1. Clarify and describe the problems of the NHS Choose and Book System. What management, organization, and technology factors were responsible for those problems? When senior cardiologist Duncan Dymond complained in 2010 that patients were arriving at his hospital at incorrect times and, far worse, in need of a different specialist, it was neither the beginning nor the end of problems with the Choose and Book system. Installed in 2004 as part of a £200 million IT modernization of Great Britain’s National Health Service (NHS), the patient booking system was supposed to enable patients to select a hospital for an outpatient appointment from a range of options, primarily with the help and direction of their general practitioner (GP). A letter with a referral number and a secure code was then generated so that the patient could either go online or call a central booking service to confirm the appointment. Initial contact could also occur directly via the national appointments line or at the HealthSpace Web site. The goals were threefold:

to speed up the referral process, eliminate costly paperwork, and encourage patient participation so as to stem losses of up to £225 million annually from 1.6 million patient no-shows.