Georgia Geary
Introduction
Surgical Hubs are central to the government’s strategy for addressing postCOVID elective surgery backlogs. In January 2025, BMA Referral-to-Treatment data highlighted 7.43 million patients on elective waiting lists. The government’s target is for 92% to receive treatment within 18 weeks by mid-2029, yet 3.06 million have already exceeded this. The Institute for Fiscal Studies estimates a 4.9% annual increase in treatment volumes is needed to meet this goal. This demands innovative system change prioritising both efficiency and patient experience.
Methods
We present a novel clinician-led Failure Modes and Effects Analysis (FMEA) to drive frontline service redesign. This was applied in expanding a Day Surgery Unit into a high-output, GIRFT-standard Surgical Hub at University Hospital Llandough, Wales. A team of five clinicians and senior nursing staff identified risks to efficiency and designed new pathways. Efficiency was assessed over 30 weeks (900 theatre sessions), alongside 500 structured patient feedback calls.
Results
Ten high-risk failure modes were identified. Interventions included:
Streamlined admission/discharge pathways
Acquisition of new ward space with overnight capacity
A local anaesthetic pathway and procedure room to increase out-of-theatre and off-ward capacity
Consent clinics to reduce on-the-day cancellations
Outcomes included a 24% increase in weekly sessions, 34% drop in same-day cancellations, and approximately £435,000 in additional case value.
Conclusion
This framework enabled frontline staff to lead structured, effective quality improvement with measurable gains in efficiency and capacity. We propose a replicable model for other day surgery services, showing the impact of empowering frontline leadership to drive sustainable change.
Authors
Georgia Geary
University Hospital Llandough, Cardiff, United Kingdom
Alice Jones
University Hospital Llandough, Cardiff, United Kingdom
Ryan Trickett
University Hospital Llandough, Cardiff, United Kingdom