Mater Dei Hospital's Outpatient Department has improved in many ways particularly in terms of the number of patient visits, the increased availability of clinical specialities, and work practices adopted. However, excessive waiting times for outpatient consultation appointments remains an issue of concern for both patients as well as the hospital; Auditor General Charles Deguara noted in a report concerning the hospital.

The report observes inefficiencies in three major areas, namely inappropriate referrals, unequal distribution of patients between consultants and no-shows, individually and collectively, influence outpatients' demands significantly

This is attributed to the fluctuation of patients between private and public healthcare, the fragmentation of health policy and protocols, shortcomings in primary health care as a gatekeeper to secondary care, as well as MDH's limited enforcement action over inappropriate referrals and patient no-shows.

The cost of delivering outpatient services exceeds an estimated €32 million annually, however, the hospital does also face a number of constraints when balancing supply with demand, which limits the hospital from extending its outpatient services.

These limitations relate to issues arising from the availability and synchronisation of MDH's resources as well as work practices

Deguara notes that the hospital is still in the process of developing a strategic operational framework for the Outpatient Department, and the absence of such framework along with complementary protocols are both conducive to clinical specialities pursuing their particularistic interests rather than hospital-wide goals.

It is also observed that the hospital's complex organisational structure means that reporting and communication lines are often ambiguous as the involve the hospital, the ministry for health, line managers, and heads of various professional streams.

The absence of an integrated administrative IT system-which captures, processes and provides up-to-date and reliable management information-hinders planning as well as management direction and control.

The National Audit Office is also informed of plans for a new outpatient premises but notes that its full potential will only be realised through a more robust strategic and policy direction, stronger management control as well as streamlined work practices.

The report proposes a number of recommendations aimed at the strategic, operational and IT levels; including increasing its collaboration with the private health sector, Public-Private Partnerships, provide real-time information relating to the waiting times, and step-up efforts to minimise the incidence of unjustified no-shows.

This report may be accessed through the NAO website www.nao.gov.mt or the NAO Facebook page www.facebook.com/NAOMalta.