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Let's be clear on cancellations

The service has a duty to be transparent about cancelled operations - and keeping track of the figures has helped one trust improve its record

Recently I talked with a patient whose operation was cancelled on more than one occasion in the early part of this year.

She and her family were deeply upset, and understandably so. The effect this and related conversations had on me was profound.

This particluar patient’s operations were cancelled during a period of sustained emergency pressures on our hospitals. Many patients and their families have shared similar experiences over winter and deserved a better experience than we provided. But due to the pressure on our services, we had to prioritise more urgent cases and operations to our available beds and critical care.  

At every opportunity during this period I, on behalf of Nottingham University Hospitals Trust, have apologised to patients, their families and their loved ones for the inconvenience, upset, pain and anguish the cancellations caused. I did so face-to-face, via letter and by phone.

Humbling experience

My meeting with this particular patient was a humbling experience. She laid out her pain quite openly to me. It was an authentic account of her experience. We met after she had had her operation. She asked me for two things. A verbal and written apology and an answer to the question “what is the hospital doing to ensure this doesn’t happen again?”

I wanted to reflect her openness and her honesty with my own spirit of transparency.

Much lip service is paid by public sector bodies about being open and transparent. But there are times when you have to put your money where your mouth is. And that’s exactly what we have done in Nottingham.

Throughout our period of emergency pressures we have been asked, and quite rightly - “how many operations have you cancelled?” Like other NHS trusts we report “on the day” cancellations. We do so via our board’s monthly integrated performance report which is in the public domain.

However, many operations are cancelled before the day of surgery. These figures are not currently routinely collected by NHS trusts or published.

Duty of openness

We have a duty to our patients and as a public organisation to be open and transparent. In order to give as full an account of cancelled operations as possible we have completed a look-back exercise - which involved trawling through many thousands of records - and published total cancellations figures and the reasons for them.

We took this decision knowing - and experiencing from the contact we have had with patients and the staff who have to relay this unwelcome news to patients - the effect of every cancellation on our patients and their families. We believe we are the first trust in the country to adopt this approach. As of last month we are now reporting total cancellations and the reasons for them at our public board meetings.

More than 63,900 operations and procedures were performed at our hospitals between January and June this year. In the same period, we cancelled 3,283 operations in total (742 on the day). 43 per cent of cancelled operations were due to unavailability of beds and 20 per cent to make way for emergency or cancer surgery.

What influenced our decision to publish total cancellations? First and foremost, our patients. They deserve a better experience and because we want to be open about our plans to ensure fewer cancellations and continued improvement. Our extensive analysis has given us the opportunity to look in greater depth at cancelled operations and find better solutions to the way in which we can deliver more efficient emergency and elective care in our hospitals.

To measure is to manage

Our performance is now much improved, with significantly fewer operations cancelled since the end of April (our cancellation rate has reduced from 10 per cent January to March to 4.3 per cent April to June). Our board is to set bold targets to further reduce the number of cancelled operations. We know this will considerably improve the experience of patients, their families and staff.

This is in the spirit of all that we do at Nottingham’s hospitals. We are upfront with our patients and staff when we fall short or get things wrong. We talk openly with our patients and staff about our challenges. Last and by no means least, we recognise and celebrate our successes and achievements. Only by doing each of these things can we demonstrate that we truly are a learning organisation.

I believe that this represents true transparency in modern healthcare. Let’s tell it exactly like it is. This is what we owe to our patients, to the public, our staff, and to one another.

Peter Homa is chief executive at Nottingham University Hospitals Trust

Readers' comments (2)

  • Richard Russell

    Wow - like it.

    So by focussing on the patient experience first and foremost NUH is reducing the number of cancelled operations and thus making better use of the capacity it has available and I presume improving their financial efficiency.

    I love it when, by focussing on the patient pathway and the patient experience, we can find ways to also become financially more efficient.

    Congratulations to all at NUH

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  • This is extremely encouraging and something which I suspect other Trusts will (or at least should) also adopt.

    I have a couple of queries - firstly, has the reduction in cancellations been due to process changes (e.g. changing the way operations are booked) or due to fundamental system and operational changes?

    Secondly, is the downward trend in cancellations comparing the current month with the same month last year, or with the other months of this year? The latter will presumably lead to seasonal variations affecting the pattern and it would be great to hear that cancellations have reduced relative to last year too.

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