Published: 20/03/2003, Volume II3, No. 5847 Page 22 23

I believe that all of us in the NHS would benefit by trumpeting the many improvements we achieve, but which go unnoticed in the constant barrage of criticism. I would like to share with you one success story from the Oxford health and social care system.

Like in many other places, we struggled to meet the accident and emergency targets. For a long time, we have been among the worst in the 12-hour trolley waits. No matter what we did, we were unable to sustain any performance improvements.

With the new challenge to get 90 per cent of admissions through the A&E department under four hours pending, we needed a real breakthrough.

We applied the 'theory of constraints' as a practical method enabling us to identify the true underlying causes, rather than the symptoms of the problem. By using the theory of constraint, we were able to carry out a thorough analysis of the Oxford health and social care system and pinpoint precisely where to channel our efforts. It was the accuracy of our improvement focus on the one hand, and the system-wide nature of the solution on the other, that delivered the much needed breakthrough.

We saw the first improvements within a week of implementing the solution. In a short space of time, we completely eliminated the 12-hour trolley waits.

Today, the progressive trend of our improvements makes us confident in both the sustainability of this change and meeting the four-hour targets.

Jan Elliott Director of patient access The John Radcliffe, Oxford