title: Evaluating the impact of the reconfiguration of gynaecology services at a University Hospital NHS trust in the United Kingdom.
abstract: BACKGROUND
  The project aim was to investigate the impact of reconfiguring gynaecology services on the key performance indicators of a University Hospital NHS Trust in the UK. The reconfiguration involved the centralisation of elective gynaecology on one hospital site and emergency gynaecology on the other.
  
  
  METHODS
  Data measuring outcomes of the Trust's performance indicators (clinical outcomes, patient experience, staff satisfaction, teaching/training, research/development and value for money) were collected. Two time periods, 12 months before and after the reconfiguration in March 2011, were compared for all outcome measures except patient experience. Retrospective data from the hospitals audit department on clinical activity/outcomes and emergency gynaecology patient's feedback questionnaires were analysed. Staff satisfaction, teaching/training and research/development were measured through an online survey of gynaecology consultants.
  
  
  RESULTS
  Post reconfiguration, the total number of admissions reduced by 6% (6,867 vs 6,446). There was a 14% increase in elective theatre sessions available (902.29 vs 1030.57) and an 84% increase in elective theatre sessions cancelled (44.43 vs 81.71). However, the average number of elective operations performed during each theatre session remained similar (2.63 vs 2.5). There was a significant increase in medical devices related clinical incidents (2 vs 11). With patient experience, there was a significant reduction in patient's overall length of stay on the emergency gynaecology ward and waiting times for investigations. For staff satisfaction, Consultants were significantly more dissatisfied with workload (3.45 vs 2.85) and standards of care (3.75 vs 2.93). With research and development, consultants remained dissatisfied with time/funding/opportunities for research. No significant impact on undergraduate/postgraduate teaching was found. No financial data on gynaecology was provided for the assessment of value for money.
  
  
  CONCLUSIONS
  Reconfiguration of gynaecology services at this Trust may have resulted in a reduction in gynaecological activity and increased cancellation of elective operations but did not significantly reduce the number of elective operations performed. Although consultants expressed increased dissatisfaction with standards of clinical care, clinical incident reports did not significantly increase apart from medical devices incidents. Patient experience of emergency gynaecology services was improved. This manuscript provides a framework for similar exercises evaluating the impact of service redesign in the NHS.
authors.affiliation: Department of Obstetrics and Gynaecology, Nottingham University Hospitals, Queens Medical Centre, Derby Road, Nottingham NG7 2UH, UK. teck.choo@nhs.net.
authors.forename: Teck
authors.initials: T
authors.lastname: Choo
authors.forename: Shilpa
authors.initials: S
authors.lastname: Deb
authors.forename: Joanne
authors.initials: J
authors.lastname: Wilkins
authors.forename: William
authors.initials: W
authors.lastname: Atiomo
mesh_terms: D006748:Hospital Departments / Q000458:organization & administration; D006785:Hospitals, University / Q000458:organization & administration; D006801:Humans; D008505:Medical Staff, Hospital / Q000523:psychology; D009775:Obstetrics and Gynecology Department, Hospital / Q000458:organization & administration*; D009936:Organizational Innovation; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013222:State Medicine; D011795:Surveys and Questionnaires; D006113:United Kingdom