Organisational features associated with high performance of high-volume low-complexity surgical hubs in the UK (31 May 2026)

Summary

High-volume low-complexity elective hubs have been central to NHS England’s strategy to reduce waiting times for planned surgery. By concentrating activity in dedicated units, separating elective from emergency care and applying operational management principles, they are expected to deliver high levels of productivity and throughput, benefitting patients, populations and the system. The aim of this study was to identify features of hubs that contribute to strong performance in optimising care delivery, with a view to offering practical insights for those leading new and existing surgical hubs.

Content

Findings

For those designing, delivering and overseeing surgical hubs, this study has several implications.

First (and most prominently), work to ensure the implementation of standards relating to hub delivery, such as those set out by accreditation criteria, need to be accompanied by efforts to secure continuous improvement, for example through collection and regular review of process data to identify challenges to productivity, quality and patient experience as they arise. Active work to learn from the views of patients and staff appears to be an essential component of this since their experience of care as delivered will help to identify opportunities for improvement that may not be apparent from activity data alone.

Second, since not all influences on productivity are within the scope of control of hub leads, a strong relationship with host organisations is vital, both in providing hubs with the latitude to implement staffing models and work routines that are appropriate to their distinctive needs, and in ensuring that emerging challenges to service delivery are dealt with promptly.

Finally, efforts to foster strong relationships across a coherent set of clinical and non-clinical staff appear crucial. Besides ensuring that insights were transmitted from frontline staff to service managers in the hubs we studied, familiarity between staff groups also oiled the perioperative pathways, and created an environment that was receptive to the continuous adjustments needed to maintain productivity, quality and patient experience.