Case study: Norfolk and Norwich University Hospitals NHS Foundation Trust


Norfolk and Norwich University Hospitals NHS Foundation Trust

What was the problem?

  • Internal pressures with a waitlist of approximately 175,000[1] (around 50,000 of these are new patients who have not been seen) and increasing waiting times for appointments in an acute setting
  • Inconvenience to patients from time-consuming, expensive and stressful travel when they may not need to be seen in acute setting
  • Clinicians fatigued working unsustainably with limited time to invest in long-term improvement e.g., training, advice & guidance, research

What was the solution?

  • Reduce unnecessary follow-ups, repurposing clinician capacity into valuable activity thus improving patient experience and reducing wait times for acute appointments
  • Review existing waitlist and inform appropriate, clinically-validated patients that their pathway will change and they will not have scheduled appointments going forward but have the opportunity to request an appointment if their situation changes (e.g., symptoms return).
  • Follow-ups to be initiated by patients going forwards unless clinically relevant exemptions are satisfied to be decided at time of appointment

What were the challenges?

  • Identifying appropriate cohorts to move to this pathway through defining rules/ criteria to reduce the amount of patient-level waitlist validation required
  • Finding clinical time to review and validate patient-level waitlist
  • Engaging specialties to complete the significant asks and cascade information necessary for successful implementation
  • Identifying investment required to ensure patient safety and satisfaction i.e., to ensure robust patient safeguards are in place to remotely monitor and track patients
  • Resource, training and preparation of centralised admin resource to act as a first point of call to patients releasing burden from specialties
  • Implementation of tech platforms and sufficient training in tight timelines

What were the results?

  • Initial analysis highlighted approximately 21% follow up reduction opportunity split between:
    • Repurposing time from existing variation on 19/20 follow-up activity where efficiencies had already been made
    • Enabling patients who were on the waitlist to initiate their own outpatient appointments  if clinically-validated as appropriate
  • Up to ~9,000 4-hour sessions could be released per year
    • This could be repurposed to: New appointments, procedures, seeing those patients who initiated a follow-up appointment and advice & guidance
  • Since launch of POP programme at NNUH in February 22’, there has been between 55% and 80% increase in appointments that result in patients being added to a patient-initiated pathway
  • Confidence that these results will increase with widespread roll-out, implementation of supporting tech platforms and incentives to complete further retrospective waitlist validation

What were the learning points?

  • Ensure patient safety is the top priority by consistent involvement of clinicians and patient panels throughout to challenge actions and mitigate risks
  • Visible executive drive necessary in all aspects of the program
    • CEO chairing Programme Board and COO involved day-to-day with workstream leads, specialty engagement and stakeholder comms
  • Strong clinical backing and champions to validate opportunity and foster engagement among colleagues
  • Widespread, exec-driven comms to engage internal and external stakeholders
  • Empowered, dedicated project team with clear workstream leads, well-defined deliverables and robust governance to drive forward objectives and monitor progress
  • Maintained focus, delivery and real time problem solving through short touch base meetings 3 time a week.

Next steps and sustainability

  • Specialties to continue defining assessment forms, questionnaires and PROMS to remotely monitor patients and gather information if they request a follow-up. Clinicians will define patient pathways from the form responses.
  • After a period of monitoring, clinic templates will be changed allowing different types of activity to be booked into slots that were originally for follow-ups
  • Embed long-term behaviours by tracking metrics in a monitoring dashboard to be discussed with specialties at regular meetings and presented to Trust board weekly

Want to know more?

Sheila Glenn

Operations Director: Transformation & Integration (POP Programme Lead)


[1] Active and inactive RTT waitlist