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How can we meet the revised elective targets as winter closes in?

There are clear expectations that NHS Trusts will stabilise their elective waiting lists and clear very long waiters by March 22. The NHS continues to face challenging times as it heads into what is predicted to be a tough winter ahead, but it will need to respond to the call for getting more done in a changing environment of expected efficiencies.

Brian Wells, Managing Director of Four Eyes Insight argues that focusing finite resources on recognized priorities will enable NHS Trusts to keep the elective pathways running as A&E creaks under the pressure of increasing attendances.

And a good place to start is to focus on those ring-fenced elective centres (Hubs) and those elective pathways which are most remote from the impact of acute medicine.

Host trusts should look for and expect higher levels of productivity through their dedicated elective centres and pathways. With staffing levels under pressure, it is even more vital that every operating session is maximized to its true potential.

We ask ourselves, why are green pathway still experiencing lower levels of utilization than prior to COVID? Why is there greater focus on providing more operating sessions and resourcing additional hours in preference to focusing on maximizing those operating lists in play?

The elective centres and ring-fenced pathways need to be the foundations for High Volume-Low Complexity (HVLC) delivery. Day case units rarely reached higher levels of productivity even before COVID materialised, so a focus on those operational factors that, when done well, move the dial on productivity and deliver more is critical to elective recovery.

So, our top tips on where to focus:

  • Plan, test and trial HVLC productivity lists. Be ambitious for your service. When staffed and managed well these operating lists are focused, buzzing environments where morale is high and expectations are clear. No one is rushed and patient safety is paramount. So explore their potential. Look to make them mainstream.
  • Examine and address short notice cancellations. Why are there patients on operating lists who no longer require surgery? It was a rare phenomenon but now an increasing issue. Launch a Task and Finish Group to get under the causes of last minute cancellations, especially on those patients where good processes would intercept and reduce these.
  • Consider standby patients. There are many patients out there who will be willing to come in on short notice, so plan for this.
  • Consider higher levels of productivity through superlists, parallel lists and other high productivity lists. These allow for much greater throughput and maximise the use of existing theatre stock and available sessions. Explore their potential.
  • Examine the capacity and capabilities of your processes for planning for high productivity. How effective is the 6-4-2 and operating list planning? Can it deliver on expectation? Are your operational and reporting process responsive to high levels of productivity?
  • Start on time. So many operating lists start significantly late so plan and expect to get things underway to ensure the available surgeon time is maximised. This is very possible, although it needs a strong focus and pathway discipline to ensure the pre surgical planning tasks are completed. Explore ‘First’ or ‘Golden’ patient principles, they make a difference.
  • Measure and report. Ensure your operational teams have sight of the impact of what they do. Look back on recent performance, challenge, address and resolve repeat issues. Push through custom and practice in favour of evidenced based performance. Call out success.

There are clearly other issues and processes to address but these are some of the big-ticket items that, when addressed, are highly impactful on elevating the safe and effective productivity from your elective pathways.

At Four Eyes Insight, we really know how to turn up the dial on elective productivity. We work alongside your clinical and operational teams at pace and with absolute focus on the things that make the difference.

If we can help to transform your theatre efficiencies, please do get in touch by email or visit