Logo, black text, South Tees Hospital, blue background, white text, NHS

Key Outcomes

44% increase in productivity

3% increase in output, while reducing from 7-day to 5-day working week

94.5% plant utilisation compared to 82.7% previously

Six-figure cost-savings for the NHS by eliminating outsourcing

Improved staff engagement and morale

Mindset Programme

  • A two-day senior management development session on changing mindsets and implementing a learning culture
  • Growth mindset tools and techniques to equip and enable participants to drive change
  • Marginal gains methodology for developing, prioritising, implementing and monitoring a roadmap of improvements

"Adopting marginal gains is not only having a dramatic impact on efficiency, budgets and on patients, it is also creating a more collaborative culture and improving staff morale."

Dr Darren Craig
Consultant Gastroenterologist & Clinical Director
Endoscopy South Tees Hospitals NHS Foundation Trust

NHS endoscopy team increases productivity while eliminating outsourcing and reducing risk

Executive Summary


Part of the South Tees Hospitals NHS Foundation Trust, the Endoscopy Centre in The James Cook University Hospital in Middlesbrough offers the full spectrum of both diagnostic and therapeutic procedures from a purpose-built facility housing the gastroenterology department and its team of clinical specialists.


National demand for endoscopies has doubled in the five years up to 2018. To cope with increasing demand, the department was operating under pressure seven days a week, affecting staff quality-of-life and morale. It was also obliged to outsource routine procedures to private providers at weekends, which not only increased costs but also introduced greater clinical risk by the break in continuity of care. The department wanted to optimise utilisation of its facilities and resources to increase capacity, improve patient care and reduce pressure on staff.


As part of the NHS North East Leadership Academy (NELA), Dr Darren Craig, Clinical Director of Endoscopy for South Tees Hospitals NHS Foundation Trust, took part in a Growth Mindset programme led by Matthew Syed Consulting. The programme provided proven techniques and practical tools to help change fixed mindsets, create a learning culture and drive continuous improvement. Using the toolkit provided by Matthew Syed Consulting, Darren worked with his team to drive a change in mindsets and to develop, prioritise, implement and monitor a roadmap of improvements based on staff feedback and suggestions.


Changes implemented over just 18 months have delivered impressive outcomes, including:

  • 44% increase in productivity as a result of improved organisation, communication and efficiency
  • 3% increase in overall output; the volume of procedures performed has risen from 15,900 to 16,400 per annum while reducing to a five-day working week from a seven-day week
  • 94.5% plant utilisation, compared to 82.7% previously, optimising facilities and resources

The improvements mean that staff no longer have to routinely work beyond the end of their shift. Together with the elimination of weekend outsourcing, this is improving quality of life and helping to boost staff morale. Eliminating outsourcing has saved the NHS a six-figure sum of money whilst reducing risk and improving quality of care for patients.