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CASE STUDY 8.2

MIDLANDS HOSPITAL

(NHS TRUST)

Midlands NHS Trust Hospital is one of a large number of trusts that together make
up the National Health Service of the United Kingdom. This case (reported in Newell,
2003) describes attempts to develop a new procedure for the treatment of cataracts
(a disease of the eye) at the hospital.
The existing procedure involved cataract sufferers in a long and complicated pro-
cess to receive treatment. For example, the patient would begin at the optometrist
(the local high street optician) who would diagnose that the patient had cataracts
that were significantly reducing vision, and then refer that patient to his or her gen-
eral practitioner (GP) for further treatment. After a visit to the local GP, who not
being an eye specialist would generally rely on the diagnosis of the optometrist, the
patient was forwarded onto the hospital for further examination. At that time, the
patient would meet briefly with the consultant and, in a separate appointment, meet
with the hospital nurse for a physical examination. Only when all of these visits were
complete would the patient get in the queue for obtaining a date for the cataract
surgery. Post-surgery, another visit to the consultant was scheduled to check on the
patient and then the patient was referred back to the optometrist for a new pair of
glasses. Therefore, it took patients at least six visits and often well over a year to have
a routine, 20-minute, outpatient, surgical procedure.
Streamlining this long and complicated process began with the formation of a
project team which, unusually, brought together representatives from the whole
range of groups involved in diagnosis and treatment. This included the head nurse
in the eye unit, a hospital administrator, general practitioners, a set of optometrists
from the local community, and a surgical consultant who was instrumental in cham-
pioning the need for change and in leading the change process. Getting this team
to work together effectively was not easy. There was a history of significant distrust
amongst some of the professional groups involved. For example, eye surgeons were
generally quite contemptuous of the expertise of optometrists.
Over a six-months period, however, and through working together, greater trust
and social capital developed amongst the team members. This enabled the sharing
of knowledge and an agreed analysis of the diagnosis and treatment problem. Based
on this analysis, plus an increased awareness of the competencies and skills of the
various groups involved, the team were now able to see alternatives to the traditional
process. In doing this, each individual in the team drew upon his/her own experience

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