution must be exercised however in applying these costs on a wider scale given the variables in process, acquisition systems and staffing of such clinics.