Small changes, big impact: transforming an MSK injection service through Lean workflow redesign
This article describes how a radiology-led team at St James’s Hospital successfully transformed a severely constrained MSK corticosteroid injection service using Lean quality improvement principles. By early 2025, rising demand, fixed staffing and inefficient legacy workflows had led to a 25-month waiting time and a backlog of nearly 900 patients, with clear negative consequences for patient outcomes and staff morale.
Rather than seeking additional resources, the team undertook a structured Lean analysis involving multidisciplinary staff. Tools such as value stream mapping, Gemba walks and motion analysis revealed multiple sources of waste, including a single-room bottleneck, excessive staff movement, over-complex injection packs, fragmented referral systems, variable patient flow and suboptimal role allocation.
Six targeted, low cost interventions were implemented. These included introducing a two-room parallel workflow to eliminate downtime, redesigning injection packs, reducing unnecessary staff movement, digitising and validating the waiting list, standardising patient flow, and better utilising nursing and healthcare assistant roles to free radiologists to focus on clinical tasks.
Over one year, the redesigned service delivered striking results without additional staff, funding or extended hours. Weekly capacity doubled, waiting times fell from 24 months to six months, patient lead time dropped by 73%, and the total waiting list was reduced by over 60%. Staff reported reduced fatigue, clearer roles and smoother sessions, while patients benefitted from faster, more streamlined care.
The article concludes that ultrasound services are ideally suited to Lean methods and demonstrates how small, practical workflow changes – supported by staff engagement and data transparency – can deliver sustainable, high impact improvements in patient care.
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