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Elective Hubs: struggling to achieve productivity

elective hubs surgery room

An estimated 780,000 more patients in England will benefit from additional surgeries and outpatient appointments by 2024, according to NHS England, thanks mainly due to Elective or Surgical Hubs.

Recently, Brian Wells, Founder of Four Eyes Insight hosted a webinar, discussing if Elective Hubs could help ease NHS winter pressures, in response to the NHS setting out steps to rapidly boost capacity and resilience prior to the current winter pressures.  A main element of the webinar was to examine the challenges faced by elective hubs.

Elective hubs, whether stand-alone or integrated, ring-fenced or part of acute capacity; are predominantly dedicated elective services that focus on a narrower cohort of low-complex elective procedures treated through highly productive clinical pathways. The emphasis here is achieving higher levels of productivity than would be seen within an acute service, where clinical complexity and emergency pressures can directly impact throughput along the elective pathways.

Within the healthcare system, demand and access often exceed available resources, but this has been seriously compounded by the considerable impact on elective pathways from the recent pandemic.

There are approximately 90 elective hubs across England suitable to treat over 60% of patients currently waiting for surgery, an opportunity acknowledged by NHSE South East which has a number of elective hubs and dedicated ring-fenced elective pathways established on its patch. Therefore, assurance that these elective hubs or dedicated ring-fenced elective pathways were being used to their full potential was critical to the region’s elective recovery plans.

Elective hubs should achieve higher levels of productivity through a mission to target patients requiring lower complex procedures treated through consistent and standardised pathways where each element of the patient’s treatment is predictable and efficiently planned. However, that isn’t necessarily the case, as Brian Wells explains:

“What we’re seeing in the data coming out of these surgical hubs is that they are struggling to achieve the high levels of productivity that is possible. There are the usual signs of operational challenges inherent within elective pathways such as under-scheduled operating lists, start delays and cancellations, but there are several cross-cutting themes that have emerged that need to be addressed if the ambitions for high performance are to be met. These themes include;

– A need for dedicated leadership with the ambition and capacity to transform the pathways for high performance,

– Having a dynamic workforce plan designed to deliver higher productivity. Moving beyond the standard guidance for the traditional operating lists of ‘one after the other’ but towards HVLC, Superlisting and HIT listing, where dynamic flow planning allows for parallel activities from enhanced teams that increases in-list utilisation and productivity and reduces downtime.

– Achieving a cultural shift towards productivity through a compelling narrative that effectively engages clinicians and secures buy-in to the principles of high-volume operating lists, and,

– The complete adoption of the core principles for optimising elective pathways as business as usual.”

Following the success of the Elective Recovery Support Programme completed in partnership with the region, Four Eyes Insight was invited to complete a programme of work that included assessing if these elective hubs or dedicated ring-fenced elective pathways were planned or being used to their full potential.

The programme had a significant impact in several areas, with highlights including the trialling of a ‘super list’ ahead of further rollout, the completion of a series of best practice workshops to facilitate the upskilling of staff in best practice processes to maximise elective capacity, and the completion of analytical scenario modelling and delivery targets set to meet productivity expectations.

“Ever since I started Four Eyes Insight back in 2014, I’ve been involved in supporting elective services. We know the exemplars, such as SWLEOC and now hubs across NHSE South East are looking to gear up their capabilities with those exemplars in their sights. Can elective hubs make a difference? Absolutely they can, As stakeholders gain a greater understanding of the things that make the difference and focus on those themes that are challenging progress we’ll see the hubs rebound and deliver”.


About Brian Wells

Brian is a Founder of Four Eyes Insight who trained as a Registered Nurse in the Army specialising in theatres and anaesthetics.

Following a long clinical career, he went on to hold senior management posts in the NHS including, Managing Director of SWLEOC (a centre of excellence in elective orthopaedic care), and Director of Orthopaedics at Guy’s & St Thomas’ NHS Foundation Trust where he provided senior leadership with a focus on clinical productivity, process standardisation and operational grip and control. Brian led the development of the national theatre productivity methodology and analysis and continues to advise on high-performance elective transformation.

Connect with Brian on LinkedIn.