Hillingdon Hospital | Pressures on the Emergency Department

Client: Hillingdon Hospital

Sector: Healthcare

Timeframe: February 2018 – May 2018

Hillingdon CCG (“HCCG”) and The Hillingdon Hospitals NHS Foundation Trust (“THH”) have experienced on-going pressure at the front end of the urgent care system for some time. There was a strong desire to understand and address these problems amongst both commissioners and providers.

HCCG & THH commissioned a joint team from Methods Analytics and Methods Advisory to undertake a three-phase study into these problems, their underlying causes and the factors that had hindered previous attempts at making improvements. The final phase of the assignment involved helping THH and other organisations involved in the urgent and emergency care pathway develop actionable plans and business cases aimed at coherently addressing the issues that had been uncovered.

THH is a medium-sized district general hospital in West London with over 400 beds and 3300 staff. It provides urgent, emergency and elective care to a diverse population of over 350,000 and serves as the emergency hospital for Heathrow Airport. The Emergency Department had recently been augmented with an upgraded, co-located Urgent Care Centre and a new Medical Admissions Unit.

Approximately 125,000 urgent and emergency patients were being seen per year in total at the time of the study.


To help understand and explore in depth the issues affecting the emergency and urgent care service at THH; to identify factors that may have hampered attempts to improve the service in the past; and to support the CCG and THH in developing a prioritised set of interventions aimed at addressing the issues that were uncovered.


A three-phase approach was used, with three distinct deliverables:

  • Phase 1 was primarily data-driven using national and local data to provide a detailed, quantitative and objective review of the situation. Specifically, assumptions about the causes and drivers of ED pressures were amined and challenged where the data warranted.
  • Phase 2 involved a qualitative analysis of pathways and processes; pathway management; organisational structures and interactions; and previous improvement initiatives, investigating themes from Phase 1 and factors not directly amenable to quantitative approaches.
  • Phase 3 supported THH and HCCG in developing of a coherent, prioritised set of interventions aimed at ddressing the key issues uncovered in Phases 1 and 2. The approach involved working closely with stakeholders from across the whole of the local urgent care system, developing five initial outline business cases through a series of large-scale, interactive decision workshops.


The review generated considerable interest and increasingly strong engagement from all those involved in urgent and emergency care locally, culminating in very well attended strategic business case development workshops.

The Phase 1 and 2 reports helped to move discussions on from questions about the quality of data to examination of underlying issues and consideration of more effective kinds of intervention. During Phase 3 a strong consensus on priorities for action and approaches emerged amongst the workshop participants and service managers. It was widely recognised that a system-wide, co-ordinated approach to promoting and managing change was needed, challenging assumptions and geared to avoiding repetition of previously tried but ineffective strategies.


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