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Moving past backlogs and waiting times

Find out more about how improvers are addressing backlogs in care and improving access to services through six case studies.

About the project

Addressing backlogs in care and improving access to services is an urgent and vital system priority, an area where the skills and mindsets of improvers can be highly useful in developing solutions. We wanted to explore Q members’ experiences of the role for improvement in this work.

In July, we spoke with a group of members to explore the current challenges for people working to address backlogs in care and improve access to services and heard that they wanted to understand more about what others were doing. They specifically wanted to draw out learning about how to balance short-term needs and long-term goals; make better use of data to support improvement, and apply systematic improvement tools, methods and approaches to address both the technical and human side of change

What we did

Over the last few months, Q’s insight team, alongside a panel of Q members, have been gathering insight and stories that bring to light projects that are responding to the need to urgently address the backlogs in care and improve access to services.

Through a series of interviews, the team have surfaced six case studies that demonstrate key pieces of the puzzle for improvers to use to respond to this unique challenge.

1. Embedding an improvement system for better productivity and experience: transferable learning from Guy’s and St Thomas’ vaccination service

How, in a highly pressurised context, implementing a systematic and enabling improvement approach can improve productivity, efficiency, and staff and patient experience. See also the application of Lean case study for benefits of applying Lean approaches.

Download case study 1

2. Implementing Patient Initiated Follow Up: a phased approach to improve access to services, NHS Surrey Heartlands CCG

The short-term benefits of implementing a Patient Initiated Follow Up (PIFU) pathway for prompting services to validate and better understand their patient lists; and the longer-term potential of PIFU for improving access to care and supported self-management for people living with long-term health conditions. See also the Health Connect Coaching case example for PIFU-related learning.

Download case study 2

3. Health Connect Coaching: developing a peer-to-peer coaching service to increase access to supported self-management

Learning from co-designing a volunteer peer coaching service to enable more people to safely join the Patient Initiated Follow Up pathway and increase supported self-management for people with long-term health conditions. See also the PIFU case study on the benefits of implementing a PIFU pathway to prompt.

Download case study 3

4. Embedding organisational analytical capability: improving flow on inpatient stays

The service-level benefits of integrating data and analytical capability at all stages of improvement programmes to improve inpatient flow, and the longer-term cultural and system-level changes needed to realise the full potential of this. See also the Lean improvement training programme case study, for a different angle on improving inpatient flow, and the local system collaboration example, for building system-level data and analytical capability.

Download case study 4

5. Local system collaboration: implementing new pathways with Advice and Guidance and enhanced perioperative care

Learning from local system collaboration in the Birmingham and Solihull Integrated Care System. Addressing care backlogs that pre-dated COVID that were exacerbated by the pandemic, by developing new ways of working to reduce new outpatient referrals through Advice and Guidance, and creating new capacity for post-operative recovery.

Download case study 5

6. Applying learning from an online Lean improvement training programme: Redesigning the paediatric pathway

The benefits of applying a Lean improvement methodology to make service changes to improve productivity, clinician capacity and patient experience.

Download case study 6

Find out more about what we learned by reading Henry Cann and Jo Scott’s blog.


This project has been led by members of Q’s Insight team, Jo Scott, Henry Cann and Jess Shivji with support from Q member interviewers and reviewers: Chris Pavlakis, Joe Home, Larry Koyama, Lyn Williams, Minesh Khashu, Rachel Rainford, Sarah Clarke, Suzanne Wood, Ursula Clarke.

We’re grateful to our interviewees: Helen Davies-Cox, Krystina Bones, Iain Smith, David Smith, Andy Sandford, Jack Bramhall, Paul Dias, Clara Day, John Mortimer, Miles Sibley, Sygal Amitay, Anil Mathew, Joanna Turville, Adam Binnie, Sophie Bulmer, Carol Dale.

Throughout this work, we had to make decisions about the learning we prioritised, and what we didn’t have space to explore. We may have missed some elements of the work: this omission is ours. Participants’ views may not represent the majority experiences or perspectives of those in their organisations and teams.