Regional Health System Redesigns Pathways

Providing pathway efficiency support to one of the largest NHS Strategic Health Authorities in England.  Focused on improving and alleviating the causes of poor health for the benefit of the regional population of 4m people.  It comprises 9 Acute Hospital Trusts, 3 Mental Health Trusts, 1 Learning Disability Trust and 1 Ambulance Trust.


The government had devised a new Referral To Treatment (RTT) lead-time target of 18 weeks.  As an early achiever the Trust wished to demonstrate significant progress 9 months before the target coming into force.

The Trust required support to design, redesign and maximise pathway efficiency across pathways such as Cardiology, Urology, Orthopaedics, Mental Health, Chronic Pain and Gynaecology.


Develop a multi-disciplinary programme team  comprising key stakeholders from across the region.

Identify 27 care pathways for improvement to achieve 18 week RTT through the deployment of Lean Thinking.

Review, map and measure the existing pathways to establish a baseline and identify key issues.

Organise Rapid Improvement Events (R.I.E.) to redesign the pathway focused on maximising efficiency and improving patient care, whilst reducing waste and referral to treatment lead-time.

Create the long-term impetus for Lean and Continuous Improvement, through the transfer of knowledge and the building of capability.

Develop a pathway specific performance measurement system to monitor the efficiencies across the 27 projects.

Facilitate inter-trust networking and best practice in order to support cultural change, collaboration and cross-organisational learning.


RTT lead-time reductions of between 40% and 80% across the 27 clinical pathways.

Standardised suite of Lean metrics devised, leading to reduced RTT, cancellations, inappropriate referrals, follow-up appointments and pathway backlogs.

Inclusion of pathway focused metrics into regional operational performance and governance reporting process.

The programme facilitated very important work at a critical time for the SHA.  The work continues to be important and the skills and knowledge that were left behind in the workforce have been invaluable.” Head of Service Redesign




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