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The Perfect Storm

  |   Thought Leadership

Operational Management is hard enough without a system decision or nudge to aggregate priorities on hospital performance.

  • Urgent Care Target (at all costs)
  • Cancer 62 days (try not to make it worse)
  • RTT 18 weeks (with whatever is left)


Any run on the A&E target which is supported by short term interventions such as opening extra beds staffed by Agency clinicians, GPs in A&E, will skew demand profiles and build up referral patterns within a hospital that become established quickly.

It is Failure demand.

The key principles for operational managers are Balance & Clinical Agility. Hospital capacity is not one-dimensional. If Elective theatres aren’t open for RTT cases, re-allocate Surgical Job Plans to perform Outpatients. Increase diagnostic capacity in the winter. Insource capacity and focus it on the front end of the Cancer and RTT pathway.

Hospitals balance their clinical work if they continue to trust the fact that 3 targets all require the same operational management disciplines. Aggregating their importance is exacerbating the failure demand cycle.

Data Quality: the accuracy of patient level data, end-to-end Urgent care waiting times, the source codes for Cancer and RTT and key SOPs within the booking cycle;

Capacity & Demand Schedules: the accuracy and churn within clinic templates within each clinical sub-specialty. The formulation of flexible job plans;

Governance & Treatment Management Compliance: Access policy compliance and feedback loops on long waiting patients;

Chronological Schedules and Queueing: the balance of urgent-soon-routine-overbooking slots, and their impact on waiting time shapes;

Clinical Leadership: who is responsible for clinical oversight of scheduling and booking (theatres and outpatients);

Training: new staff and refresher training for Admin and Junior Medical staff;

Clinical Quality: the alignment of the clinical governance & audit programme to the Trust’s operational management teams;

Leadership: General Management systems. Issues such as devolved or centralised booking. Control systems.


It sounds easy. It isn’t.

It requires constant dedication to communication and openness with clinical staff. It requires flexibility and it is driven by managers and clinicians using data together.

The perfect storm is when on top of this operational challenge, the “system” decides to make life easier for itself. By abandoning activity based contracts and going on block. By focusing on new formations and structures. By exposing one part of its ecosystem (the expensive part) to aggregated risk.

The Hospital COO is managing the ship. Make it easier for them to do it.