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Case Study: Transforming Theatre Management

The NHS Foundation Trust in the South East performs up to 250 surgeries weekly across several surgical specialties, and managing a high volume of sessions has been a challenge.

Four Eyes Insight was invited to support the Trust by implementing its Theatre Productivity Software, which led to marked improvements in operational visibility and efficiency.

In response to the challenges faced by the Trust, FEI presented a comprehensive, strategic approach that put collaboration and customisation at the forefront of the project.

  • Active Engagement: This was initiated with the Trust’s Data Team, fostering a collaborative environment that facilitated a clear understanding of their specific needs and goals.
  • Automation: Ensured real-time data availability and enhanced the accuracy and speed of decision-making processes.
  • Training: To ensure staff could understand and use the software confidently and to its full potential.
  • Support: A robust customer support system was implemented, including a regular feedback loop with the hospital team

 

The partnership between the Trust and FEI reaped meaningful benefits, setting new standards for operational visibility, efficiency, and performance tracking.

 

Results

One of the most significant improvements has been the comprehensive increase in operational visibility. The Trust now has a daily updated view of historical and projected performance, improving the management and planning of hospital operations.

The software’s ability to create standard and customised reports, as well as email notifications, has increased this visibility. These data and notifications enable the hospital to address performance adjustments as soon as they occur, keeping the management team informed and responsive.

The software’s ability to visibly illustrate improvements has motivated the team and reinforced the positive effects of their efforts, with an improvement in efficiency and an increase in touch time utilisation.

Cardiology Demand & Capacity Programme

This programme was designed to support the Cardiology team at an NHS Trust in the south west region in tackling a critical challenge of understanding and addressing the gap between demand and capacity across three key service areas:

  • Outpatients
  • ECHO
  • Cath Labs

 

Four Eyes Insight set out to determine if more efficient and effective care delivery could be achieved by balancing patient requirements with available resources through practical productivity improvements.

Our method included a thorough evaluation of existing procedures and practices in addition to in-depth analytics.

Determining Capacity

Through a robust analysis of floor plans, rotas, and templates, we were able to determine capacity. We gained a better understanding of usage from historical activity data. Discovering the need was made possible by referrals, growth, and backlogs. Following the identification and validation of the demand-capacity mismatch with the service, a range of scenarios were modelled to illustrate the potential impact on productivity.

To assess the recommendations’ practicability and identify potential roadblocks to change, we conducted observations and interviews with departmental operational and clinical leaders and team members.

The data reveals a clear imbalance, with demand exceeding capacity across the Cardiology service, however opportunities to enhance productivity and reduce the need for additional capacity were identified.

27 recommendations were made to support the service to close the gap, with key ones being:

 

Outpatients:

  • Aim to reduce variance in the volume of slots between clinicians completing like-for-like activity
  • Review clinical pathways for follow-up patient management (considering new to follow-up ratios, community/PIFU opportunities)

 

ECHO:

  • Ensure adequate nursing resource and ring-fenced beds to protect procedure room capacity

 

Cath Lab:

  • Consider extended recovery time to allow for greater flexibility of scheduling stents.
  • Dedicate portering to the service to increase flow and reduce delays.
  • Undertake a workforce plan for lunch relief so that Cath labs can undertake run-through lists.
  • Work with BIU teams to improve data quality, providing more reliable productivity data.

 

Anticipated results

Our data and analytics team identified the following anticipated results:

Outpatients:

  • Utilising the new outpatient model recommended could improve the DNA rate to 5% and reduce the gap by 60 patients per month.

 

ECHO:

    • If the TOE service provided the capacity to see an additional one patient per clinic, they would have sufficient capacity to meet demand, and the backlog would be cleared within 22 months.
    • Running half-day weekend sessions and adding two additional sessions per weekend would enable an additional 33 patients to be seen each month.

 

Cath Labs

Several scenarios were modelled and found that:

  • By realigning capacity across the two labs to provide one full lab for angiography and one full lab for pacing, there would be sufficient capacity to clear Angio waits within 15 months.
  • By realigning capacity and improving productivity to provide one full lab to angiography and one full lab to pacing, while improving utilisation of capacity to 80% in both labs, Angio backlogs could be cleared within 14 months, and Pacing growth would reduce to 6 patients per month.

 

Contact us to learn about how we can support the understanding of Demand and Capacity in your organisation.

Walsall Healthcare NHS Trust: Diagnostic Review of Endoscopy

Four Eyes Insight and Walsall Healthcare NHS Trust collaborated on a 10-week Endoscopy Programme that was split into two phases (1) diagnostic and (2) implementation, supporting the following workstreams:

1.Pre-Assessment

2.Scheduling, capacity, and session/list productivity

3.Managing the flow of the Endoscopy Unit

 

Objectives of the programme included:

  • To reduce unwarranted variation and benchmark practices with other endoscopy services
  • To review productivity data and performance.
  • Support operational grip and control across endoscopy including booking processes
  • Support flow within the endoscopy service ensuring compliance with JAG standards
  • Provide SME and JAG support

 

The service had several vulnerable areas that needed addressing, including patient pathway/flow within the unit; Pre-Assessment model and delivery; workforce competence and training; data provision, quality and performance monitoring and more.

To drive improvements and understand where the benefits lie, FEI supported the Trust to address vulnerable areas and help them on their way to JAG accreditation.

 

Results

The anticipated benefits for endoscopy pre-assessment, include:

  • Estimated 20% reduction in patient cancellations
  • 5% increase in activity from improved planning procedures that optimise funded capacity
  • Increased capacity and slots to meet service demand
  • Increased list utilisation and management
  • Optimisations of pathways
  • Increasing alternative pathways
  • Anticipated reduction in OTD cancellations.

In addition, FEI supported the team in gaining JAG accreditation.

“Thank you for your feedback and support in achieving JAG, we couldnt have done it without you!” Clinical Lead, Walsall Healthcare NHS Trust 

PAH Ophthalmology

PAH: Ophthalmology Demand and Capacity Programme

The ophthalmology team at Princess Alexandra Hospital NHS Foundation Trust (PAH) has experienced significant challenges over recent years. Waiting lists are growing, with demand for the service outweighing capacity. Demand and capacity is particularly challenging for long-term-condition follow-up patients. These patient cohorts do not form part of routine activity performance monitoring and, therefore, nationally are afforded less focus than other patient groups.

A recent visit by GIRFT and subsequent workshops helped to challenge the views on what improvements could be made with the current workforce and capacity. Four Eyes Insight was asked to support the programme by undertaking a detailed demand and capacity exercise for ophthalmology to understand how the planned changes would impact waiting times and performance.

Delivery Approach:

A pathway-wide model was designed to understand the demand and capacity for the ophthalmology service at a sub-speciality level. A series of bespoke scenarios were tested to review the impact of service improvement and productivity enhancement initiatives, such as:

1. The expansion of virtual Outpatient appointments for Glaucoma and Medical Retina patients

2. The introduction of high-volume cataract lists in theatres

3. An improvement in utilisation across the service (outpatients, diagnostics, POA, theatres).

For the duration of the programme, a weekly workgroup was established that brought together a multi-disciplinary team of key stakeholders to validate the model inputs, agree on reasonable assumptions and sign off on the accuracy of the final outputs.

 

Results:

The model delivered a robust understanding of the true gap between capacity and demand at a sub-speciality level across the full patient pathway.

It was established that backlogs for theatres could be controlled in line with the national target of 85% (0.65 additional patients on the average list) and introducing 3 high-volume cataract lists per week into business-as-usual processes.

The model also demonstrated improvements that could be made in outpatients by increasing virtual capacity and improving productivity to 95% (booked). However, it was clear that further changes would be required to meet follow-up demand fully.

Sustainability:

The ophthalmology team continues to work alongside GIRFT to redesign outpatient pathways, supported by the outcomes of our analysis.

Case Study: Improving Theatre Management

The Trust invited four Eyes Insight to implement our Theatre Productivity Software, which led to marked improvements in operational visibility and efficiency.

In response to the challenges faced by the Trust, FEI presented a comprehensive, strategic approach that put collaboration and customisation at the forefront of the project. Implementing the software had a positive impact on the following deliverables:

  • Booking process map
  • Training of scheduling staff
  • Training of management staff
  • OPCS code training and crib sheets
  • Embedding into scheduling meeting
  • OPCS code training and crib sheets
  • Booking process map
  • List review meeting
  • Scheduling action log
  • Pre-op Green to Go

The partnership between the Trust and FEI reaped meaningful benefits, setting new standards for operational visibility, efficiency, and performance tracking

 

“The software has now been successfully embedded, and in the first three weeks of December, despite significant winter pressures, we were able to carry out 118 more cases as a result. This is a fantastic achievement.” CEO NHS Foundation Trust

 

Results

One of the most significant improvements has been the comprehensive increase in operational visibility. The Trust now has a daily updated view of historical and projected performance, improving the management and planning of hospital operations. Key results include:

  • 19% ROI from using the software
  • 118 additional cases delivered at a potential of £137k in benefit over the first three weeks of software implementation
  • Through utilising the FEI software, the Trust were able to deliver a benefit within four weeks of starting the programme, equating to a £2.3M FYE

 

Business case hillingdon hospitals nhs foundation trust maximising theatre estate utilisation

Theatre Estate Utilisation Business Case: Hillingdon Hospitals NHS FT

Hillingdon hospitals logo

After undertaking an analysis of the Trust’s theatre estate utilisation, FEI revealed that a notable 18% of the theatre estate is vacant during core hours (per annum and after the removal of bank holidays, audits, and strikes).

The outcome of the analysis presented a significant opportunity to increase the volume of patients able to be treated through the existing estate by targeting fallow sessions that are dropped mainly due to a lack of annual leave cover for the clinical workforce. While acknowledging the challenges associated with regular backfill of dropped theatre sessions, the gains are significant—the ability to accommodate over 1,500 patients annually.

Hillingdon Hospitals NHS Foundation Trust enlisted the support of FEI to provide theatres expertise and practical capacity to develop a robust business case that outlines the cost and benefits of delivering this invest-to-save opportunity.

Our delivery approach to creating the theatre estate utilisation business case

Drawing on extensive experience within theatres, FEI conducted rigorous scenario modelling to identify a suitable opportunity to target, which considered the following that would result from reducing the lost capacity in theatre estates: 

  • Activity expectations
  • Bed requirements
  • Staffing projections
  • Financial implications

 

Throughout the four-week period, FEI collaborated closely with operational and financial teams to ensure the accuracy of analysis and viability of implementing solutions before crafting the final business case. 

Our approach enabled informed decision-making and culminated in the agreement of the recommended option, positioning THH for improved patient outcomes and enhanced financial resilience.

Results

In line with the objective of the programme, FEI delivered a theatre estate utilisation business case with a net income range of £1,275,714–£1,825,760.

The robust business case was agreed upon by core stakeholders and has the ability to achieve the following benefits:

  • 80% of the total opportunity that was identified
  • 614 additional sessions per year through the existing theatre estate
  • 1681 additional patients able to be seen based on the average case per session
  • Inpatient >52-week waits eliminated within 11 weeks

 

To learn more about how we can support your organisation, contact us today.

capacity and demand modelling case study

Demand & Capacity Modelling: Regional Elective Hub

As part of the 10-week programme, Four Eyes Insight (FEI) produced an integrated activity, workforce, and finance model supported by a compelling narrative describing the benefits of launching a high-volume regional elective hub for an NHS Acute Provider Collaborative (APC), as outlined below.

Activity

  • A scenario-based modelling tool to support the planning and delivery of activities was created.
  • Activity predictions were built up from procedure-level data based on average touchtimes.
  • Clinical agreement to the ability to perform certain procedures through high-performance lists, also known as super-lists was established.
  • The ability to manipulate core inputs (utilisation/session duration/session volume/volume of high-performance lists) in an interactive tool allowed flexibility to increase and decrease expectations weekly across the year.

Finance

  • A financial strategy options paper provided three main options for decision, largely premised around the profit/risk share model across Trusts.
  • Incentivisation options were presented at organisational and workforce levels.
  • Financial implications of the hub were considered as part of the integrated modelling with the ability to demonstrate impact due to implementing various scenarios.

Workforce

  • There was discussion and impact modelling of the effects of various alternative roles.
  • A review of staffing implications for high-performance lists was conducted.
  • Workforce modelling was integrated within the demand and capacity analysis and staffing requirements were varied alongside operational plan alterations (e.g., session duration and volumes)
  • Supporting documents for the recruitment strategy were developed.
  • Consistent and high-quality job descriptions addressing the skill sets and deliverables specific to Elective Hubs were designed.

Engagement and Results

  • Subject Matter Expert-led clinical engagement sessions were held to support the ambition for change and improvement.
  • Operational delivery model scenarios were agreed.
  • A compelling narrative was written to communicate the model across providers.
  • Workforce recruitment commenced aligned to the agreed new ways of working.
  • Anticipated benefit: the ability to treat an additional 4316 ENT and urology patients annually and 52-week backlog clearance within 3-6 months.
  • Almost 2500 hours of capacity was identified for release at non-host sites.
Outpatient improvement programme walsall healthcare nhs trust

Walsall Healthcare NHS Trust: Outpatient Improvement

 

FEI Impact on Walsall Healthcare NHS Trust

In Spring 2022, the NHS England Elective Care Improvement Support Team (IST) undertook a qualitative diagnostic review of Walsall Healthcare NHS Trust’s (WHNT) outpatient booking processes, making 19 recommendations for the Trust in their final report.

Keen to address the recommendations made, WHNT embarked on a transformative programme, guided by the IST and their mission was clear:

    – Overhaul outpatient booking processes
    – Combat high Did Not Attend (DNA) rates
    – Optimise clinic utilisation
    – Ensure equitable access to healthcare in a region struggling with health inequalities

The Trust put in place an improvement plan and requested support from Four Eyes Insight (FEI) to deliver tangible improvements against the most challenging areas of reducing DNAs, improving clinic utilisation, improving governance, and providing training.

At its core, the programme was scoped to support WHNT to address health inequalities, and improve patient access to the Trust and was part of a wider package of work underway to reduce safety risks associated with long waits.

The patient population served by the Trust is characterised by its diversity in terms of socio-economic status, introducing unique challenges related to digital disparities, language barriers, and financial constraints. WHNT is in the 10% most deprived districts in the country, and its population experiences significant health inequalities; with both infant and under-75 mortality from preventable causes significantly worse than the England average, with the COVID pandemic exacerbating existing issues across the region.

Target KPIs

    The programme launched with an Insight and Discovery Phase, used to identify opportunities and agree on stretching yet realistic key performance indicators (KPIs) on which the programme’s success could be measured. The KPIs encompassed both numerical metrics and process-driven initiatives, representing a holistic approach aimed at demonstrating tangible outcomes and ensuring the sustained effectiveness of the interventions. KPIs included:

      – Achieving a 2% increase in booked and capacity utilisation
      – Achieving a 2% reduction in the DNA rate
      – Tangible evidence of an increase in patient attendance
      – The implementation of a refined 642 booking process
      – Impact scoring of Admin and Clerical training
      – Tailored DNA reduction initiatives within agreed specialties
      – The establishment of streamlined communication channels


    A collaborative ethos that ensured both FEI and WHNT were fully aligned with the programme’s objectives was a critical component of the programme’s success. Other crucial contributing factors to the realisation of the KPIs included:

      1: Establishing a robust governance structure to underpin the programme’s delivery
      2: Develop a comprehensive set of reports to baseline and track performance
      3: Creating a patient-centric approach with special attention given to traditionally under-represented demographics, ensuring that the programme was finely tuned to address patient needs and concerns.

    Adopting a phased approach enabled quick implementation of improvements and offered agility to adapt and fine-tune the new processes at pace. The four core phases were:

      1: Insight and discovery:Engagements, onsite observations, and data analysis led to KPI development.
      2: Implementation of process change:Guided by the results of patient feedback, the multidisciplinary Task-and-Finish Groups supported two core workstreams to agree upon and implement new processes.
      3: Delivery period: At the time of physical change, KPIs were closely monitored to measure the impact.
      4: Handover: With assurance, the results could be sustained.

    The programme encompassed a range of process changes that were implemented to address specific challenges the Trust faced. The result was a tangible improvement to operational delivery, providing healthcare professionals with more structure and visibility in business-as-usual tasks. For patients, the work has improved access to healthcare, increased available slots, and provided a range of communication methodologies that were previously unavailable.

Increasing Utilisation

Specifically, the core actions taken to enable an increase in utilisation are as follows:

    • Vacant Slot Report (VSR): FEI collaborated with the health informatics team to create an hourly-refreshing VSR, offering a real-time view of available capacity. This data empowered better capacity utilisation.
    • Slot Management Rules: Rules were developed to guide staff on converting and managing short-notice capacity efficiently.
    • Digital Solutions for Patient Communication: Introducing enhanced patient communication methods enabled rapid notifications to multiple patients regarding short-notice appointment capacity. This approach significantly reduced the time required to fill open slots compared to traditional phone call-based scheduling, increasing utilisation of capacity and releasing staff to focus on scheduling up to 6 weeks in advance.
    • Addressing Recurring Capacity Gaps: FEI identified and resolved chronic underutilisation issues by collaborating with clinical and operational leaders. Solutions included template changes, adjusted booking rules, and the release of reserved slots to optimise utilisation.
    • 642 Process Enhancement: The programme revamped outpatient estate and clinic utilisation management. We refined 642 scheduling meetings with a new Standard Operating Procedure focused on forward planning and action, supported by an interactive floor plan amongst other tools for better visibility of capacity.
    • Streamlined Communication Channels: The introduction of a centralised area on Microsoft Teams established a clear structure for efficient outpatient and communication operations. The Trust began to utilise a RACI matrix for escalation policies to ensure communication reaches the right recipients at the right time and we designed Microsoft Forms for streamlined short-notice booking requests, improving clarity.

Reducing DNAs

In order to reduce DNAs, several steps were taken to modify processes such that disadvantaged patient populations would not be disproportionately affected. The critical changes embedded included:

    • Appointment Reminders: Rolled out to over 200 previously excluded clinics, with voice reminders being introduced for patients without mobile phones and efforts made to provide reminders in multiple languages.
    • Transport Support: Following a pilot project assessing the impact of offering free transport options to patients, a streamlined process for claiming travel costs was introduced. Patients could now be reimbursed on the day of the appointment, eliminating the need for lengthy processing. Information sheets explaining the process and eligibility were included with appointment letters, resulting in increased financial support uptake and helping to reduce DNA rates.
    • Letter Enhancement: Letter language was simplified, and patients were encouraged to check in at the outpatient reception desk to receive directions once at the hospital.
    • Webpage Translation: A dedicated webpage was created to translate appointment reminders into different languages, ensuring inclusivity for patients with diverse linguistic backgrounds and enabling automatic translation during phone calls with hospital staff.
    • Printing Letters: Issues related to letter communication were addressed, including ensuring all users could print externally for timely letter delivery. Training materials were provided to support appointment booking.
    • Bespoke Processes: Specialty operational and clinical leads collaborated to develop targeted approaches where DNA rates were high; including, overbooking slots in some clinics, implementing Patient Initiated Follow-Ups (PIFU), and using bespoke text messages to address specific challenges in various specialties.
    • Validation Initiatives: Validation exercises initiated in specific specialties, like Gynaecology and Trauma and Orthopaedics, expanded across the Trust. FEI drafted Standard Operating Procedures (SOPs) which the Trust rolled out across specialties.

Patient-Centric Results

The actions mentioned in the previous section enhanced healthcare resource management, patient engagement, clinic operations, and communication efficiency.

    As a result of these actions, the following tangible improvements were realised:
    – 4.8% improvement in Booked Utilisation
    – 3.1% improvement in Capacity Utilisation
    – An increase of 1255 attendees across the 6-week delivery period
    – Reduction of 52 DNAs per week
    – 14% reduction in patient complaints

    In addition, the Trust has seen £1.73M ERF income for the first 5 months of the year attributed to outpatient attendances and a £9000 reduction in monthly outpatient WLI spend.

      “Working alongside Walsall to deliver this programme has been a very rewarding experience. Together, we have improved the operational processes within the outpatient department, leading to better use of the available capacity, easier communication routes for patients, and a marked reduction in the volume of patients who have missed their appointments.  The success of this programme can in part be attributed to the dedicated time the Trust has provided to drive forward the changes alongside us. Despite significant operational pressures, the end goal has remained a firm focus and Trust colleagues have embraced the capacity and subject matter expertise our support provides.” 

    Samantha Sullivan,
    Delivery Director,
    FEI.

To learn more about how Four Eyes Insight can help your Trust improve, contact us through the button below.

Connect with Samantha on LinkedIn.

In partnership with Walsall Healthcare NHS Trust, we’ve been shortlisted for the 2024 HSJ Partnership Awards in the category of Best Elective Care Recovery Initiative.

HSJ Partnership Awards Best Elective Care Recovery Initiative

Great Western Hospitals NHS Foundation Trust: Transforming Theatres with Performance Software

Theatres Performance Software at Great Western Hospitals NHS Foundation Trust

Click on the image below to access the full case study on our Theatre Performance Software ⬇️

Great Western Hospitals NHS Foundation Trust: Transforming Theatres with Performance Software

With 16 operating rooms and 125 weekly elective care sessions, Great Western Hospital NHS Foundation Trust in Swindon performs 250 to 300 surgeries weekly across several surgical specialities.

Managing a high volume of sessions has been a challenge, the most critical being the lack of daily visibility into theatre performance, impacting resource allocation, patient safety, and overall hospital efficiency.

Four Eyes Insight was invited to support the Trust by implementing the Productivity Software, which led to marked improvements in operational visibility and efficiency.

The challenge: visibility into Elective Theatre performance

Grappling with the challenge of needing daily visibility into theatre performance, the Trust required improvement of effective resource management and overall hospital efficiency.

Great Western targeted Four Eyes Insight to support by:

  • Developing a robust solution that enhanced operational visibility.
  • Implementing the software solution within an ambitious six-week timeframe.

Solution: Theatre Productivity Software

Four Eyes Implemented its Theatre Productivity Software, offering the Trust an innovative web-based platform for monitoring and improving the efficiency of elective theatres.

Our software supported Great Western Hospitals NHS Foundation Trust with:

  • Daily view of theatre performance
  • Standardised report outputs
  • Improved resource management
  • Improved efficiency
  • Bespoke reports
  • Automatic email summaries
  • Streamline operations
  • Access to expert customer service

In response to the challenges faced by the Trust, Four Eyes Insight presented a comprehensive, strategic approach that put collaboration and customisation at the forefront of the project and included:

  • Active Engagement
  • Automation
  • Training
  • Support

More information on these project elements is available in the full case study here.

The results

The partnership between Great Western HospitalsNHS Foundation Trust and Four Eyes Insight has reaped meaningful benefits, setting new standards for operational visibility, efficiency, and performance tracking.

Key results include:

  • Increase in operational visibility
  • 7% increase in touch time utilisation
  • Ability to treat an additional 182 cases

All results can be accessed in the case study document.

Click here to learn more about the Four Eyes Insight Theatre Performance Software or contact us to arrange a demo.

 

 

 

NHSE South West: Elective Recovery Support

During the pandemic, the elective care setting of the South West Region was one of the most adversely affected in the country. Together, NHSE South West and Four Eyes Insight developed a large-scale elective recovery programme that launched in early 2022 across six of the Trusts in the region.

In response to the challenges of approximately 25% of all non-admitted patients waiting over a year for treatment, and over 2% waiting two years or more, the programme scope was to identify areas of opportunity to:

– Improve productivity

– Support in-scope Trusts with trajectory modelling areas of improvement

– Collaborate with Trusts to develop medium–long-term strategic improvement and delivery plans

– Support the sustainability of embedded practices through the delivery of a series of tailored, region-wide training workshops

Through the use of Four Eyes Insight’s nationally recognised Theatre Productivity Methodology, opportunities were identified where a surgical list had the capacity to perform additional cases to improve efficiency and tap into unutilised capacity.

Across the six organisations, a 29% in-session productivity opportunity was identified amounting to a potential 17,500 additional cases which could have been performed within sessions running between April to October 2021 – the equivalent of 84 additional cases per weekday across the six organisations.

Working together, Four Eyes Insight, NHSE South West and the six Trusts set ambitious objectives and targets to improve efficiency markers, including touch time utilisation, list downtime and day case rates, helping the reduction of backlogs within specialties deemed to be of greatest challenge and the largest opportunity for high-impact change.

Data-driven software

In support of the programme, the Four Eyes Insight Theatre Software was implemented at both Trust and Regional levels, enabling a data-driven and target-orientated approach to planning and performance review.

A unified approach to productivity methodology, terminology and data interpretation enabled a granular review of past performance at the specialty level and at the NHSE level, providing a holistic view of pressure points across the region and easy access to up-to-date and validated productivity metrics to support decision-making.

The software was implemented as part of the programme through a phased process including;

– Data assurance

– Validation with clinical and operational teams

– Stakeholder training and deployment

The deployment of a single theatre productivity methodology also facilitated standardisation and interpretation of performance metrics between Trusts around the region which supported collaborative working practices within the margins of the programme and beyond.

Implementation and Governance

The 16-week programme was designed to make an instant impact, whilst providing the region with a sustainable legacy of best practices through an established partnership with NHS stakeholders.

During the initiation of the programme, a high-level timeline and detailed project milestone planner were developed and installed to guide the programme at a deeply granular level; allowing both the NHSE and Four Eyes Insight teams to form a strong partnership, working towards the common goal of enhancing the patient experience through a continuous improvement approach.

This not only complemented the internal project governance but supported risk and change management processes to ensure the continued momentum of implementation actions agreed upon.

Impact and results

Improvements during the programme were overwhelmingly positive:

– Average case per session (ACPS) for in-scope specialties increased by over 8% and by as much as 20% in some specialties

– The increase in ACPS translates to over 230 additional cases per month throughput by the conclusion of the programme, directly contributing to driving down the 104-week wait position

– Touch time utilisation, saw over 9% improvement recorded, which can in part be attributed to the recommendations to reduce late starts in theatres by over 17% on average

– The result of these improvements drove the opportunity which existed in the form of excess capacity down by over 34% during the programme with the ambition to continue these favourable trends

Soon after the conclusion of the programme, the overwhelming majority of specialties were able to appropriately prioritise and release the excess capacity identified through the programme to effectively clear their 104-week wait position.

By identifying major improvement themes across the six Trusts and creating a Shared Learning Group to forward this agenda post-program, regional shared learning was brought into clear light. Scheduling and planning, workforce contingency, enhancing theatre efficiency, IPC rules, and ensuring the continued sustainability of improvement initiatives region-wide were balanced among the major themes.

These advancements have a wide range of effects on patients and healthcare workers. Utilizing every session will increase theatre efficiency overall, which will directly affect the country’s health. Urgent referrals will be handled more quickly, and patients who have been waiting for care who may be deteriorating, rendering them unable to work or adding to the NHS’s financial burden, will be seen sooner.

Sustainability assessments were undertaken as a final output to provide a feasibility assessment of theatre improvement plans, helping Trusts identify areas where their improvement plans require further work to ensure they are sustainable for the medium to long term.

Foundations for sustainable change

As a result of the success demonstrated during this programme, a further programme of work was commissioned for a second cohort of seven additional trusts across the region.

The programme’s legacy is one of continuous improvement facilitated by empowered local teams equipped with the tools, knowledge, confidence, and motivation to transform elective care.

The region-wide focus on elective recovery ensures efforts to reduce waiting lists and improve patient throughput are sustained beyond the programme. Efforts which are now coordinated through a shared learning partnership between NHSE and all acute Trusts across the region.

If you would like to learn more about the work Four Eyes Insight has done to support NHSE South West, or how we can support your organisation, please contact us.