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Optimising the Delivery of OAB Services

Case Study:

Optimising the delivery of OAB services following the COVID-19 pandemic


The Client

Our client is a leader in providing treatments that support urology patients. They commissioned us to help better define the care pathway activities required to support the optimal management of overactive bladder (OAB).


A review of local guidelines revealed that there is wide variation in OAB care pathways and the activities and standards that each use to support primary care decision-making about the management of these patients. This results in variation of outcomes and referrals seen in secondary care (e.g. urology) services, creating patient waiting list backlogs. The COVID-19 pandemic exacerbated this backlog.


The work aimed to support commissioners and service leaders evaluate and update OAB care pathways in line with best practices, as validated by experts:
To enable effective, efficient management by primary care teams
To help reduce unnecessary referrals to secondary care, helping reduce the patient backlog
Improving the experience of care by the patient



Based on this we designed a Delphi-based approach to help define, validate and amplify support for pathway activities that would improve patient experience, outcomes, and help reduce unnecessary specialist referrals.

Our Process

Step 1

A multi-disciplinary group of experts specialising in urology across all regions of the UK were facilitated to pinpoint the challenges related to optimising the delivery of OAB services to patients, particularly following the devastating impact of the COVID-19 pandemic and then define a set of statements that described ‘ideal’ practice or best practice principles.

Step 2

A structured online survey was developed and disseminated across other urology specialists across the UK. The online survey tested the strength of agreement that existed in relation to the statements (best practice principles) developed.

Step 3

A subsequent facilitated review of the full dataset by the steering group led to the development of a core set of recommendations that reflected the results achieved. These were focused on the optimal management and treatment of overactive bladder.

Step 4

A commissioning guide was developed which outlines the case for change, acting on clear, expert validated best practice principles to optimise the care pathway. Also included, is a practical checklist which helps decision-makers to audit their current guidance. To support this, there is a suggested ‘model care pathway’ to help illustrate how local or regional guidance could be provided, using the validated principles (recommendations) from the expert consensus.



Responses achieved from urology specialists across all regions of the UK.


Clear recommendations which informed potential improvements to the management of overactive bladder and guided the development of a ‘model care pathway’.

Provided a strong platform for the client team to engage with key stakeholders to support updates to local and national guidelines

Already emerging evidence of local guideline updates that reflect best practice principles developed


  • A commissioning guide was developed as the core output – supporting commissioners to audit their current services and ensure guidance aligns with expert-confirmed best practice
  • Key Account Managers were equipped with the knowledge and materials to deliver local meetings with OAB service leaders, to encourage positive changes to local care pathways
  • A strategic policy summary was provided, to enable engagement at a regional and national level to create support for local change

“The pathway guide was extremely well received. It generated a lot of questions and led to a meeting with the service director to learn about how this could positively impact their local guidance.”

“[HCP] was particularly impressed with the input being from external experts as this gave the document extra ‘gravitas’ and all the key sections resonated well. It was very timely as they are currently updating guidance for primary care.”


“It’s an excellent piece of work and very useful for current plans to encourage protocol / pathway updates”

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