Foot and Ankle Service

Project Team: Chris Blundell, Howard Davies, Mark Davies, Carolyn Chadwick, Donna Shaw, Megan Smith, Michelle Peachey, Ann Jones, Kath Hawke, Helen Stamp, Laura O’Byrne.


The Orthopaedic Foot and Ankle team were keen to look at the outpatient pathway to see what improvements could be made. Building on improvements made in the Foot and Ankle Surgical pathway over several years, the outpatient team began meeting weekly in December 2014 and have since continued to meet regularly using the clinical microsystems approach to test changes and make improvements. The overall vision is to create a smooth pathway for Foot and Ankle patients from referral to discharge.


Data was collected from multiple sources including patient and staff feedback, clinic activity data, utilisation data, and existing processes were mapped to ensure a comprehensive assessment of the current service. The Initial data indicated several themes for improvement:
  •  100% of Foot and Ankle patients requiring an x-ray will have a weight bearing x-ray by the start of July 2015
  • To reduce the wasted time between arrival and x-ray
  •  To start every Foot and Ankle clinic on time


The team tested and measured new ways of working to achieve the above aims including the following:
  • Nursing staff to turn computers on in each room before clinic begins and preparing the case notes to relevant page ready for for review
  • Consultants to arrive early to enable prompt clinic start
  • Requesting x-rays for at the end of the last appointment
  • Nurses requesting x-rays
  • Request x-rays when reviewing referrals
The focus on reducing patient waiting times in clinic has enabled clinics to start on time with 100% reliability. The team have successfully engaged with Radiology colleagues to improve patient experience and flow in clinic in relation to the X-ray process.
Patient and Staff Feedback: Throughout the improvement process, feedback was sought from patients and staffs about the improvements to practice, some comments were as follows:
Throughout my treatment at NGH, I feel I could not have got better treatment anywhere within the UK even if it was private. Many thanks to all involved.
Everybody was friendly and helpful, I couldn’t find fault with anything
Good flow. Speedy. Good communication, Very helpful and staff are well organised”
 The environment is good and we get great support from the nursing staff.
The Service Improvement process has been effective in building a team of people who have progressively made service improvements. I have not witnessed this before in 10 years as a consultant.
Future progress:The team have collected data to inform a concept paper to better utilise a vacant room in the department. The paper was approved by CIT in 2015 and the team are currently working with estates to explore options.

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