General Surgery Improvement Programme

In September 2022, University Hospital Sussex partnered with Practicus and The Transformation Clinic to improve the leadership, culture and ways of working and delivery of emergency care within its General Surgery Department

Challenge

Following a CQC inspection and critical reviews by external bodies such as Edgecumbe, Professor Dawson and NHSE, it was deemed necessary to undertake an improvement programme to deliver change within the General Surgery department. Gaps in performance were a result of a mismatch between demand for the service and the availability of workforce and physical capacity. The requirement entailed new models of care that would facilitate the repatriation of Upper GI Cancer Surgery, restore trainees, improve the departmental reputation and create a new fit-for-purpose operating model.

What we did

Through an experienced team that had unique insight into the operational nuances of the department, they have created:

• A detailed work plan for the targeted workstreams including a flexible plan modelled for service demand and capacity based upon actual demand levels
• Engagement practices that increase engagement of clinicians and staff to overcome internal workforce barriers and provide a more cohesive and flexible service of care for patients
• A new Target Operating Model that addresses the CQC and external reviewers’ concerns, establish an environment for the return of trainees, is aligned to service demand, enables safe General Surgery, and is affordable
• A new Learning Agreement recommendation to formalize the process of goal setting and review meetings, underpinning training for Junior Doctors

Outcome

As a result, there has been significant improvements already since the beginning of the programme in September 2022.

The team’s unique knowledge and experience in this area of General Surgery has proved invaluable to improving the engagement of clinicians and staff across the department which has facilitated the gains made over the past 6 months of the 12-18 month programme. These have included and continue to be:

• Increased the efficiency of delivery of patient care within the targeted workstreams enabling a much improved balance between demand and clinical capacity
• Improved collaboration amongst clinicians and staff to engage with a new Operating Model and resource structure in support of the programme
• Address the concerns of the CQC and external reviewers and continue to work towards repatriation of the Upper GI Cancer Surgery to UHS

Achievements

Imperative to the success of the programme was to achieve success in delivering against the following workstreams:

• Clinical Quality Governance
• Operational and clinical management
• Service and Workforce model
• Leadership and Culture
• Programme Management

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