ENTire system transformation

Streamlining pathways and processes to improve access for patients to Ear, Nose, Throat (ENT) services


2021 - ongoing


Mater ENT team


HSE Spark Innovation


As with many medical specialties in Ireland, getting an appointment with an ENT consultant is difficult to secure. At the start of this project, there were a large number of patients waiting to be seen by ENT specialists at the Mater Hospital.

Almost all available appointment slots were being used for urgent cases which meant that wait times for those with routine conditions had become excessive, despite the impact of these conditions on quality of life for patients. Staff in the ENT service felt stressed and overwhelmed with trying to provide a service under these conditions.

The team were aware that many of their processes were labour intensive and largely paper based. However, due to their heavy clinical workload, it was not possible to stand back, see the whole picture and tackle the problem in
it's entirety.


Mater Transformation worked closely with the ENT multidisciplinary team to carry out a full system review. This began with a period of data collection and extensive mapping of all the existing processes. The team then came together in a week-long ‘Value Stream Analysis’ event, to make sense of this data and to collaboratively build a roadmap for change.

The first task was to streamline the processes of referral, triage and scheduling as well as to digitise paper processes where possible. These gains helped to give some time back to the team and enabled a more clear picture of actual demand and capacity for each of the sub specialties — Rhinology, Otology and Head and Neck.

New ways of delivering care were then explored. For example, could patients with voice disorders have direct access to Speech and Language Therapy rather than requiring that they wait to see the consultant first?


There has been a 73% increase in volume of new patient appointments being offered weekly.
The average time from referral received to triage was reduced from 7.3 days to 2.8 days.
Steps to schedule patients for theatre were reduced from 17 touch points to 5 touch points.


Key insights from the lean six sigma diagnostic process included:
  • The demand on the ENT service significantly exceeded existing capacity
  • Multiple different referral pathways were in place with the result that patients were not consistently assigned to the most appropriate sub-specialty
  • Triage and booking processes were also paper heavy and disjointed
The challenge therefore was to optimise the use of existing resources to improve the overall service. This work is ongoing and the following improvements have already
been made:
  • Referral and triage processes were redesigned and standardised, moving from all referrals joining a general ENT waiting list to new sub speciality
    waiting lists.
  • Where possible, the team moved to electronic systems for triage and booking.
  • Structured mechanisms like post clinic huddles were put in place to improve clinic communications and
    improve throughput.
  • Clerical staff were recruited to reduce the administrative burden for non-consultant hospital doctors, improve the theatre booking system, and facilitate multi-disciplinary team meeting processes
  • Consultants began reviewing waiting lists and identifying patients that could be seen directly by Audiology, Speech & Language Therapy or a GP specialised in ENT rather than waiting to see the consultant in a clinic first.
New therapist and GP led pathways are being explored to reduce total reliance on consultant led services to allow increased access for patients.

What’s happening now?

Mater Transformation continues to support the ENT team, building new services and developing more sustainable ways
of working.

Currently, the team is developing a new integrated pathway, funded by the HSE Spark Community Innovation Fund, where patients with chronic rhinology conditions are seen at a GP led community clinic with access back to ENT Consultant as required.