What we've done so far
Find out more about some of the super clinics and other projects that have helped reduce our waiting lists.
TOWIE - Our surgery teams maximise efficiency in latest successful initiative
Last week, our theatre operational, clinical and improvement teams worked together to facilitate ‘TOWIE’ (Theatre Operational Week – Improving Efficiency) at both King George and Queen’s hospitals.
The aim of the initiative was to run our theatres as efficiently as possible, to identify opportunities for improvement and moving forward to take on those learnings.
Lucy Gladman, our Deputy Divisional Manager for Surgery, explained why TOWIE was introduced: “Our continuing focus as we recover from the pandemic is to ultimately tackle the patient backlog, and improve our patient’s experience when coming in for an operation at our sites.
“We decided a key part of this would be to maximise the efficiency of our theatres, hence the conception of TOWIE.”
The project involved a range of staff, from clinicians to admin support, who pulled out all the stops to ensure our theatres were running in top gear.
Lucy explained how the teams went about it: “We introduced a range of new measures focusing on efficiency, such as ensuring lists were booked up to four weeks in advance and that the right staffing was available for the operations.
“Throughout the week there was an emphasis on patient experience; we made sure there was good communication, minimising on the day cancelation; and we worked hard to improve the flow of the patient journey in our hospitals on the day of their treatment.
“There was also a huge focus from everyone involved to reduce wasted time between cases.”
The teams identified issues early and worked together to resolve them. Claire McGregor, our Interim Director of Improvement, credits this team spirit as a key factor in the week’s success: “A huge thank you to everyone who was involved, as they worked incredibly hard throughout the week.
“They’ve had to cope with additional issues due to winter pressures, so this was by no means an easy task, but we believe it be a success and we look forward to reporting back with the full results and how we intend to take on the learnings to improve our theatres going forward.”
Theatres 3.0 project sees triple the number of skin cancer patients than normal treated in one day
Our Surgery team (above) pulled out all the stops to operate on 32 skin cancer patients in just one day on Saturday 27 November – triple the number which would usually be seen on an average day.
The Saturday clinic was held in addition to our normal clinics with the aim of getting as many patients as possible the treatment they needed, helping to reduce our waiting lists which have been impacted by the Covid-19 pandemic.
It was led by Maxillofacial, Head and Neck surgeon Neil Shah, who said: “The pandemic has caused many issues, including patients not going to their GP as they were scared. This has led to a backlog of work which we are keen to get through as quickly as we can.”
Mark Churchill, Theatres Matron, had the idea to carry out a high number of simple procedures on a single day, and the team set to work identifying suitable patients.
On a usual day, they would treat around eight to ten patients, however, careful planning and teamwork meant we were able to carry out triple that. All the procedures were for facial skin cancers, predominantly small lump removals.
Our team worked so efficiently, there were just minutes between patients leaving the theatre, before it was cleaned and ready for the next one.
Neil, who has been at our Trust since 2006, added: “Everyone had a specific role and we worked in a very structured way. To make this happen we needed lots of staff, and goodwill from them to come in on a Saturday and make it work.
“Everyone was great, and we’ve had excellent feedback from our patients.”
Further high-volume days like this will be held in the new year to help us continue to reduce our waiting lists. Neil also plans to use the same format to carry out more complex procedures, aiming to complete up to 15 in a day.
‘Gastronaught’ project sees doctors and clerical staff work together to review patients - slashing wait times
Our ‘Gastronaught’ project was set up to reduce delays for those gastroenterology patients facing particularly long wait times due to the Covid-19 pandemic. It achieved that and more with our team reviewing almost three times as many patients as planned, slashing waiting times by five weeks, and finding a new way of working.
Service Manager Allison Wood said: “This project was a huge team effort which took weeks of planning after our divisional director challenged us to review 250 patients facing long waits and get them the treatment they needed.
“Everyone played a role, and they did it so well we actually ended up reviewing 636 patients! Different members of the team played their part whether it was in the planning stages, finding additional capacity, filling in for colleagues released to be part of Gastronaught, or reviewing patients with our doctors. Now we’ve seen the benefits, I can’t imagine working any other way.”
A key part of the project was members of clerical staff sitting with our consultants to triage patients – where they found 51 per cent didn’t need an appointment.
Sarah-Jane Moore, one of the support managers helping to triage patients, said: “Once our doctors had the tools and know-how to access the system and review patients, they really enjoyed it and didn’t stop, which was why we triaged almost triple the number of patients we set out to.
“From this, we found only 49 per cent needed to be seen in our outpatient clinic. Some needed other services which we could refer them to directly, others we were able to send straight for tests or offer advice. This meant 51 per cent of our referrals didn’t need to sit on a waiting list for several weeks, and the 308 patients who did need to be seen, could have their appointment a lot quicker.”
Previously, patients referred to our gastro team were all given appointments, which due to the pandemic, some were waiting over three months for. Now our doctors have smartcards to access the right systems, and are confident using them, all referrals can be triaged by a consultant before being offered an appointment. This has already seen waits reduce to seven weeks, which is expected to come down further as the new way of working continues to pay dividends.
Prem Premchand, gastroenterology consultant, worked alongside Sarah-Jane to review patients. He said: “Once I had access to the patient list and knew what I was doing, I spent a weekend reviewing 90 patients by myself! I found I enjoyed it.
“The difference it has made to our waiting lists shows it was really worth the effort. It’s a very good system and will help to avoid unnecessary delays. It will make a big difference to our patients.”
Not only did the project slash waiting times, it also identified a small number of patients who had been referred on a routine pathway, when they actually they needed much more urgent attention. This meant we could ensure these patients were seen within two weeks.
Allison added: “I’m so proud of what the team managed to achieve for our patients, especially as this was all done on top of their normal day jobs.”
Pictured top are (l-r): Allison, department manager James Biggs, Sarah-Jane, Prem, and Divisional Director of Nursing for Surgery, Julie Wright.
Bones R Us
Our Trauma and Orthopaedic team started our Bones project last October, carrying out 250 procedures, including 135 joint replacements, in just seven days. Among those treated was 31-year-old Natasha Mercer who had a hip replacement and was able to go home safely that same day.
Natasha, who thought her surgery would not go ahead once the pandemic hit, was excited to be able to play more actively again with her two children, aged seven and 10.
Over the last two months, we’ve held two further ‘Bones R Us’ weeks. In June we focused on patients needing surgery to their upper limbs, feet and ankles, completing 60 procedures in five days.
Patient Georgina-Hope-Crossley, who had her right thumb operated on, praised our exceptional staff for caring for her so well, and providing reassurance in case she needs further surgery in the future.
Our Trauma and Orthopaedics team has also been holding super clinics since April, during the week and at weekends, to help get patients the care they need.
During a two-day clinic on 12 and 13 June they saw 260 outpatients.
Consultant Shivakumar Shankar said: “We’ve seen over 1,300 additional patients thanks to our weekend clinics. This is on top of the hard work of our teams during the week as well.”
Our most recent Bones R Us week was held in July, and this time we carried out 51 hip and knee replacements. Grandfather Mark Wells-Bolger (pictured above) called his experience ‘top-notch’ following his second knee replacement (the first was carried out during our October Bones week) and given his job as a bus driver, was relieved to be out of pain with his knees.
Our Bones weeks involve carrying out a much higher number of procedures than we would normally, for example, in an average week we’d carry out between 10 and 12 joint replacements. This is only made possible by having a focused effort across various teams to ensure we can best maximise our resources.
The project is also gaining external recognition and has been shortlisted for the upcoming HSJ Value Award of the Year. And it’s not the only area our surgery team has been recognised in – they’ve been shortlisted in a total of four categories.
The quick work of our Trauma and Orthopaedics team to keep patients safe at the beginning of the pandemic has been shortlisted in the Operations and Performance Initiative of the Year category. The team relocated to the Independent Treatment Centre at King George Hospital in just a week, so we had a Covid-protected site to safely care for trauma patients.
Our Academy of Surgery, an innovative training pathway for doctors wishing to pursue a surgical career, has been shortlisted for the People and Organisational Development Initiative of the Year.
And we’ve been shortlisted for the Acute Service Redesign Initiative, for our subspecialist twinning programme which trains senior nurses and healthcare professionals to become advanced surgical care practitioners and physician associates.
Ophthalmology team reduce waits to under two months
Refocusing resources, running twilight clinics and a paediatric super clinic has seen our Ophthalmology team reduce their backlog.
They looked at ways to safely and efficiently see as many patients as possible, introducing periods of running clinics every day, including weekends, and twilight evening clinics. During a nine-day test period, they saw 596 patients – way above the usual 450 they would see over the same period. Their second run of daily clinics more than doubled that to 961 patients.
During their super clinic week for paediatric patients, they saw 326 children, five times the usual average.
Their hard work has paid off with waiting times now under two months. Future initiatives to ensure they can maintain this standard include a high volume week for cataract patients.
Our Scalpel project set out with an ambitious aim in May this year – to see 1,000 surgery outpatients at special Saturday clinics spread across several months.
They saw 162 patients at the first clinic in May, with some patients able to have injections to help their symptoms, others booked for follow-up appointments or discharged back to their GP and many one step closer to having their operation.
Subsequent clinics in June saw 180 and 210 patients respectively. Pictured above are staff who supported the clinics.
Our Neurosurgery team got in on the act and held a spinal review super clinic, Back2Backs, seeing 119 patients in one day on Saturday 12 June.
The clinic boasted a one-stop-shop to get patients ready for their procedure, something which was appreciated by patient Anna-Maria, who had been waiting to see a neurosurgeon for 10 months.
She said: “Everyone was amazing and it was fantastic that it was a one-stop-shop as it means I don’t have to wait again. It was well worth it.”
Pictured above is complex spine consultant Ahmed Ibrahim, during our Back2Backs clinic.
Urology super clinics
Our Urology team held two super clinics, on separate days over the weekend, to help reduce their waiting lists.
The first saw an impressive 72 patients and the second and incredible 120 in one day.
Surbjit Kudhail, the team’s patient pathway manager, said: “Both clinics were really successful, it’s really important patients know we can still care safely for them. Covid-19 has been our biggest challenge but initiatives like this show our recovery plans are effective.”
Cardio-Respiratory Physiology unit
In March, our Cardio-Respiratory Physiology unit was praised for their efforts to reduce their backlog, which had built up to 3,545 outstanding referrals by October 2020. The team expanded their hours, running early morning clinics as well as seeing patients over lunchtimes and on Saturdays. This was despite strict limits on the number of patients who could be in the department at the time.
Their hard work paid off as referrals were down to pre-pandemic levels of 400 by February this year.
Expanding our diagnostic capacity
We couldn’t offer planned care and reduce our waiting lists without first having in place the capacity to correctly diagnose our patients.
An expansion to our Ultrasound department at King George Hospital will allow our sonographers to carry out between 100 to 150 additional scans each week – absolutely key in reducing wait times for our patients.
We’ve also added an additional CT scanner to our Radiology department at King George Hospital, and our two MRI machines are being replaced with state-of-the-art machines which are 35 per cent faster than our existing versions.
Pictured above is Rakhee Jagatia, general ultrasound lead at King George Hospital, in one of our newly updated ultrasounds rooms.