Improving theatre productivity in West Hertfordshire

Across the country there are over 7 million patients on waiting lists for elective care; the backlogs existed before the COVID-19 pandemic, but the impact of the pandemic has compounded the problem and more people than ever are waiting for surgery.  

In January 2023, Newton and West Hertfordshire Teaching Hospital NHS Foundation Trust (WHTH) started a programme of work to improve the effectiveness of their operating theatres. At the start of the programme the Trust had 5,500 patients waiting for surgery with many of these people having been waiting for well over a year. The Trust had limited visibility over how theatres were operating, meaning that surgeries were often being cancelled on the day, and it was difficult to have grip on the situation.  

WHTH needed to improve their theatre effectiveness to ensure that they were providing the best standard of care for their patients.  

The programme, co-designed by Newton and WHTH, has embraced a clinically-led change approach from the outset, empowering clinicians and the teams around them to design and own the solutions to improve theatre performance. To kickstart this, 105 staff across the division (clinicians, theatre staff, waiting list coordinators, divisional management and more) took part in workshops to set a clear vision for the programme. Key principles underpinning this vision were: 

• Calm, efficient surgeries with smooth patient flow minimising delays. Multi-disciplinary teams working together to create a fantastic patient experience.   

• Every operating list is at full capacity, to ensure prompt finishes without finishing early.  

• Prompt starts and smooth turnarounds, with a standardised process to call for the next patient and lists reviewed ahead of the day to prevent order changes. 

An on-the-day process for theatres has been agreed by all involved in the process, from those booking the surgeries to the surgeons, to prevent delays ensuring that surgeries start sooner and turnarounds between surgeries are efficient. A separate booking process ensures that the lists created will have the right number of patients, helping them to run to time and enabling full utilisation of valuable theatre time.  

These changes have been enabled by a newly implemented theatre performance tool.  

The theatre performance tool which has been implemented as part of this programme of work is providing WHTH with greater visibility than ever before. The theatre management software provides two main views:  

• Booking view – enabling improved forward-looking visibility, of how full lists are, and providing confidence that a list will be well utilised. This is encouraging ownership of lists, and allows for flexibility in booking. 

• Reporting view – showing how theatres have been utilised and where cancellations have occurred, allowing clinicians, theatre staff and management to continuously identify blockages and ensure they are addressed going forwards.  

The tool also provides easy use of surgeon-specific median operation times to ensure lists can be optimally used.  

Since implementing the tool, lists are better planned, theatres are more utilised and patients are not waiting so long for surgery. In addition, staff are enabled to have better grip on services and can work proactively to ensure that the new processes are being followed.