Unlocking Hidden Capacity in NHS Diagnostic Services

Why this topic matters

NHS diagnostic services are under immense pressure. National targets, such as the 6-week diagnostic standard and the 28-day faster diagnosis standard for cancer, highlight the urgency of improving access and turnaround times. Prolonged waits for diagnostics lead to anxiety for patients, delays in treatment, and can worsen clinical outcomes. For the NHS, this translates into increased costs through longer hospital stays, emergency presentations, and reduced productivity.

Unlocking hidden capacity is not about working harder, but working smarter. It involves a systematic review of how work flows through a department, identifying inefficiencies, and implementing changes that allow for more patients to be processed with existing resources. This approach is particularly valuable in the current financial climate, offering opportunities for improvement where capital investment may be limited.

Practical explanation: What is hidden capacity?

Hidden capacity refers to the unused or underutilised potential within a system. In diagnostics, this can manifest in several ways:

• Equipment downtime: Machines standing idle between patients, during breaks, or due to preventable maintenance issues.
• Suboptimal scheduling: Gaps in diaries, inefficient booking practices, or mismatched patient types to available slots.
• Workflow bottlenecks: Points in the patient journey where work accumulates, such as patient check-in, reporting, or results dissemination, causing delays downstream.
• Variation in practice: Inconsistent ways of working across staff or shifts, leading to less efficient operations in some areas.
• Underutilised staff skills: Highly skilled staff performing tasks that could be competently undertaken by others, or staff not fully deployed to their scope of practice.
• Ineffective spatial layout: Poor design of physical spaces leading to unnecessary movement or delays.
• Data and information flow issues: Delays or errors in sending and receiving patient information, referrals, or results.

Identifying these areas requires a detailed understanding of current processes and a willingness to challenge established norms. It’s often through the cumulative effect of small, incremental improvements that significant capacity gains are realised.

Common pitfalls

Successfully uncovering and utilising hidden capacity is not without its challenges. Awareness of these common pitfalls can help teams navigate the process more effectively:

• Lack of baseline data: Without understanding current performance metrics (e.g., scan times, report turnaround, wait times), it's difficult to quantify problems or measure the impact of interventions.
• Blame culture: Focusing on individual 'failures' rather than systemic issues can hinder open communication and prevent staff from sharing valuable insights.
• Resistance to change: Staff may be accustomed to current ways of working, and proposed changes may be met with skepticism or resistance, particularly if the rationale is not clearly communicated.
• Insufficient resources for improvement: Even small changes require time and effort for planning, implementation, and monitoring, which can be hard to find in busy departments.
• 'Quick wins' over sustained effort: While quick wins can build momentum, sustained improvement requires ongoing commitment and monitoring.
• Not involving front-line staff: Those directly involved in the diagnostic pathway often have the best insights into inefficiencies and potential solutions. Excluding them can lead to poorly designed interventions.
• Lack of system-wide perspective: Addressing a bottleneck in one part of the pathway without considering its impact upstream or downstream can simply move the problem rather than solve it.

Step-by-step approach: Unlocking diagnostic capacity

This framework outlines a structured approach to identifying and utilising hidden capacity within diagnostic services:

Step 1: Define the scope and establish a baseline

• Identify a specific area: Start with a focused area experiencing significant pressure e.g., 'MRI scanning for neurology outpatients', 'histopathology reporting for suspected colorectal cancer samples'.
• Collect baseline data: What are the current waiting times, throughput, staff utilisation, equipment uptime/downtime, and turnaround times for your chosen area? Quantitative data is crucial here.
• Map the current process: Visually map the entire patient or sample journey. Include all steps, decision points, handovers, and potential delays. Value Stream Mapping (VSM) can be an effective tool here.
• Engage stakeholders: Involve staff from all roles (radiographers, radiologists, pathologists, allied health professionals, porters, administrative staff, IT support) and representatives from referring services.

Step 2: Identify bottlenecks and waste

• "Walk the process": Observe the process in real-time. Where do queues form? Where are there delays? What activities add no value from the patient's perspective?
• Analyse data: Look for patterns in your baseline data. Are there specific times of day, days of the week, or types of cases that show reduced efficiency?
• Use the '7 Wastes' of Lean: Applicability in a diagnostic setting:
  • Defects: Inaccurate scans, mislabelled samples, incorrect reports.
  • Overproduction: Producing reports not immediately needed, excess stock.
  • Waiting: Patients waiting for scans, samples waiting for analysis, reports waiting for verification.
  • Non-utilised talent: Highly skilled staff doing administrative tasks, skills not matched to demand.
  • Transportation: Unnecessary movement of patients, samples, or staff.
  • Inventory: Excessive consumables, reagents, or stored reports.
  • Motion: Unnecessary movement of staff within their workspace.
• Root cause analysis: For each identified bottleneck, use tools like '5 Whys' to understand the underlying causes rather than just addressing symptoms.

Step 3: Develop and prioritise solutions

• Brainstorm solutions: With the engaged stakeholders, generate ideas to eliminate waste and overcome bottlenecks. Encourage creative thinking.
• Technological solutions: Could digital dictation, AI-assisted reporting, automated scheduling, or enhanced picture archiving and communication systems (PACS) improve efficiency?
• Process redesign: Can steps be combined, eliminated, or reordered? Could staff roles be optimised? Consider demand smoothing and capacity matching.
• Prioritisation matrix: Evaluate solutions based on impact (e.g., potential capacity gain, patient benefit) and feasibility (e.g., cost, effort, resources required). Focus on high-impact, high-feasibility options first.

Step 4: Implement and test changes

• Pilot small changes: Use Plan-Do-Study-Act (PDSA) cycles to test interventions on a small scale before wider implementation. This allows for learning and adjustment.
• Communicate clearly: Explain the 'why' behind the changes to all staff and provide necessary training.
• Collect data during implementation: Monitor key metrics to see if the changes are having the desired effect. Be prepared to adapt.

Step 5: Sustain and spread improvements

• Standardise new processes: Once effective, embed the changes into daily practice, update protocols, and provide ongoing training.
• Celebrate successes: Acknowledge the efforts of the team and the positive impact on patients.
• Continue monitoring: Regularly review performance to ensure gains are maintained and identify further opportunities for improvement.
• Spread learning: Share successful interventions with other departments or across the wider organisation.

Example in clinical practice

A large NHS Trust's radiology department faced increasing wait times for ultrasound scans, particularly for abdominal and pelvic examinations. They followed the steps above:

1. Scope and Baseline: Focused on general ultrasound. Baseline data showed significant variation in scan times between sonographers, frequent gaps in morning clinic lists, and delays in patient handover from waiting areas to scan rooms. Patient flow mapping revealed bottlenecks in patient check-in and room turnover.
2. Bottlenecks and Waste: Root cause analysis indicated that administrative staff often struggled with complex booking rules, leading to empty slots. Sonographers spent valuable scanning time retrieving previous imaging or reviewing referral details. Room turnover was slow due to inconsistent cleaning protocols.
3. Solutions:
   • Simplified booking system: Developed clearer booking guidelines and provided additional training for administrative staff, empowering them to fill slots more effectively.
   • Pre-scan preparation: Implemented a system for administrative staff to pre-fetch relevant prior imaging and referral details before the patient arrived in the scan room, presenting it to the sonographer.
   • Room turnaround checklist: Introduced a standardised, visual checklist for cleaning and preparation between patients, reducing downtime.
   • Skill mix review: Explored delegating some basic patient preparation tasks to support staff.
4. Implementation and Testing: Piloted the new booking guidelines and pre-scan preparation in one clinic first. PDSA cycles identified the need for clearer digital access to prior imaging for administrative staff. The room turnaround checklist was refined based on feedback.
5. Sustain and Spread: After a successful pilot, the changes were rolled out across all general ultrasound lists. Regular audits of booking efficiency and scan room utilisation demonstrated a 15% increase in daily patient throughput without additional staff or equipment. This success was later shared with gynaecology ultrasound services.

This example illustrates how a structured approach, focusing on waste reduction and process optimisation, can unlock significant hidden capacity and improve patient access.

How Lazomis can help

Lazomis provides a suite of tools that can significantly support your efforts in unlocking hidden capacity within diagnostic services:

• Data Dashboards: Visualise key metrics such as waiting times, throughput, equipment utilisation, and staff activity. Identify trends and bottlenecks quickly to target your improvement efforts effectively.
• Process Mapping Tools: Digitally map your current diagnostic pathways, highlighting each step, handover, and potential delay. This provides a clear 'as-is' picture for analysis.
• Project Management Templates: Structured templates to plan, implement, and track your quality improvement (QI) initiatives, including PDSA cycles for testing interventions at scale.
• Collaboration Features: Facilitate team engagement, allowing staff to input ideas, share observations, and document progress within a centralised platform.

By leveraging Lazomis, teams can move from anecdotal observations to data-driven insights, ensuring that improvement efforts are targeted, measurable, and sustainable. This resource supports, but does not replace, clinical judgement. Local policy, formulary and specialist advice should be followed.

Key takeaways