Themes
- Increasing theatre productivity
- Mutual aid
- Reducing waiting times
South Warwickshire University NHS Foundation Trust (SWFT) is an acute and community trust that provides services from four hospitals as well as community services to over half a million people across Warwickshire. Following a strategic refresh in 2022, SWFT has identified improvements to productivity as a key strategic pillar of its organisational strategy which is focused on supporting patients to lead healthier and happier lives.
Reducing waiting times by maximising the efficiency of surgical hubs
The trust has set up a mobile operating theatre to conduct elective orthopaedic procedures, with a corridor connecting it to SWFT's existing orthopaedic elective ward. This has helped to streamline the entire patient experience and ensured all the necessary clinical adjacencies are in place to keep the patient pathway as efficient as possible.
One of the key reasons for the trust's success has been its creation of a back up list of 'diamond patients'. In addition to having a set list of patients scheduled for procedures each day, 'diamond patients' have agreed to be seen at short notice should any cancellations arise. Patients on the diamond list are contacted by 9am on the day of surgery to let them know if they can be seen on that particular day. This has brought significant benefits to theatre productivity as it has ensured that the trust can consistently carry out a minimum of four procedures a day and has meant that no slot has been abandoned since the mobile facility opened.
Furthermore, the trust has tripled its day case rates and reduced length of stay (day one discharges have increased to 80%) to ensure there is sufficient bed capacity available to treat the increased volume of elective patients treated via the new surgical hub. These improvements have partially been achieved by expanding post-operative patient management, with the on-site therapy offer being extended to 8pm each day to help SWFT discharge patients more efficiently. Overall, the new surgical hub has substantially increased SWFT's elective capacity, with
the trust previously having the capacity to carry out approximately 1,200 procedures each year. This has now been expanded to over 1,600 procedures annually. The new facility has offered significant benefits to patients who are now being seen much quicker, preventing a deterioration in conditions and helping to ensure speedy recoveries. While this expanded capacity has offered benefits for the local area, it has also allowed the trust to support system partners in reducing waiting times for their patients through mutual aid programmes.
Mutual aid – collaborating with partners to tackle shared challenges
SWFT is a member of the Foundation Group, alongside Wye Valley NHS Foundation Trust, George Eliot Hospital NHS Trust and Worcester Acute Hospitals NHS Trust, which is organised under a shared leadership model. All members share the same chief executive and chair, but remain sovereign organisations with their own board and committee structures.
One of the primary benefits of being part of the Foundation Group has been the structure it has created for peer-to-peer networking and relationship building between the groups' members. These connections have enabled them to work closer together to develop innovative solutions to shared challenges and learn from what’s working in each other’s organisations.
Following the pandemic, and to support the group's efforts to recover care backlogs, a mutual aid programme was established with the trusts agreeing to a set of shared objectives and goals across a range of different service lines, including trauma and orthopaedic surgery, general surgery and urology. The group host fortnightly mutual aid meetings, which allows operational teams to check in with each other, share data and identify opportunities where support can be provided. For example, SWFT has consistently had a strong frailty model and has supported other group members in identifying solutions to improve their performance. The trust has now established a regular process with another group member, treating ten of their long-waiting elective patients each month and agreeing to operate on them within four weeks.
The benefits to patients are clear. Those on waiting lists have been offered treatment at alternative sites within the group in order to be seen quicker as well as offering patients with more complex care needs access to the specialities of the wider group. The programme has substantially reduced waiting times for some patients and has effectively utilised expertise across the group. The programme has received broad support from both patients and clinicians and its adaptability has meant the programme can be replicated across a broader range of service lines provided by the group, taking learning from previous models into account to maximise efficiency.
Overall, the group's mutual aid programme highlights how effective collaboration between trusts can yield substantial benefits for patients, by reducing waiting times and expanding their access to a wider range of clinical expertise, as well as improve the productivity of the respective organisations.
Reflections
The new surgical hub at SWFT has had a significant impact in reducing waiting times for patients, both in the local area and throughout the wider region. However, while such an expansion in surgical capacity may not be possible for all trusts, the work SWFT has carried out to optimise bed capacity, reduce length of stay and maximise theatre productivity offers valuable lessons for others.
Furthermore, the trust's emphasis on working with its partners and expanding its mutual aid programme highlights how effective collaboration between providers can simultaneously improve productivity for organisations and offer better outcomes for patients.