Is the Orthopaedic elective surgery pathway at ESNEFT, fit for purpose from a patient and staff perspective?


The NHS constitution states that patients have the ‘right to access certain services commissioned by NHS bodies within maximum waiting times’. Within 18weeks of referral, 92% patients with non-urgent conditions should have started consultant-led treatment (King’s Fund, 2021) (DHSC, 2022). Whilst there are no set standards for the maximum waiting times following decision for routine elective surgery, there is guidance from NHSE that waits over 104 weeks should be eliminated by July 2022, and 52 weeks waits by March 2025 (NHSE, 2022).

As of April 2021, 5.7million people were waiting for elective surgery, with an estimated 1.5 million people added each month (Ward, 2021). Trauma & Orthopaedics holds the largest share of these patients and adherence to these standards have deteriorated (King’s Fund, 2021).

Research Question:

Is the Orthopaedic elective surgery pathway at ESNEFT, fit for purpose from a patient and staff perspective?


1. To compare SWOT (Strengths, Weaknesses, Opportunities and Strengths) analysis results of the Orthopaedic elective surgery pathway between a patient and staff perspective.

2. To quantify the impact of timely and effective communication on pathway efficiency.

3. To consider the impact of patient education, self-management and preparation prior to surgery on clinical outcomes.

4. To provide recommendations on how to optimise/improve the orthopaedic elective surgery pathway via LEAN methodology.

Data Collection Methods:

This research question will adopt a mixed-methods approach, following the SPIDER framework:
Sample – Orthopaedic elective surgery staff and patients at East Suffolk and North Essex NHS Foundation Trust (ESNEFT)

Phenomenon of Interest – Orthopaedic elective surgery patient pathway
Design – Primary data in the form of retrospective observational surveys
Evaluation – LEAN methodology of the service to optimise efficiency, effectiveness and economy
Research Type – Grounded theory. The utilisation and analysis of data to conceptualise processes, structures and patterns within Orthopaedics


A random sampling design will be used to select about 300 patients (discharged within the previous 3 months) to complete a survey to document their recent experience, perception and attitude of the process towards their Orthopaedic elective surgery. They will also be encouraged to provide their opinion on the value added for certain components of the patient pathway.

This will be supplemented with an analogous survey to involved members of staff (e.g. surgeons, registrars, specialist nurses, theatre staff) to enable direct comparison between the staff and patient perspective.

Differences in the perceived benefit of patient pathway components will establish potential sources of improvement to streamline the system; reducing inputs, accelerating throughputs and increasing outputs to address the waiting list time performance trajectory.
This primary data will be analysed in tandem with secondary data, using case studies nationally and across the globe, to benchmark different service delivery models for Orthopaedic elective care and support sharing best practice.

Applying this research question through the FINER criteria, I think it is suitable for further exploration:

Feasible – Utilisation of Orthopaedic patients contact information via ESNEFT database
Interesting – An opportunity to thoroughly assess a patient pathway and dissect way to optimise using LEAN methodology would support my development and career progression
Novel – Few studies have analysed sources quality improvement from a staff and patient perspective combined

Ethical – Patients will be asked to give consent to participate in the survey. Their personal details will remain anonymous throughout
Relevant – ESNEFT has approved business plans for the development of a dedicated Orthopaedic elective care centre for 23/24 with the aim to increase capacity, reduce theatre cancellations and tackle waiting times (ESNEFT, 2020).

Data Analysis:

The CQC is an independent organisation that inspects and rates NHS health and social care services based on the following criteria: safe, effective, caring, responsive and well-led to determine whether it is fit for purpose. The data collected from surveys will be centred around these components in order to answer the research question at hand.

DHSC. (2022) The NHS Constitution for England. Department of Health & Social Care. Available from: [Accessed 29/05/2022]

ESNEFT. (2020) Elective Care Centre Feedback Set for Discussion. East Suffolk and North Essex NHS Foundation Trust. Available from: [Accessed 29/05/2022]

King’s Fund. (2021) Waiting Times for Elective (Non-Urgent) Treatment: Referral to Treatment (RTT). The King’s Fund. Available from: [Accessed 29/05/2022]
NHSE. (2022) 2022/23 Priorities and Operational Planning Guidance. NHS England. Available from: [Accessed 29/05/2022]
Ward, D. (2021) NHS Waiting Lists: How Big is Big?. The King’s Fund. Available from: [Accessed 29/05/2022]