Transforming dermatology by cutting waiting lists and innovating medical skin education.
- Time
- 2023 – 2025
- Client
- Mater Hospital Dublin, Dermatology Department
- Team
- Mater Transformation: Alan MacFarlane, Siobhan Manning, Emer O’Kane
- My role
- Service innovation, product design, co-creation
Challenge
How might we help the dermatology team handle the continuously increasing number of referrals?
Approach
Co-design with the dermatology team, general practitioners and medical schools.
Outcome
Reduction of the routine dermatology wait list by establishing alternative care pathways.
Problem definition
The global rise in dermatology cases, especially skin cancers, is stressing healthcare systems globally. This trend can be observed in Ireland, with 58,009 dermatology outpatients on the waiting list nationally. The Mater Hospital alone accounts for 5% of the national dermatology waitlist.
There are over 3,000 patients awaiting initial dermatology outpatient appointments in the Mater Hospital — the second highest medical specialty and the fourth overall.
National Purchase Treatment Fund, January 2025
It’s like we’re caught in a tsunami of patient referrals.
Capacity for appointments exceeding
Dermatology clinics are overwhelmed by the surge in cases, resulting in longer waiting lists and delayed care.
Longer wait times for routine patients
Continuing prioritisation of urgent cases has led to even longer wait times for routine dermatology patients.
General practitioners referring mainly urgent cases
Cases that are typically triaged as ‘routine’ by dermatologists are often being referred as ‘urgent’ by GPs.
Design research
How might we support general practitioners to manage common skin conditions in the community?
Asking the people who know best
In light of the problem identified through project analysis, it became essential to understand the perspectives of both hospital dermatology and primary care practitioners. With direct access to the dermatology team throughout the research phase, it became invaluable to engage with general practitioners.
In addition to individual interviews, we recruited 22 GPs for a focused two-hour session to explore potential solutions. During this session, participants took part in a dot-voting exercise to prioritise the most promising options for trial.
Developed interventions
SimU Skin teaching aid
High-fidelity models of skin conditions have been incorporated into a book set that will transform how dermatology is taught. These silicone models enable general practitioners as well as medical and nursing students to appreciate aspects such as surface texture, colour and depth of colour.
Purpose
- Teaching tool designed to enhance the identification of skin conditions, from inflammation to infections to tumours, by simulating actual skin textures
- Detailed silicone skin models cover 26 conditions across 14 booklets, offering realistic visual and tactile feedback
Impact
- Improved dermatology learning outcomes for nursing and medical students at UCD IRIS, the School of Nursing and the Mater Hospital
- Finalised product ready for non-profit sale across teaching facilities in Ireland
- Stakeholder research with GPs, medical students and dermatologists
- Development and design of the physical booklet set, content and labelling
- Facilitating the printing and publishing process
- Marketing of the finished product, website and social media
Siilo advice channel
Using the established Doctolib Siilo messenger in the hospital as a quick channel out into the community. General practitioners are able to send photos of routine dermatology conditions they are uncertain about, to seek advice from the specialists in the hospital.
Impact
- Piloted with selected GPs in the hospital’s catchment area and social inclusion hubs to test feasibility and refine the process
- Led to the establishment of a remote Siilo outpatient clinic, operated one day a week
- Improved photo quality, enabling faster and more accurate diagnoses
- Increased confidence and reassurance among general practitioners
- Service development from scratch with dermatology consultants and registrars
- Led the pilot testing, gathering GP feedback and iterating on the process
- Observations and shadowing in primary care, with in-depth interviews
Active Discharge Letter
These new forms of letters assist dermatologists in the hospital by streamlining the process of managing routine cases, quickly generating a dermatology care plan for patients to be passed on to general practitioners in the community for further consultation.
Impact
- Pre-populated Active Discharge Letters save doctors’ time in clinic
- Provides GPs with actionable treatment plans, rather than generic rejection letters
- Offers patient-specific, editable templates with multiple treatment options
- Designed and developed the letters across seven iterations
- Integrated them within the hospital system
- Led co-design sessions with consultants to refine the process
- Collected GP feedback to improve the system
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