Reducing NHS Waiting Times Through Patient Self Scheduling With Nordic

[00:00:00] Your agents aren't producing accurate answers because they don't have a complete semantic understanding of your data. And Denodo is solving this and solving it through semantic consistency. Through semantic consistency, your agents can start making accurate predictions in real time. So see what else Denodo can do by visiting denodo.com to learn more. But now let me introduce you to today's guest.

[00:00:33] What if giving patients greater control over their appointment times could play a significant role in reducing missed visits, shorten waiting lists and return thousands of hours to hospital admin teams? Well, anyone familiar with the 8am GP phone lottery here in the UK may already suspect that there is room for improvement. But in today's episode, I'm going to be joined by Alison MacDonald.

[00:01:01] And she is the European lead and senior vice president at Nordic Global. And she has a fascinating story. She is a registered nurse who moved into digital health after discovering how new technology and better data could improve patient and clinician experiences. So we will discuss Nordic's work with Cambridge University Hospitals NHS Foundation Trust,

[00:01:25] where over 20,000 patients self-scheduled their appointments and over 3,000 accepted earlier offers following cancellations. And as a result, appointments were also brought forward by an average of 16 days. And while admin teams saved an estimated 10 minutes for every single self-booked appointment.

[00:01:48] I want to hear about the tech behind it, because Alison is going to address healthcare AI, clinician burnout, interoperability and digital exclusion. We're going to cover it all today. So could improving access begin with something as simple as allowing you to choose your own appointment, Tom? And while you ponder that for a moment, I'm going to officially introduce you to my guest. So thank you for joining me on the podcast today.

[00:02:15] Can you tell everyone listening a little about who you are and what you do? Yeah, sure. So my name is Alison MacDonald. I am the European lead and senior vice president for Nordic Global. I am a registered nurse and have took the leap going into digital health. Ooh, I want to say over 15 years ago. Started my digital health career working at a hospital just outside of Toronto that was implementing an EPR.

[00:02:45] It was tertiary mental health. And from there entered the consulting world and started working for a company called HealthTech out of Canada that does digital health consulting. They are owned by Nordic. So about four years ago, I took a secondment to support Europe and I haven't left. I love it. And I spend my time between Canada, the UK and elsewhere in Europe. So I love it.

[00:03:15] Brilliant. And I'd love to dig into your origin story just for a little bit more. I was fascinated by what it is that makes people pursue a career in tech. And very often it isn't I've always wanted to be in tech. It kind of happens by accident or life happens or the universe points you in the right direction at the right time. So what made you go from nursing into the world of digital health and tech? So interesting. It did happen by accident.

[00:03:40] And I would say when I was in uni and we had to take one class on what they called informatics at the time. And I was so bored. I thought, I'm never going to do this. I don't care about any of this stuff, computers and clinical care. And I was working in the community, the community sector. So doing home care and was training new nurses that were coming in to work for the organization I was at.

[00:04:08] I was one of the youngest on the team and they were like, hey, we're going to do this new electronic health record project. You seem to know how to use a computer. And you take the lead on it. And interestingly enough, I thought at the time we were basically taking pieces of paper and converting them into an electronic health record. And I thought there's got to be a better way to do this. Anyways, that led to me being more interested in digital health.

[00:04:36] I was actually doing my master's degree at the time. So I switched streams and went into kind of more of a data analytics quality informatics stream in my master's. And then I took a course on informatics by a professor who was actually, I was at the University of Toronto. She was a nurse who became a CIO at a hospital in Toronto. She was very inspiring.

[00:05:01] And from there, I just became more and more interested in what digital health and technology could do, specifically around the access to data, improving patient outcomes and improving the patient experience. And then I just kind of ended up finding my role in that tertiary mental health organization I talked about. And from there, got into consulting. And I've been working as a consultant doing this type of work for over 12 years now. So it's been really great.

[00:05:30] And I'm very passionate about the fact that if we do things right from an digital perspective, it's an enabler to really transform health care and improve the patient and the clinician experience. Incredible story there. I absolutely love it, especially because you've got this unique vantage point and know how to make a difference or what you want and what you don't want to see in health care.

[00:05:53] And fast forward to present day, I think universally health care systems around the world are all under enormous pressure to do more with limited resources. And I'm curious, from your conversations with providers across the NHS here in the UK to Canada and elsewhere, what are the biggest operational challenges that health care leaders are trying to solve right now? What are you seeing? Yeah, I mean, it's pretty consistent across the globe. Everybody is trying to do more with less.

[00:06:21] So rising demand, I think workforce capacity and clinician burnout. And I think that was just exacerbated coming out of COVID. There's not as many people interested in working in the health care system anymore. Even, you know, coming from a nursing background, I encourage people to go into nursing because I think it's a career where you can end up like where I end up or you could be doing clinical care. But there's definitely a shortage of nurses. We know about the shortage of doctors.

[00:06:51] And then compounding that is wait lists, access to care issues. And then from a digital perspective, fragmentation around information, limited interoperability. And then the ongoing financial sustainability of the health care system in general. Most health care systems are built around hospital care. Hospitals are expensive to run.

[00:07:18] And unfortunately, the funding for things like primary care, community-based care comes second to the amount of money that we need to spend in hospitals. And then obviously, as us as patients start to look and families of patients start to look at what we can do with access to information. And with AI adding to that, it's that those patient expectations are also increasing.

[00:07:45] So it definitely compounds all of the different issues that we're seeing. And some of the differences I see, specifically if I were to look at the NHS versus Canada, the NHS has a complex national framework. So, you know, I always think of it as a big business beast, the NHS.

[00:08:05] Whereas in Canada, our health care system, while it's federally led at a national level and we have a framework for it, the delivery of it is actually within provincial structures. So in the smaller provinces, you see, if you look at Alberta as an example, they have a single digital health system that they've implemented. And by doing that, they can start to look at maximizing efficiencies because they're all on the same platform.

[00:08:33] They can look at the data in a structured way. Whereas in Ontario, where I am right now, outside of Toronto, it's a much bigger province, much bigger population. And we don't have that single source of truth or single system. So there's tons of systems around similar to the NHS. And so those structures require a different type of governance and a different type of understanding of how we can transform.

[00:09:01] But I think common across the globe is technology is not the answer. It's actually about using the technology as an enabler to actually transform the health care system. And it takes time. So cool. Cambridge University Hospitals NHS Foundation Trust.

[00:09:21] I was reading that they've recently achieved some pretty impressive results through patient self-scheduling and automated report appointments and management. So talk me through what that situation looked like before the project and what changes delivered the biggest impact for both patients and staff. I would imagine, from my own experience, that very often when you're given a hospital appointment, it's like, can you come three o'clock on Wednesday afternoon? You're like, hey, I work here. I've got responsibilities. I can't turn it around that quick.

[00:09:50] But what have you seen and heard here? Yeah, perfect. So we've had the pleasure of working with Cambridge on this project. So they had a fairly low do not attend rate. So we call that the DNA rate compared to other NHS organizations. But they still were losing about thousands of outpatient appointments annually.

[00:10:15] So they were losing about 5% of the 750,000 patients that they had. And by doing that, they're losing clinical capacity. So if you have patients not showing up, you've got a block of time that could have been used to see another patient. And so that clinical capacity was becoming an issue. And they're not able to fill those slots at short notice.

[00:10:38] So you've got admin teams also spending time contacting patients, rearranging appointments, all of those inefficiencies. So every missed appointment is an opportunity for another patient who's on that wait list to get seen faster. So the booking optimization project was enabled through a patient self-scheduling function within Cambridge uses Epic.

[00:11:06] So Epic's MyChart, which is a patient portal that is integrated with the EPR. So they rolled out self-scheduling. So it was a big project because all the outpatient services had to be looked at differently because of how the workflows work and the types of services being provided.

[00:11:25] But through that process, the DNA rates fell from 5% to 2.2%, which is significant in terms of impacting clinical capacity and throughput to be able to see more patients. So the biggest impact was the freeing up of time for staff. So that's 10 minutes per self-scheduled appointment and the ability to bring forward appointments for patients on the wait list.

[00:11:50] So on average, that brought appointments forward by 16 days, which is really significant in being able to minimize wait list time breaks. It really does. Another statistic that stood out to me, I think it was more than 20,000 patients successfully self-scheduled their appointments and DNA rates were cut in half. So why do you think giving patients more control over scheduling had such a dramatic effect on both engagement and attendance?

[00:12:19] It seems like an obvious answer, but I'm curious on your thoughts on this. Yeah, so I think, you know, from a personal experience, I just, our family doctor rolled out a self-scheduling app. I don't have to call the office. I don't have to wait on the phone to figure out when to book the appointment. I can go in, pick a time that makes sense for me. I can see the full schedule, full availability, and there's no back and forth.

[00:12:45] So I think from a patient's perspective, I see why, you know, 20,000 patients thought, oh, this is fantastic. So when being able to access the healthcare system fits more easily into your life, your engagement is going to improve. I can, you know, you can book an appointment after hours. You don't have to be on the phone at your workplace or during your workday trying to get a hold of someone to get an appointment booked. It's fantastic.

[00:13:14] So that convenience and flexibility to use a time that suits you, we do that every day for other things. And so we have come to expect the same from the healthcare system. So if, and if you can arrange that appointment right from the get-go at a time that works for you, you're much more likely to attend that. So these small improvements have a big impact on efficiency and waiting lists as we can see from the results.

[00:13:42] And ultimately it does what we want it to, which is improving that patient experience through creating flexibility, reducing wait times, and not having to deal with missed phone calls and letters that you missed. Or if you were late for an appointment because you didn't see the letter. So all of those different things that come up when we use kind of inefficient paper-based or phone-based systems. And definitely if you have a more engaged and more satisfied patient, they're going to be much more active in being a participant in their care.

[00:14:12] And I'm curious, just on a personal level here, how long do you have to wait for, let's say you went on to your app to book a GP appointment in Toronto. What kind of wait are we talking here? Because I know here in the UK there's various frustrations that it can take three to even four weeks to get that appointment. Is it similar over there? It would be similar. It depends. So there are a few.

[00:14:37] Now my family doctor is not in a family health team, but there's some family health teams where you can access an appointment with whoever is in that team. So that definitely expands your access. I would say if I, I think it's about three weeks to get in. If you really need an emergent appointment, you can pick up the phone and call. But generally if you need a same day appointment, you're going to a walk-in clinic. Now we have walk-in clinics. Now this is the Ontario experience.

[00:15:06] So again, depending on where you are in Canada, you'll definitely have a different experience. I actually lived in Ireland and there I was part of a GP practice and it didn't matter what GP you saw. You could just, as long as you were registered, you could book your appointment. So that turnaround time, I could get an appointment next day in the particular practice I was part of. Now that was in the Dublin area.

[00:15:31] I'm not sure if you get that in the rural areas of Ireland, but definitely it's still way more efficient than going on the phone and doing the back and forth. And if I have to cancel my appointment, it's easier to do it just from my phone than trying to call and leave a message and all of those things. Yeah, it can become like a competition over here. The lines open at 8am and 10 past 8. They've all gone. Call at 8 o'clock tomorrow. It's brutal. Brutal. Yeah.

[00:15:58] And waiting lists, of course, remain one of the biggest concerns for healthcare providers and patients alike. And the program enabled patients to bring their appointments forward by an average of 16 days, you mentioned a few moments ago. What lessons can other healthcare organizations maybe learn from that approach? And where are the biggest opportunities to reduce those delays without increasing workload? Anything you can share around your experience there? Yeah. So, I mean, we see this across the board with waiting lists.

[00:16:28] You know, this is an example of outpatient waiting lists, but you have things like waiting lists for surgeries. And sometimes it's not necessarily that you need to hire more staff or, you know, open more theaters or open more appointments. It's that you can unlock capacity by looking at how the process is operating and looking at gaining efficiencies within the process.

[00:16:55] So, are you making full use of the capacity that you already have? So, things like do not attend rates or how you're managing your theater bookings. Those processes are ripe with opportunities to look at how you can maximize efficiencies and get patients seen faster. And so, digital self-scheduling is one example. And digital rescheduling.

[00:17:24] So, that allows patients to book change, cancel appointments online without having to tie someone up on the phone. There's also smart waiting list management. So, that is a way to get a hold of a patient to let them know that there's a newly available appointment that's come up if something's been canceled. And then, we're seeing all the advantages of digital front door.

[00:17:50] So, digital front door is a streamlined way where a patient cannot use the patient portal in a similar way, book the appointment. But they can also complete any pre-visit questionnaires online. So, you're not wasting time in the appointment answering questions. All of your historical information can be there. And you can actually have the doctor or the nurse, whoever, seeing you pre-read that information. So, there's no – so, you're actually making things more efficient in that process as well.

[00:18:19] So, it's really about the people and the process and then the technology to enable it. And, of course, here in 2026, AI is often presented as almost a silver bullet for all things healthcare. But you've spent years helping organizations modernize complex health systems. So, where are you seeing AI genuinely improving patient outcomes and operational performance?

[00:18:44] And also, where do you think organizations might need to be a little bit more realistic about its limitations too? Yeah. So, AI is definitely not a silver bullet. AI in healthcare needs specific use cases. So, I always encourage organizations, you know, people speak about AI in generic terms. I prefer to speak about the use of AI based on case needs.

[00:19:10] One of the biggest examples where you see AI assisting is actually in the radiology and medical imaging space. So, that's definitely somewhere where they're much more advanced in how they use AI. Other areas include actually waitlist management and wait times for your A&E or an emergency department, as we would call it here.

[00:19:33] But we actually have a few case studies that we've seen where emergency departments roll out chatbots supported by AI. And that helps streamline whether you should come in and be seen or makes recommendations on some eMERGE departments are actually using it to, they'll have two streams come in, wait to be seen, or they'll have an appointment booking time. So, you actually can book an appointment in your eMERGE department. And that's all streamlined through the use of AI and chatbots, which is really cool.

[00:20:03] And I think organizations who invest more in just technology, but combine the technology with a foundation around data governance and effective workflows, change management and workforce adoption, will see better use of AI in the future.

[00:20:23] We're also looking at AI, not necessarily in the delivery of care, but can AI be used to understand where you maybe have capacity issues. It can actually do a lot by looking at your workflows and making recommendations of where you can actually find efficiencies within your process. So, I see that as another way that we can use AI in healthcare.

[00:20:50] And I was also reading about you that at this year's eHealth Conference, you heard reoccurring conversations around interoperability, information sharing, digital transformation, etc. And a question I've got to ask here, especially from the UK side of things, because as a techie, I think it's got to be easier than ever to join everything together, where if you see a GP, go to a hospital, even different wards or different departments inside in a hospital, nobody seems to know what the other is doing.

[00:21:20] So, why does connecting systems remain such a challenge in healthcare? And what practical steps can organizations take to maybe improve how information is moving across that care setting and the whole journey? Healthcare's complex. Yeah. It's not predictable, especially hospital-based healthcare. It's definitely not predictable.

[00:21:42] And so, from an information perspective, how we've set up our healthcare systems across the globe is you have, you know, your acute care, your tertiary care levels, you've got primary care, and how we've organized that each of those service areas might use a different system. Or they might still be on paper. And there's still a number of organizations, especially in the NHS.

[00:22:08] Despite the implementation of EPRs, they're probably not used as efficiently as they could be. And so, what you see is a lot of what I would classify as hybrid workflows. So, partially paper, partially electronic.

[00:22:21] And so, when you have a patient whose journey is spanning multiple organizations and care settings, the information, to make it seamless, you would want the information to move seamlessly so that the right information is available to the right provider at the right time. But as I alluded to, that kind of hybrid environment of, you know, partial paper, partial electronic, and the fact that organizations use different systems makes that very challenging.

[00:22:51] If you are within one organization, sharing information is probably much simpler. But if your single organization isn't fully electronic, I always like to use the analogy of the paper chart and being a clinician. And when we roll out a fully integrated EPR, the amount of time that someone saves not looking for that paper chart,

[00:23:19] tax what, you know, we get a lot of complaints about how much time it takes to do things electronically versus on paper. But if you were to add up the amount of time that probably a clinician spends trying to find the paper chart, you'd actually be amazed at what that is. So, there's definitely huge, huge things we can see to be done around interoperability between healthcare organizations using different systems. And then the other challenge is the data itself.

[00:23:49] So, I have done a number of projects in larger jurisdictions where you have multiple organizations that are trying to move to one EPR. And one of the challenge is what standards they're using and the terminologies. And I'll use a simple one as pain. So, there are different pain scales that can be used to measure pain.

[00:24:16] And so, most places will ask on a 1 to 10 scale, you'll rate your pain. But without that standard, if you have one organization that's using a 1 to 10 scale and another organization that's using a 1 to 5 scale, for example, and you're trying to share information, you're not able to compare the same data. So, the pain threshold of a 5 at one site is high, a 5 at the other site is actually in the middle, right?

[00:24:41] So, just coming up with the standards around how we capture information from patients, that's hard work. And the technologies require that in order to be able to seamlessly share information. So, practically, I think what organizations can start to do is understand that interoperability and integration, to make that happen, it's actually about the people, the process, and the governance around the data.

[00:25:11] You need people to change how they document. You need people to change the types of questions they're asking, and actually change how they're looking at information. And clinicians are notoriously, they like to hold on to where they feel comfortable. So, as soon as we start to change that, we get a little bit anxious. So, focus on sharing of information is really critical,

[00:25:35] and keeping the patient at the center of that circle around sharing the information. And we like to look at transitions in care as one of the most important places to adequately share information. And I call it a minimum data set. So, what's the minimum amount of information that we need to make sure we seamlessly share about a patient when they're moving either from one ward in a hospital to another,

[00:26:02] or when they're going to move from, they're being discharged from the hospital setting, and maybe they're going to have a community care provider or their primary care physician is going to be following up. So, what is that information that we need to share? So, typically that's things like results, medications, care plans, any follow-up appointments, history, and then agreeing to what those standards are. So, how do we define that and make sure everyone is communicating in the same way?

[00:26:31] And then building that interoperability requirement into procurement. So, that's really important when we're procuring new solutions is that we have a base standard that we're saying you must comply with this. And the other thing that healthcare organizations do, which we advocate against, is bespoke integrations. So, doing it, customizing it to that organization,

[00:26:57] that breaks that whole concept of standardization and disrupts that ability to share information seamlessly. And then it's really about creating strong information governance and making sure that the organizations who are sharing it understand how the data is governed. We talk about data ownership. So, ultimately, the patient owns their data. But there is a lot of legalities, depending on where you're working, around the management of that patient's chart.

[00:27:27] How does that get accessed? So, again, making sure we're paying attention to privacy and then how it can be shared and when. So, that's really important to think about. And, of course, many of the problems that we're talking about here also have a knock-on effect to clinician burnout and workforce shortages are also continuing to impact healthcare systems. So, how do you see tech automation and AI helping reduce some of those admin burdens that we've discussed today,

[00:27:54] while also allowing the healthcare professionals that run everything here to spend more time focused on patient care? Yeah. So, I think in healthcare, we're notoriously bad at when we want to implement, say we want to put a new form out or we need to put a new form out. We don't then look at what we're going to take away. So, we're going to add something, but what do we take away? How do we make that more efficient?

[00:28:20] So, that, I think, is something that us as clinicians and people who work in a healthcare system need to think about. So, making sure we're not just adding for the sake of adding, but we're always thinking about what can we take away so that we're not just continuously adding more and more administrative burden to our clinicians. I think the other thing that's a game changer is ambient clinical documentation.

[00:28:44] And actually, my example of my family doctor, where I booked my appointment online at the last appointment we went to, they, my family doctor said, do you mind if I use AI to help with my note taking? So, they record the AI scribe tool, integrates with the electronic patient record, and basically summarizes it, creates the framework for that note for the clinician who's using it.

[00:29:10] And that clinician then, rather than typing it all, reviews it, makes any corrections, and it makes that process much more efficient. So, there's really been positive impact on clinician satisfaction and productivity with this. And in the NHS, evaluations showed actually a 23.5% increase in direct patient interaction time and an 8.2% reduction in appointment length.

[00:29:36] And then it also improved productivity in the emergency department when the AI scribing tool was used. And that was from a study that was done at GOSH in late 2025, when I talked a bit about the effective use of, you know, theaters and appointments, but also how do we deploy our workforce in a way that we are ensuring we're efficient and we're maximizing what we can do from a capacity perspective. Lovely.

[00:30:05] And we do have an international audience. So, if you were advising a healthcare leader at the beginning of their digital transformation journey, they could be located anywhere in the world right now. What are the three areas that you would prioritize first to help improve patient experience, operational efficiency, and long-term sustainability? Any tips there? Yeah. So, I would focus less on the technology and more on the outcomes that you're trying to achieve as an organization.

[00:30:35] Digital health solutions can be expensive to implement. So, if you don't have a vision for why you're implementing it and you're just doing it for the sake of doing it, you're probably not going to get the best return on that investment. So, the three key questions that should be asked is, how do we make it easier for patients to access care, to do things online, like we said.

[00:31:02] So, things like booking or self-scheduling or self-canceling appointments. Can we send reminders electronically? How can we enable patients to access information? It's not every patient is going to want it. So, we always have to think about making sure that we still have those old ways of interacting for people who are maybe not as digitally savvy. But that's the first piece that we need to think about.

[00:31:27] The second piece is, how do we make it easier for clinicians to do their jobs and also our administrative staff to do their jobs? So, how do we make sure we have the right information at the right time?

[00:31:40] So, really looking at those core workflows and where the biggest inefficiencies in your organization or even in the bigger healthcare system and how can we use a digital foundation to improve that? And then how do we then make that sustainable for the future?

[00:32:02] So, you know, you create that foundation around your base level technology, which is really your kind of standard EPR, your electronic patient record. And then you use that as the base to build upon. So, sustainability for the future, ensuring that your data and AI strategy is based on use cases. So, the example is you create your foundation, everyone gets the same kind of baseline, and then you start to look at those specific areas where you want to see improvement.

[00:32:31] And then you look at the workflow, and then you build the technological improvements to enhance that. I think that's a powerful moment to end on. And anyone thinking about ROI of this technology we're talking about, let's go back to some of those big stats. More than 20,000 patients successfully self-scheduled their appointments. DNA or did not attend rates halved for self-scheduled appointments.

[00:32:58] And over 3,000 patients accepted earlier appointment offers as a result. Incredible what you've achieved here. And for anyone listening who would like to carry on this conversation or find out more about you and your work, where would you like me to point them? Perfect. So, I think the first place would be our Nordic Global website. So, it's nordicglobal.com. We also have a very active LinkedIn page. And then we will be at a number of upcoming industry events.

[00:33:26] Specifically, HET in the UK is upcoming. There's also a Meditech user network conference coming up in October that's in Liverpool. And there's a number of other industry events we typically share on LinkedIn. Awesome. Well, I'll include links to everything that you mentioned. And for people listening, I urge you to carry that conversation on, find out more information or attend one of those events. It would be great to hear back from you after you do so.

[00:33:54] But more than anything, just thank you for coming on, sharing your story. Great origin story as well. But thank you. Oh, awesome. Thanks so much. I think Alison's examples today demonstrated why healthcare modernisation should begin with the outcome rather than the technology. Cambridge wanted to reduce missed appointments, improve access and make better use of existing clinical capacity. And self-scheduling and automated earlier offers.

[00:34:23] These are the things that provided practical ways to achieve those goals. And I think the wider lesson appears across healthcare. Leaders should ask whether a digital service makes care easier to access. Does it make work easier for clinicians and the admin team? And does it create a reliable base for future improvements? Because yes, AI can support imaging, documentation, workforce planning and waiting list management.

[00:34:51] But success also depends on useful workflows, trustworthy data, staff adoption and alternatives for patients who cannot or don't want to use digital channels. So a massive thank you to Alison for sharing her clinical and digital health perspective. I think she's got quite a unique vantage point there.

[00:35:13] And remember, you can learn more about Nordic Global's healthcare technology work over at nordicglobal.com and follow its latest updates on LinkedIn. I'll include links to everything. But which part of the patient journey would benefit most from better scheduling, information sharing or maybe even automation? Love to hear your thoughts on this. techtalksnetwork.com. Pop over. Follow me on socials at Neil C. Hughes. But send me a message as well.

[00:35:42] Always love hearing from you all. And when you're on Tech Talks Network, I am at a lot of events coming up. So click on the events page and let me know if I'm going to be in a town near you. But I'm afraid we're out of time now. So speak with you all again bright and early tomorrow. Bye for now.