Investigating consistent patterns of variation in short-notice cancellations of elective operations: the potential for learning and improvement through multi-site evaluations

As part of efforts to increase productivity in healthcare, there is considerable interest in the extent and causes of variation in the performance of provider organisations. In this study we use publically-available data from the English NHS to examine the characteristics of variation in the rates of short-notice cancellations of elective operations due to hospital-reasons (e.g. lack of the required resources such as operating theatres and beds). We find that the variation between hospital trusts is very non-random. There is a fourfold difference in the cancellation rates between the top and bottom deciles of performance. Little is known about the causes of this. There is a large and striking consistency in the relative performance of hospital trusts on cancellation rates over the last five years. Thus the best and worst performers are consistently relatively very good or very poor, so a multi-site comparison of practices, and accounting for confounds like patient demographics, could be very valuable to inform both this knowledge gap and practice in healthcare. Of particular interest is that the cancellation rates could be a symptom of deeper issues with the efficiency of patient flows within hospitals.