In the face of mounting pressures on NHS services, one North West NHS Trust has taken bold steps to tackle one of the largest gynaecology waiting lists in England.

With over 763,000 women waiting for care, delays are impacting both physical and mental health. This case study highlights how a strategic partnership between Four Eyes Insight and Prism Improvement helped the Trust redefine its approach to elective theatre utilisation. A strategy was delivered to increase throughput by 28% (12 additional cases per week, equivalent to 600+ patients per year).

The Challenge

As a tertiary centre, the Trust handles highly complex gynaecological cases. Despite early efforts—such as moving non-complex work off-site, investing in insourced lists, and extending theatre durations—utilisation remained suboptimal. Up to 75% of theatre lists were finishing an average of 88 minutes early, revealing significant inefficiencies.

The Strategy

The programme began with a deep dive into the Trust’s operating model, identifying three key areas for improvement:

• Reducing changeover time through overlapping activities like anaesthetic prep and recovery.
• Amending list durations to better match case complexity.
• Reviewing case mix to strategically balance throughput and care quality.

Pilots were launched to test innovations such as High Performance Lists (HPLs) and standby patients, with a focus on filling short-notice gaps and increasing intermediate case capacity.

 Key Achievements

• Developed and piloted a new model to that would aim to increase weekly case throughput by 28% (12 additional patients per week). This could be achieved by:
  • The hospital aiming to reduce cancellations to 9%
  • Deploying standby patients with 75% success rate
  • Running three dual-theatre HPLs per week
• HPL Pilots:
  • By implementing HPLs, financial modelling showed potential to reduce insourcing costs by up to £550k annually
  • Pilots demonstrated a 30–35% sustainable increase in patients per list.
  • Identified 213 patients waiting over 18 weeks suitable for HPLs

Firm Foundations for Sustainable Change

To ensure long-term success, the programme embedded:

• Daily review huddles and refreshed cancellation meetings.
• Training on scheduling and RTT rules.
• Cross-site governance forums to share resources and drive productivity.

 Cultural Shift and Future Outlook

Clinical teams are now fully engaged in the HPL model, with standby patient adoption becoming routine. The programme didn’t just deliver operational improvements—it redefined how complex surgical care can be scaled safely and efficiently.

Three months post-programme, early signs of sustained progress are evident. The Trust now has a clear blueprint for moving from underutilisation to maximised capacity—offering a scalable, evidence-based model for elective recovery across the NHS.

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