Organisational features associated with high performance of high-volume low-complexity surgical hubs in the UK: qualitative interview study

Background: High-volume, low-complexity (HVLC) elective hubs have been central to NHS England’s strategy to reduce waiting times for planned surgery. By concentrating activity in dedicated units, separating elective from emergency care and applying operational management principles, they are expected to deliver high levels of productivity and throughput, benefiting patients, populations and the system. This study seeks to identify features of hubs that contribute to strong performance in optimising care delivery, with a view to offering practical insights for those leading new and existing surgical hubs. Methods: Qualitative interviews with staff in a variety of job roles from high-performing elective hubs covering a variety of specialties. Results: 23 staff members from five high-performing surgical hubs took part in qualitative interviews between September 2024 and February 2025. Participants described a variety of features that they saw as enhancing the performance of their surgical hubs, from collaborative team relationships and effective leadership to specific productivity-focused activities. Efforts towards standardisation, in line with guidance and accreditation criteria and national recommendations, were central to their accounts. However, participants also emphasised the importance of adaptation, flexibility and judgement in realising consistent high performance. Conclusions: A combination of strategies underpinned staff efforts to maximise throughput and productivity. Besides efforts to enact national standards and recommendations, our analysis suggest the importance of ongoing agility, responsiveness and sensitivity to shifting needs, as well as work to ensure delivery models are attuned to the particularities of local staff and patient populations.