Delivering a Timely Diagnosis for Patients with Head and Neck Cancer
Aneurin Bevan University Health Board
Introduction:
This project aimed to reduce the time from suspicion to diagnosis for Head and Neck Cancer patients to 28 days by August 2025. At baseline, patients waited an average of 62 days for a decision to treat, with only 19.3% starting treatment within 62 days. The delay risked harm, reduced survival rates, and breached the principles of the Duty of Quality. A Quality Management System (QMS) approach was adopted to address inefficiency, inequity, and lack of person-centred care.
Methods:
A core team - including clinicians, managers, and improvement specialists - used Lean methodology to identify delays. A deep-dive analysis and Pareto chart revealed that delays were most prominent in three areas: first outpatient appointments, ultrasounds, and panendoscopy procedures. A phased improvement approach was taken, focusing first on outpatient and ultrasound delays. Stakeholders, including patients and booking staff, contributed insights via interviews, focus groups, and surveys. Monthly QMS meetings supported planning, testing, control, and assurance.
Outcomes:
Through 12 PDSA cycles, significant improvements were achieved. First outpatient wait times reduced from 8.9 to 6.1 days; ultrasound delays fell by 15 days; pre-assessment delays dropped from 21 to 2–3 days. The full diagnostic pathway improved from 62 to 28 days. Treatment within 62 days rose from 19.3% to 64%. Staff morale improved, and the team embedded QMS meetings and continuous monitoring as standard practice.
Learnings:
Clear shared goals, strong collaboration, and patient voice shaped a more effective and compassionate service. Testing change via PDSA cycles built confidence, but faster progress could have been made with more protected time or parallel teams. Embedding quality control was essential to sustain gains. A cost-effectiveness analysis estimated a 0.67 QALY improvement per patient, potentially saving 10 lives annually.
What Next?
The team now aims to treat 75% of patients within 62 days. The methodology is being shared with other cancer services, and national conference presentations are planned. The collaborative QMS approach is being championed across ABUHB.
