validus management consultancy UK

NHS Case Study

Midlands NHS Hospitals Trust

Historical problems and issues within Rheumatology department
New processes defined, agreed and signed onto by Rheumatology staff and senior hospital management


A major NHS Hospitals Trust in the Midlands


  • Historical problems and issues within the Rheumatology department included:
    • Poor quality referral letters and inadequate information to allow prioritization of patients Outdated and cumbersome patient monitoring systems
    • Lack of sustained investment in buildings and equipment
    • Fast growing and inadequately resourced bone densitometry and osteoporosis service
  • Poorly differentiated communication channels and management structure
  • Lack of investment in infrastructure
  • Lengthy queuing by patients during clinics
  • Need to develop and nurture the required 'attitudes and behaviours' of staff within the department
  • Need to develop a review and re-engineering approach to be added to a hospital wide change management 'toolkit' and applied to other areas within the hospital


  • Interviewed consultants, nursing and administrative staff to gain their perceptions and insights
  • Interviewed patients to gain understanding of their experiences, issues and concerns
  • Coached selected members of the management and staff in our review and re-engineering methodologies and techniques
  • Reviewed the current Rheumatology administrative processes and information flows in detail
  • Jointly critiqued process with managers and staff highlighting process weaknesses, inefficiencies and problem
  • Developed improved processes and information flows
  • Examined infrastructure and made recommendations for improvements
  • Defined implementation programme


  • New processes defined, agreed and signed onto by Rheumatology staff and senior hospital management, new processes feature:
    • Introduction of a training process for all new Rheumatology cases
    • Development of monitoring activity back to GP's
    • Significant saving on nurses 'data input' and administrative activities / hours
    • Upgrade links with densitometry IT system for use of data in research and analysis of drug effectiveness
  • Improved structure to address the balance of Senior Nursing staff per Consultant
  • Recommendation to appoint a clinical lead for the department
  • Improved balance between Consultants, use of Physiotherapists and suitably qualified Nursing Staff
  • Implementation of processes by Rheumatology managers and staff proceeding
  • Implementation of improved facilities and equipment proceeding