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.



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.


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

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.


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.


  • 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.


  • 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.


  • 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.

Tangible and Process-driven 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. 1: Insight and discovery: Engagements, onsite observations, and data analysis led to KPI development.
  2. 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. 3: Delivery period: At the time of physical change, KPIs were closely monitored to measure the impact.
  4. 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.
  • Bulk Texting: Implementing bulk texting allowing quick notifications to multiple patients about short-notice slots, adopting a first-come-first-served model. This significantly reduced slot-filling time compared to traditional phone calls. *Phone calls were still utilised where the next patient waiting did not have a mobile phone to ensure digital exclusion was avoided.
  • 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 Outpatient booking processes, contact us today to arrange a call with Outpatient Subject Matter Expert and Delivery Director, Samantha Sullivan.

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 per week

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.

Cardiff & Vale UHB: Theatre Improvement Programme

Download the full case study here.

Having completed several projects across the patient pathway, Four Eyes Insight (FEI) has built up a trusted relationship with CAV and recently undertook a 24-week Theatre Improvement programme with the health board that included:

– A four-week diagnostic to identify core issues

– 16 weeks of implementation support

– Four weeks of change integration

Following the effects of the pandemic, the volume of patients waiting for surgery and the length of wait for routine treatments increased significantly.

The Four Eyes Insight Approach

The programme was structured in 3 core phases:

Phase 1 Insight and Discovery

A four-week diagnostic was implemented to enable the Four Eyes Insight team to familiarise themselves with local structures and challenges, combining a series of observations, data analysis and engagements to understand all opportunities, operational, clinical and workforce related within the Health Board.

Phase 2 Rapid Implementation

During phase two, the programme focused on building firm foundations through governance and process changes that enabled the organisation to increase activity and productivity.

Phase two was split into three workstreams:

1 -Theatre Utilisation. During this workstream, best practice processes and rigorous performance management structures, underpinned by clinical performance and opportunity data to drive planning performance were implemented.

2 – High Volume Low Complexity (HVLC) listing. This workstream saw the FEI team support clinical leads and champions to adopt or adapt the clinical pathways for HVLC.

3 – Pre-Operative Assessment Clinics (POAC). Working in partnership with CAV, the FEI team redefined the criteria for walk-in appointments and amended clinic templates.

For more detail on these workstreams, download the full case study.

Phase 3 Embedment and Sustainability

This four-week embedment phase was where the FEI team stepped out of delivery and into an advisory role. Handing over ownership of the new processes to sustain delivery and enable the CAV team to continue to see improvements post-project.


Ensuring all benefits are tracked, measured and sustained is at the core of our business ethos. Throughout the project, we worked shoulder-to-shoulder with clinicians and operational teams to create buy-in for the project goals. This approach ensured that programme outputs became part of the organisational culture and assured the longevity of changes.

Key results:

– 47 additional cases seen per week across the delivery period

– 10% increase in the number of POAC attendances

– 4% reduction of in-session opportunity to see additional cases within lists


Learn more about the programme by downloading the full case study here.

using data to help meet nhs cancer standards and reduce the cancer backlog

Driving Compliance Against Operational Cancer Standards

Four Eyes Insight were part of a team commissioned jointly by an NHS Trust in the South East of England, the regional ICS and NHSE to drive improvements across Cancer pathways.

Download the full case study here.

Four eyes insight case study reducing the cancer backlog for the NHS

The Trust are a major provider of integrated hospital and community services caring for over half a million patients every year, with over 6,000 clinical staff.

With a goal to aid recovery from the Covid-19 pandemic and increase compliance against Cancer operational standards, the programme of work spanned two phases. It was successfully delivered, resulting in improved compliance with cancer operational standards and a reduction in the waiting list backlog.

The Challenge: Declining Compliance against Cancer Operational Standard
Despite continued efforts to maintain cancer services during Covid-19, like others across the country, the Trust had seen a decline in compliance against national cancer operational standards.

As such, there was a need for external sector expertise to help identify opportunities to enhance cancer pathways, and ensure a thorough understanding the core capacity available to see cancer patients in the long term.

Our Approach
Phase one focussed on driving improvements to five core functions of the cancer service:

1. PTL management

2. Tumour pathways

3. Cancer workforce

4. Quality and governance

5. Booking and scheduling

Following detailed reviews of existing practises and processes within each workstream, interventions were implemented with both short and long-term benefits. In the short term, several quick wins were introduced to retain grip and control on cancer performance.

Following the work completed in phase one, it became apparent that a consistent and structured approach to Demand and Capacity modelling, with credible and reliable trajectories for each core cancer pathway was required.

During Phase two each tumour site was modelled from referral through to treatment, considering critical stages along the pathway including OPD (N+FU), diagnostics (Endoscopy and Radiology), theatres and MOPS.

The Results
Phase one saw improvements in the Trusts performance against cancer operational standards, with key highlights including:

– 15% increase in 2ww compliance

– 27% increase in 62-day compliance

– 24% and 12 % improvement were seen against the 31-day to first treatment and 28-day faster diagnosis respectively

As a whole, the programme of work undertaken by Four Eyes Insight provided the Trust with the evidence to support its service improvement methodologies and understand the variation between demand and capacity to be able to tackle inefficiencies. This has and will continue to support better decision-making, and increase compliance against cancer operational standards.

Partnering with the NHS to reduce the cancer backlog

Our mission is to find clinical efficiencies.
Four Eyes Insight uses the combined power of our people, data and technology to get to the root cause of elective care and cancer pathway inefficiencies. We implement interventions that enable the NHS to effectively use data to understand where improvements could be made for both immediate and long-lasting change.

Click here to download the full case study.

If you would like to find out more or discuss your requirements, please Contact Us.

Transforming elective recovery across NHS South East

Following the pause of the elective activity, due to Covid-19, elective waiting lists have grown significantly.

Contact Us to transform elective recovery across your region.

The Challenge
In 2021, NHS England and NHS Improvement – South East Region commissioned Four Eyes Insight to support their Elective Recovery Support Programme in the South East of England. Following the pause of all elective activity due to the COVID-19 pandemic, elective waiting lists across the South East region had grown significantly, increasing waiting times on already pressured services. The pause caused a significant increase of patients waiting 18+ weeks for treatment. Therefore, the challenge was to implement our programme of support with the objective of ensuring each of the six trusts nominated across the South East region, had a robust recovery plan for high volume services.

Our Approach
This was a 16-week programme, covering 6 Trusts, (1 Trust from each integrated care system across the South East region) focusing on 3 specialties – Orthopaedics, ENT, and Ophthalmology. We sought to build robust and deliverable improvement plans as well as to support the identification and implementation of ‘quick wins’ to inject pace into the programme.

We began with a rapid initial data gathering exercise to establish current and historic performance levels; this information was validated with clinical and operational teams. Next, we gained feedback from focussed specialty-level team meetings and on-site observations, including 6-4-2 meetings and Theatre Utilisation Review meetings, and presented the key findings and initial recommendations to the programme board and SROs.

During the second phase we co-developed and agreed bespoke improvement plans for each Trust and commenced the monitoring, delivery and reporting against the plans. Our teams ensured delivery of plans was kept on track for the duration of the engagement and ensured mitigation actions were devised and taken when required. In addition, we conducted a Capability and Capacity Assessment for each Trust with KPIs, and improvement trajectories developed, agreed, and monitored as part of internal Trust governance processes.

The Results
The FEI team started with an initial data analysis exercise which drew a comparison between current and historic (pre-pandemic) performance levels. This allowed a pre-pandemic baseline to be established which permitted the accurate measurement of relative performance and activity going forward. For example, the initial analysis highlighted early on that late starts in theatres were an issue across the region, and this was validated directly with clinical and operational leads for each specialty.

A key component of the recovery programme was the identification and sharing of best practice across the South East region. Areas of best practice were identified during our key engagement and observation sessions, i.e., 6-4-2 and theatre utilisation. Some of the key cross-cutting recommendations from across the programme were implementation of the perfect morning to address late starts, revisions to in-house opportunity reporting and re-visiting theatre/estate utilisation. FEI also led region-wide and Trust-specific training sessions, with good engagement from clinical and operational teams.

Organisational good practice was also shared across the region. For example, during our observations we identified that the 6-4-2 process at NHS Trust 1 represented regional best practice. It incorporated key elements of an efficient and well organised 6-4-2 meeting, which were shared with other organisations in the region, ensuring the teams are looking 6 weeks out, with good levels of engagement and regularly addressing any blockers.

The recommendations were further supported by the FEI admitted PTL tool to explore the backlog, looking at key criteria such as weekly additions, patient priority, procedure types, average touch times and regional comparators. Utilising this data, demand and capacity modelling was undertaken for each provider, focusing on scenario-based trajectory modelling to improve activity levels to 120% of pre-pandemic levels. For example, the scenarios in the Ophthalmology service at NHS Trust 2 are shown in the graph below, with different session lengths, theatre utilisation (%) and weekly additions to the waiting list used to map the different scenarios.

There was a positive outcome at both system and Trust level, with each Trust having signed-off robust recovery plans, which Trusts are currently implementing. Capability and capacity assessments were also conducted for each recovery plan, highlighting areas that may need executive support. Improvement plans were also supported through in-depth data analysis. For example, NHS Trust 3 now have an elective recovery improvement plan in place, consisting of 22 actions covering 5 distinct areas, with time scales and owners, which clearly lays out an agenda for continued improvement.

A range of KPIs were established and formed an integral part of the recovery plans, that ensured the plans were robust and these indicators will be used to monitor the impact of improvement actions.

How Four Eyes Insight Can Support

As providers continue to work toward elective recovery, Four Eyes Insight are here to help. We use the combined power of people, data and technology to get to the root cause of NHS elective care pathway inefficiencies; working collaboratively and engaging with all stakeholders to get buy in for change from the ground up. We implement interventions that optimise elective care pathways and provide tools to monitor their effectiveness ensuring that a culture of continuous improvement to drive long term, sustainable change is embedded along the way.

To download a pdf of this case study, please Click Here.

If you would like to find out more or discuss your requirements, please Contact Us.

Improving outpatient clinic efficiency through communication

Once the Four Eyes diagnostic review was complete, 5 specialties were chosen for our first wave of implementation. After the success of this implementation the Trust has commissioned Four Eyes to develop demand & capacity models for the hospital’s outpatient clinics.