Author:Chris Duncalf

January 19, 2022

Operating Room for Improvement?

The current volume and complexity of operating backlogs pose a different question, perhaps now is the time to look for a different answer

4 min read

Improving the performance of operating rooms and theatres, reducing wait times and improving the patient experience.

Operating Room for Improvement?

Whilst we can all agree that the Covid-19 Pandemic has generated unprecedented pressure on the healthcare sector, the underlying constant of a growing and aging population, combined with an increased prevalence of multiple chronic conditions, was already taking its toll. In the UK, the gap between NHS demand and resource was manifesting itself in increased waiting lists pre-Covid, albeit over a shallower trajectory:

MonthTotal Waits52Wk+ Waits
Oct 20163.75M1.4k
Oct 20173.80M1.6k
Oct 20184.19M2.8k
Oct 20194.45M1.3k
Oct 20204.45M167.1k
Oct 20215.98M312.7k


As the demand for elective services increases, so we must ensure we are able to maximise theatre productivity and efficiency, whilst maintaining quality outcomes. However, in a complex healthcare ecosystem, operating room activities are part of a broader patient pathway and inevitably bookended by additional process, constrained by bed capacity or a hostage to workforce shortages. With all those factors in mind, let’s have a look at some of the key activities / drivers we need to consider when embarking on our operating room improvement journey.

Governance & Engagement

  • A shared vision, aligned to corporate goals, must be owned. Clear accountability, roles and responsibilities are essential. Clinical and operational leadership is key, with individuals driving change and challenging resistance within their own areas.

  • Whilst the core goal may focus on operating room throughput and performance, it will take organisational change to realise improvement. Don’t forget to include those areas / processes that deliver and receive operating room patients.

  • Gain agreement on the core metrics to be used and ensure understanding at all levels of the organisation. Aid engagement by using relevant currencies, e.g. express utilisation in minutes used, not just a percentage.

Process & Enablers

  • Segment your improvement activities into meaningful components, not only to maintain focus but also to reflect patient pathway and process, i.e. Session Set-Up, Turnover, Recovery…..

  • Scheduling is the linchpin to the running of operating rooms yet can often have its roots in a process unchanged and unchallenged for years. Mapping this complex process will often highlight previously unseen opportunity. In addition, consider the role advanced technologies can play, AI or process automation, supported by clinical insight and actual procedure times to better plan and schedule.

Data & Insight

  • To tackle the challenge, the issues need to be pinpointed and understood. Visibility is key, you can’t successfully improve that which you cannot measure.

  • Understand your baseline and realistically determine what good (for you and your patients) looks like. In the light of current pandemic events (or indeed any other internal or external factors), consider your baseline very carefully.

  • Actively engage people in the data journey and prepare for a data literacy, distrust, and quality challenge. It is possible that individuals may not have seen the data presented in this manner (or at all).

The data challenge cannot be underestimated. I am currently engaged with one of our customers implementing our Operating Room Opportunity Monitor and in reviewing the more granular service level and individual procedure / anaesthetic times via the tool, it’s fair to say their existing understanding of process and pathway has been challenged……….. as has, wait for it……. belief in the quality of the data.

There is, of course, also a huge amount of time and commitment required in executing operating room improvements and, much like any project, resourcing should be carefully considered. Anyone looking for a head start, guidance or templates should certainly check out The Productive Operating Theatre (TPOT) issued by the NHS Institute for Innovation and Improvement, it is a fantastic toolkit. Nonetheless, if you can address, as a minimum, the three factors outlined above, you should at least have an engaged, accountable team who understand current state, can articulate future state and are equipped to monitor progress.

Given current global events you may ask, is now the ideal time to ask more of people, to seek additional commitment, to review process…. perhaps not but, is this one of the key challenges we will have to address to deal with waiting list backlogs…. I think so.

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