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Sustaining Outpatient Productivity Improvements: Lessons from Two NHS Divisional Directors

Webinar: Sustaining Outpatient Productivity Improvements
Date: 23/10/2025
Speakers: Andrena Weston, Divisional Director at Shrewsbury and Telford NHS Trust; Sian Webley, Divisional Director of Operations at Walsall Healthcare NHS Trust; Samantha Sullivan, Delivery Director, Four Eyes Insight
Chair: Stephen Dorrell, Chair, Prism Improvement and Four Eyes Insight

“Earlier this year, NHS Confederation’s Jim Mackey famously called for healthcare leaders to “tear up the outpatient model” and rebuild it better. For many trusts struggling with growing waiting lists and limited resources, this isn’t just rhetoric – it’s an urgent operational imperative.” – Stephen Dorrell, former Health Secretary and Chair of both Four Eyes Insight and Prism Improvement.

Getting the Foundations Right—and Keeping Them Strong

Transforming outpatient services is only half the battle. The real challenge? Making those improvements stick.

In a recent webinar, operational leaders from Walsall Healthcare NHS Trust and Shrewsbury and Telford Hospital NHS Trust shared their journeys of transforming outpatient productivity – and more importantly, how they’ve sustained those gains months and even years after consultancy support ended.

The Challenge: Doing More with Less

A poll of webinar attendees revealed that the number one challenge facing NHS trusts today is straightforward yet daunting: demand continues to grow while resources remain limited. Other pressing concerns included backfilling cancelled appointments, managing conflicting operational priorities, and maintaining staff engagement.

These challenges are familiar to anyone working in NHS outpatients. But what sets high-performing trusts apart isn’t just that they tackle these issues – it’s that they create systems that keep working long after the initial improvement project ends.

Building on Solid Foundations

Both trusts worked with Four Eyes Insight and Prism Improvement on projects focused on maximising existing capacity through better booking and scheduling processes. The approach was intentionally foundational:

◾Clean, reliable data to understand true clinic utilisation

◾Streamlined booking guidelines – condensing complex 15-page documents into simpler, actionable formats

◾Structured booking teams with clear rotas for bookings, either by phone or letter

◾642 meetings (6 weeks, 4 weeks, 2 weeks ahead) to maintain forward visibility

◾Backfilling processes to capture last-minute cancellations

◾Digital tools like broadcast messaging to fill gaps at short notice

The results speak for themselves. Andrena Weston, Divisional Director at Shrewsbury and Telford, highlighted that booked clinic utilisation improved dramatically from April (2025) onwards and they have calculated the number of slots to potentially 15,000 per year across all specialties, while the waiting list size decreased month-on-month. At Walsall – now two years into their journey, Sian Webley stated that utilisation reached 95% and DNA rates dropped from 11% to 8%.

The Secret to Sustainability: Make It Business as Usual

When asked what it takes to sustain improvements over two years, Sian Webley, Divisional Director of Operations at Walsall, was clear: “We’ve really tried to incorporate it as part of our business as usual.”

This isn’t about maintaining a separate “improvement project.” It’s about embedding the changes into weekly routines, governance structures, and performance conversations. At Walsall, the graphs below are reviewed by teams every week and reported to the executive team every two weeks through their elective care meeting.

But data alone doesn’t sustain change – people do.

Fig. 1: One of the graphs shown from Walsall Healthcare NHS Trust in the webinar.

Outpatient DNA rate

Empowerment, Engagement, and Energy

Perhaps the most striking theme from both trusts was the emphasis on team ownership and empowerment. Rather than dictating targets from above, leaders asked their booking teams: “What do you think you can do?”

This approach had several powerful effects:

◾Pride in achievements: Teams at Walsall are now “extremely proud” of their metrics and continued to drive improvements beyond initial targets

◾Autonomy and accountability: When teams own the performance improvement, they’re more invested in maintaining it

◾Morale boost: At Shrewsbury and Telford, feeding back booking utilisation improvements “significantly boosted morale and enhanced performance”

◾Problem-solving mindset: Senior leaders positioned themselves as barrier-removers, tackling everything from broken printers to more complex operational issues

Andrena Weston, emphasised how simple changes – like implementing rotas for booking team focus – provided “greater clarity” and improved performance. Meanwhile, standardising clinic structures through a booking governance group became “a real game changer” for data quality.

Harnessing the power of the patient voice

One often-overlooked element of successful operational transformation is involving patient relations teams from the start. At Walsall, bringing the patient communications team into the project paid unexpected dividends: patient complaints related to outpatients reduced by 14%.

“We don’t always include the patient voice in operational performance work,” Sian noted, “but they can help design and inform the processes that we’ve got in operational management.”

This patient-centred approach reinforces the “why” behind the work – something both leaders identified as crucial for maintaining engagement over time. Connecting improvements to tangible patient benefits – shorter waits, better access, fewer wasted appointments – keeps teams motivated when the going gets tough.

Overcoming Barriers to Sustainability

When asked about challenges to sustaining improvements, webinar attendees highlighted engagement and conflicting priorities as key concerns. Sian’s advice was practical:

1️ Maintain oversight structures: Don’t dismantle the governance mechanisms just because you’ve hit your target
2️ Continually refresh your vision: Keep pushing – 93% utilisation today, 95% tomorrow, 97% next year
3️ Remember that basics matter: “Getting these processes in bookings correct in the first place has paid dividends on managing what felt like an unworldly PTL post-COVID”

Andrena, just three months into embedding changes, asked Sian the question many trusts face: “How do we maintain the engagement?”

Sian’s answer centred on connection, reflection, and empowerment:
◾ Connect the work to the “why” are patients waiting too long for care
◾ Show teams how far they’ve come through regular data feedback
◾ Give teams autonomy to drive improvement themselves
◾ Create energy around the achievements and their impact on patients

What’s Next: Building on Success

With solid foundations in place, both trusts are moving toward more sophisticated transformation:

◾ Shrewsbury and Telford is continuing its digital health platform rollout and reviewing clinic templates and appointment timings
◾ Walsall is focusing on referral assessment to ensure patients are seen in the right setting, and exploring ways to maximise value-added appointments (reducing unnecessary “scan and come back” visits)

These next-level improvements are only possible because the fundamentals are secure. You can’t optimise clinic templates effectively if you’re not filling the clinics you already have. You can’t implement sophisticated digital tools if your booking guidelines are too complex for staff to follow.

Key Takeaways for NHS Leaders

For trusts embarking on outpatient transformation, or struggling to sustain improvements already made, the lessons are clear:

1️ Get the basics right first: Clean data, clear processes, and empowered teams create the platform for innovation
2️ Embed in business as usual: Sustainability requires integration into regular governance, not separate project structures
3️ Empower, don’t mandate: Give teams ownership of performance improvement and the autonomy to drive it
4️ Keep the patient voice central: Operational improvements should be grounded in patient benefit
5️ Maintain momentum: Continually refresh targets and celebrate progress to sustain energy and engagement
6️ Engage everyone: From nursing teams to patient relations to executive leadership, transformation requires buy-in at all levels

From Project to Business as Usual

As Stephen Dorrell noted in closing the webinar, these improvements demonstrate that change is possible, even if it doesn’t constitute “tearing up the outpatient model” entirely. It’s about doing things differently and better, for patients, staff, and the system as a whole.

The results from Walsall and Shrewsbury and Telford tell a compelling story: productivity improvements can be sustained, waiting lists can come down, and teams can maintain motivation – but only when the work is embedded as business as usual, owned by empowered teams, and connected to the fundamental purpose of improving patient care.

Two years on, Walsall is still improving. Three months in, Shrewsbury and Telford is already seeing results. The challenge now is for more trusts to follow their example – getting the foundations right, and then keeping them strong.

We would like to thank both Andrena Weston and Sian Webley for their time and contribution to this webinar.

You can learn more about outpatient transformation by contacting us here.
The full webinar recording is available to view here.