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Systems and culture

High-volume low-complexity surgical hubs: Characterising the organisational features associated with high performance (HVLC Surgical Hubs)


The COVID-19 pandemic markedly increased both the number of people waiting for elective treatments and the time they have to wait. Given the negative effects of delays in care on patients’ health and wellbeing, the NHS in England has made reducing waiting times for surgical services a key priority.

Many of the people who need surgery in England are waiting for routine interventions like cataract removal and joint replacement – treatments that will greatly improve their quality of life and are normally straightforward, with low risk of complications. Central to NHS plans to reduce numbers and waiting times for these types of surgeries is introducing ‘high-volume low-complexity surgical hubs’ – distinct and self-contained units which perform elective surgery in one or more areas: ophthalmology, general surgery, trauma and orthopaedics, gynaecology, ear nose and throat, and urology.

Because of the NHS’s focus on reducing waiting times and volumes, it’s important to understand the impact that surgical hubs could have so that the approach can be optimised. In this study, we’ll be working with the Health Foundation’s Improvement Analytics Unit (IAU) who are examining surgical hubs’ performance using routine data. Our research will complement the work they are already doing and aims to understand and characterise the approaches taken by hubs that seem to be performing well.

We aim to explain the features of surgical hubs that are linked to higher performance, and describe what stakeholders involved in putting plans for surgical hubs into action think about how important these features are, how they affect each other, and how they can make a difference. We also aim to find out what stakeholders think about how much the different features depend on specific situations and the trade-offs they may involve. For example, we are interested in how much features that are designed to achieve maximum throughput of patients might support or obstruct other aspects of high-quality care, and the impacts of surgical hubs on activity elsewhere in trusts and systems.


  • We will identify up to six hubs that appear to be performing well, sampled where possible for variation in key characteristics such as their size and focus and the way they are organised.
  • By taking a positive deviance approach (where organisations show behaviours or practices that deviate from the norm in a positive way, and this is associated with better outcomes or solutions) we will explore features that may contribute to the performance of the identified hubs, to help us better understand what makes them successful in terms of throughput and productivity.
  • We will also look at the impacts of these features on other aspects of the care they provide, and at how they fit into wider hospitals and healthcare systems.
  • Alongside clinical staff, we will also interview staff at each site who are responsible for overseeing, organising, and carrying out the surgical hub operations for their area.

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Funding and ethics

This study is funded by the Health Foundation’s grant to The Healthcare Improvement Studies Institute (THIS Institute). It is independently led by THIS Institute. The study was reviewed by the Cambridge Psychology Research Ethics Committee (PRE.2024.025).

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