Solving problems in emergency care and neurodiagnostic services 

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Problem-solving is a cornerstone of effective improvement.  It ensures that the valuable time staff spend on improvement work is targeted at the root cause(s) of the issues and not wasted generating potentially inappropriate or ineffective solutions.   As part of our ‘general facilitation’ offer, we designed and ran a series of problem-solving workshops for North-East and North Cumbria ICB, to understand the challenges the region was facing with regards to emergency care, ambulance handover and neurodiagnostic services. 

Some of the issues the services were facing included: 

Neurodiagnostic services 

  • Long waits, up to 52 weeks or more, for Autism/ADHD/Neurodevelopmental services due to rising demand, predicted to continue to increase in the future 
  • Variation in service delivery and service offers 
  • Increasing time away from patient care to manage enquiries for scrutiny, FOI’s and from MPs due to poor patient/family experiences 

Ambulance handovers 

  • Failure to meet 15-minute handover targets  
  • Length of delay more than doubling in one year with length of delay continuing to increase 
  • 1,360 patients experiencing a handover longer than 60 minutes in one month 
  • Loss of over 6,500 hours to turnaround over 30 minutes in one month resulting in 4,500 patients not getting the response they should have received 
  • Increasing length of delay 
  • Ambulance crews not getting breaks and standing for prolonged periods directly leading to staff absence 
  • Low staffing at the start of shifts due to late finishes on the preceding shifts 
  • Diverts and deflections resulting in extended travel time, lack of local knowledge and lost hours returning to base 
  • Patients deteriorating due to delays and therefore requiring avoidable conveyance to hospital 

Clinical triage for ambulance services 

  • Clinician Capacity tied up managing 111 online and speak to dispositions – limited capacity to manage revalidation 
  • Frail elderly patients waiting on the stack for extended periods but need a face-to-face assessment 
  • Volume of Category 2 calls from Healthcare Professionals 
  • Large volume of Category 2 calls with a wide disparity in acuity 
  • Hospital Handover Delays 


We designed problem-solving workshops to specifically address the issues the services were experiencing to understand the problems, develop potential solutions and outline an achievable implementation plan.  The approach broadly involved:


  • Setting the scene/context to ensure understanding of the issues 
  • Agreeing a clear purpose and expected outputs/outcomes for both the improvement work and the workshop itself to ensure clarity and direction 
  • Exploring current improvement work/pilots to ensure alignment of improvement efforts and sharing good practice to build on what is working well 
  • Refining/defining the problems to ensure focus and specificity 
  • Ideas generation for potential solutions using facilitation methods to ensure all participants had a voice 
  • Pareto analysis to choose the solutions with the most potential impact 
  • Identifying challenges to implementing solutions and how these may be overcome to facilitate success of the improvement work 
  • Development of outline implementation plans to ensure how solutions would work in practice 
  • Action planning and next steps to ensure accountability and sustainability 
A fleet of ambulances parked outside of an A&E department


By providing robust facilitation, customers were clear on the specific nature of the problems related to the issues they were facing; which problems were the most significant; solutions that would have the biggest impact; alignment of improvement efforts to build on good practice and co-ordinate efforts; and a clear implementation and action plan.  Specifically:  

  • For neurodiagnostic services, 45 implementable solutions to improve or resolve the issues were generated, 59% of which were potentially of high impact but requiring low effort/resource  
  • For emergency care, 19 implementable solutions to improve or resolve the issues were generated, 68% of which were potentially of high impact but requiring low effort/resource  

Our methods ensured the often experienced ‘jumping to solutions’ approach was avoided so that valuable time and effort staff spent on improvement work would address the real problems and causes behind the issues being faced and ensure improvements in the quality and safety of patient care. 

An output report was produced following each workshop, which provided details of the problem faced, process undertaken, potential solutions discussed and recommendations for future action.