The National Health Service 2-week-wait skin cancer referral pathway: analysis and recommendations for process improvement

Abstract

Background: Although pressures on the National Health Service skin cancer services pre-dated the COVID pandemic, the 2-week-wait (2WW) skin cancer standards that require hospitals to provide an appointment with a specialist within 2 weeks for anyone with symptoms that may indicate cancer have deteriorated post the pandemic.

Objectives: To undertake process mapping of the current 2WW skin cancer pathways and provide recommendations to streamline and improve the pathway to meet the 2WW standards.

Methods: The 2WW skin cancer pathway is analysed in this report utilizing 4 V typology encompassing the four dimensions of operations: volume, variety, variation and visibility, and a volume-variety matrix. A performance matrix of the 2WW skin cancer pathway and SIPOC (suppliers, inputs, processes, outputs and customers) analysis are also examined.

Results: Process analysis enabled the identification of some of the limitations of the 2WW skin cancer pathway. Following analysis and redesign of the process map of the pathway, recommendations, including lesion assessment using artificial intelligence, single-lesion assessment clinics and direct access skin surgery, all of which aim to expedite patient care and increase capacity in 2WW clinics, are provided.

Conclusions: The process analysis of the 2WW skin cancer pathway provides useful insights and helps identify bottlenecks in the system. Recommendations following remapping the process offer potential solutions to help reduce time to referral and to increase capacity. These recommendations should help reduce waiting times for patients receiving an initial diagnosis and subsequent definitive treatment for suspected skin cancers.