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180 MANAGING KNOWLEDGE WORK AND INNOVATION

and knowledge, but also used their personal networks to find out what was happen-
ing in other hospitals. For example, the project team went to look at treatments in a
leading eye surgery clinic where they felt they might learn something useful to apply
to their own context.
With the benefit of these insights the team developed a new procedure which
radically streamlined the process. Non-essential visits to the general practitioner; the
consultant and the nurse were eliminated. Instead, optometrists were empowered
to decide if a patient needed cataract surgery. In doing so, they were required to fill
out a detailed form that provided the consultant with specific information about the
nature and severity of the cataract, and to call the hospital and book a time for the
patient’s surgery. Initially, there was some resistance from local optometrists who
refused to get involved in the redesigned diagnosis process. This resistance was grad-
ually overcome, however. For example, the transformation team member recounted
the story of an optometrist with a large local practice, who refused to participate
in the fast-track cataract process. As luck would have it, the transformation team
member happened to need a new pair of glasses and so decided to visit the reluctant
optometrist. She sang the praises of this new cataract procedure throughout her eye
exam. By the time her glasses were ready, the optometrist had reconsidered his posi-
tion and had decided to participate in the project.
The preliminary pre-operation physical was replaced with a self-diagnostic ques-
tionnaire that each patient was required to fill out and return to the hospital before sur-
gery. Immediately before surgery, nurses were to telephone each patient to check the
patient’s details and answer any questions. Post-operation consultant appointments
were also replaced with follow-up telephone calls. One indication of how much the pro-
cess changed was the traditional post-operation meal. Under the traditional method,
before discharge, each patient was treated to a plate of hospital food; under the new
system, they were given a cup of tea and a biscuit and were then sent home.
The new cataract procedure resulted in a number of efficiency gains. Lead times
were radically reduced from over 12 months down to six to eight weeks. In addition,
theatre utilization rates improved due to the addition of an administrator whose sole
responsibility lay in scheduling theatres. Finally, and most importantly, according
to follow-up phone conversations with cataract project patients, patient satisfaction
improved dramatically.
The redesigned cataract process was considered to be highly successful and the
trust was even given a special award by UK Prime Minister Tony Blair. The team
involved made a number of presentations to other groups within the NHS high-
lighting their re-designed process as a template which could be applied elsewhere.
Despite its apparent benefits for both professionals and patients, however, there
was little spread of the innovation from Midlands Hospital to other sites. This can be
partly attributed to the problems of getting different groups to change their prac-
tices, and the related difficulties of translating the experience of the project team into
approaches that would work in other contexts. There was also evidence, however,
that the professional groups in other hospitals were reluctant to change the divi-
sion of tasks between them. Information about the new process template was not
enough, on its own, to overcome this resistance.

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