Lessons in NHS efficiency from Team GB cyclists.

What do the NHS and Team GB’s cyclists have in common?

(Hint: it’s not the legs.)

The answer? Both are under relentless pressure to perform better, go faster and do more.

For the NHS, that pressure is often couched, overtly or covertly, in the language of transformation and reformation. “No extra money without reform” as Sir Keir Starmer famously said last year.

But whilst that reform is underway at a national level, those at the sharp end need to ensure they keep the wheels rolling, delivering high-quality care whilst making savings – despite the uncertainty of what lies ahead.

They may look to Team GB cycling, who under the leadership of Sir David Brailsford in 2003, pioneered the concept of the aggregation of marginal gains. The concept is simple: making numerous small improvements resulted in a team which won just one gold medal in 76 years to one which dominated the track and road at the Olympics and beyond.

Under Sir Dave’s tutelage, cyclists learned how and when to wash their hands to stop them becoming ill. They understood the importance of rest, and had their own mattresses and pillows delivered to hotels to improve their sleep quality. They had counselling to support their mental health. The inside of the team truck was painted white to allow them spot dust easily. Their suits were tailored to reduce drag.

The result? A team that went on to dominate competitive cycling for more than a decade, winning 16 Olympic gold medals and the Tour de France. And a way of working that’s been adopted across sports and industry, including all Team GB squads at the 2012 Olympics, Toyota’s car manufacturing system and Amazon’s algorithms.

So, how could this theory apply to NHS trusts, and the pressure to cut corporate costs whilst maintaining clinical standards?

Operational Efficiency: small tweaks for big impact

Healthcare systems are inherently complex, with countless moving parts — from appointment scheduling to supply chain logistics. Just as Brailsford’s team focused on marginal gains in areas such as bike weight, rider position, and even the fabric of their clothing, there are ample opportunities for NHS trusts to identify small operational inefficiencies that – when rectified –make a big change.

• Optimising inventory management – even minor improvements in tracking supplies will cut waste and reduce costs.
• Automation of routine processes – using simple, inexpensive automation tools can reduce the amount of time spent on routine tasks like invoice consolidation or the dispatch of purchase orders by up to 90%.
• Catalogue management – ensuring goods are ordered from a pre-approved catalogue reduces the amount of time spend ordering by up to 95% and ensures trusts are able to secure good deals with suppliers.

Staff support and performance

As Brailsford’s team focused on the mental and physical wellbeing of cyclists — from sleep quality to psychological coaching — NHS trusts can make performance gains by supporting staff more effectively, this minimising the risk of disgruntled staff leaving.

• Getting pay right – probably the most important hygiene factor of all. But it’s not just about accuracy. Getting pay right is about giving staff more control (for example, by being able to choose weekly or monthly, and an online platform to view and manage their pay). It’s also about putting under and over-payments right swiftly, and processing pay changes so they’re seen in-month.
• Supporting starters – making sure recruitment and induction are smooth, enabling new colleagues to settle into the job quickly, whilst ensuring that vital admin takes place efficiently.
• Learning from leavers – arguably the most important conversation after the recruitment interview is the exit interview. Yet anecdotal evidence suggests many trusts rarely, if ever, hold them.

Harnessing data for continuous improvement

One of Brailsford’s key innovations was the use of data and performance analysis to identify areas for improvement. The NHS already collects vast amounts of data, from patient outcomes to staff performance, but in my opinion often lacks effective analysis and the feedback loops required to drive continuous improvement.

• Real-time financial monitoring. The holy grail of finance managers everywhere, real-time (or near real time) financial monitoring is now within our grasp; it’s something that NHS SBS will be offering shortly.
• Benchmarking and learning from success. Or to use a phrase I suspect we’ll all become very familiar with, “taking the best of the NHS to the rest of the NHS”. When we’re under the cosh, our natural instinct is to look inwards, when better results might be achieved by looking outwards.
• Making data accessible. Another area AI and automation excels at. Inexpensive, tried-and-tested technology like the fuzzy logic used bn many automation algorithms can give instant, accurate insights – for example, on spending patterns or staff satisfaction, right down to identifying which staff might be flight risks.

Why Marginal Gains Matter

What makes the aggregation of marginal gains so powerful is that it doesn’t require radical overhauls or enormous budgets. Quite the reverse. It relies on a mindset of continuous improvement — identifying small wins and building on them consistently over time.

Just as Team GB cycling became a dominant force on the world stage through the power of marginal gains, the NHS could unlock new levels of performance and patient care by applying the same philosophy. Success, as Brailsford showed, isn’t about finding a single silver bullet labelled “reform” — it’s about improving 100 things by 1%, rather than one thing by 100%.

I’m lucky enough to work for an organisation that has expertise and experience in all the above. Whether you’d like to know more about what automation can do to help you, or you’d like to learn from your leavers, I – or one of my colleagues – are happy to have an informal, no-obligation chat. Email me at Stephen.sutcliffe1@nhs.net