Case Study

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.