Background
A large NHS Trust operating outpatient services across three hospital sites in England was preparing to consolidate into a new PFI facility. However, before the move, the Trust faced persistent operational inefficiencies: 44% of clinics started late, 31% finished late, and clinic room utilisation averaged only 77%, all while waiting list initiatives continued to run at significant cost.
The outpatient department (OPD) suffered from inconsistent scheduling, unclear booking policies, and a lack of real-time performance data. Senior leaders recognised the need for a strategic intervention to unlock productivity and reduce unnecessary expenditure—while improving patient access to care.
Meridian Productivity was commissioned to deliver a comprehensive improvement programme across outpatient services.
Analysis
Over a three-week period, Meridian conducted an in-depth evaluation across all three sites. Key issues included:
Misalignment between consultant job plans and clinic templates
Inconsistent room and staffing allocation due to outdated scheduling norms
Lack of in-session utilisation targets or tracking against demand
Absence of KPIs to measure late starts, late finishes, and clinic throughput
Overuse of waiting list initiatives despite underutilised routine capacity
Our analysis identified that 14,500 clinic sessions were surplus to requirements, and that substantial savings could be made by improving forecasting, planning, and performance monitoring.
Implementation
Working alongside clinical and operational leaders, Meridian introduced a structured outpatient optimisation programme, focusing on four key areas:
Forecasting and Planning
A new Master Schedule was developed, built on a refined demand and capacity model.
Clinic templates were redesigned to match actual activity, with slot durations tailored by patient type and specialty.
Assignment and Resource Allocation
Shift patterns and rosters were updated to reflect new workflows.
Nursing and administrative roles were aligned to clinic requirements using a skill-mix matrix.
Performance Monitoring
A robust management control system was installed, with weekly dashboards, KPIs, and stakeholder review meetings.
A rostering tool was implemented to ensure efficient use of clinical time.
Cultural and Behavioural Change
Workshops helped embed concepts of time-value, accountability, and real-time problem-solving across teams.
Leaders were empowered to challenge underutilisation and reduce unproductive time.
Results
The programme delivered transformational results:
£1.9 million in cashable savings, primarily through the elimination of unnecessary waiting list initiatives and improved session planning
14,500 unnecessary clinic sessions removed, freeing up space, time, and workforce capacity
Improved patient flow, with late starts and finishes significantly reduced
Better workforce scheduling, cutting reliance on agency and bank staff
Sustainable outpatient productivity controls installed, enabling teams to make data-led decisions and avoid waste
By aligning clinic capacity with real demand, this NHS Trust not only improved operational performance but also enhanced patient access to care without increasing resources.
