Not if but when - Improving theatre efficiency

Author: Andrew Boyd

In New Zealand there is a limit to the amount of elective surgery which is able to be obtained by patients through the publically funded healthcare system. The demand for elective surgery has continued to significantly increase, however the resources available in the public system are insufficient to meet this demand. Patients can obtain the required treatment through the private system which is often too expensive for the uninsured. The public systems, specifically District Health Boards, are under an increasing amount of pressure to ensure that they perform as much elective surgery as possible, and for many this means trying to schedule it around acute surgeries.

So how do you increase hospital efficiency, so that more elective surgery can be performed without compromising patient care or the quality of the service offered, within your existing budget constraints? One of our clients recently asked us to work with them to try to answer this exact question and assess a few of the initiatives which they had underway. The results were quite staggering!

Below we have presented a summary of some of the key learnings from the project along with a number of action steps which you could take to achieve significant efficiency gains. It is important to note no organisation faces exactly the same issues, so no organisation can adopt exactly the same solution to achieve its own goals. Although the following insights provide you with ways to improve the efficiency of your theatres, we encourage you to talk to one of our Healthcare experts to ensure you use the best approach for your organisation and the goals you are trying to achieve.

Case study insight – improving theatre utilisation and efficiency 

1. Standalone Elective Surgical Systems can be more efficient than combined acute/elective systems
2. Training junior surgeons slows surgery times
3. If you want theatres to run efficiently and be utilised as much as possible you need to develop high performing teams
4. Accountability is vital to improving performance
5. Surgeons work more efficiently when they are incentivised to do so
6. It is vital to obtain the right information about a patient in the pre-operative process so you can more accurately predict the likely care path which a patient will require
7. No matter how advanced the technology used is, almost all of the research suggests that computer based systems are significantly less accurate at scheduling theatres than experienced surgeons and nurses
8. Co-ordination of key resources is vital to achieving increased efficiency. However, in order to coordinate resources it is vital that the location and availability of these resources is known
9. Hospital theatre design and the design of the wider hospital have a large impact on the level of theatre efficiency which is able to be achieved. For example, if an anaesthesia room is next door to the operating theatre then the time to theatre is reduced, thus increasing efficiency.

Steps to take to realise efficiency 

• Identify change champions who will promote and implement the desired change. Make sure these people are adequately supported and resourced.
• Always look for low hanging fruit (issues which are easily solved and which provide immediate benefits) and celebrate when success is achieved. There is no better way to keep the momentum going.
• Ensure all stakeholders within all levels of the organisation and even stakeholders outside of the organisation are able to voice their ideas. The majority of the best innovative and practical ideas come from porters, nurses, surgeons, administration staff, patients and friends and family of patients. So do not underestimate the value of their input.
• Track project performance and widely communicate this. This can be extremely motivating if there is a strong connection between current activity and desired performance.
• Ensure that the executive team has a good working relationship with the rest of the organisation especially key clinicians. After all they are the ones which can either cause a project to succeed or fail. You need their support.
• Use the information you have obtained about your patients in the pre-operative process to predict the care path of the patient and allocate resources accordingly. For example, group clients into low risk and high (anaesthetic) risk patient segments so resource demand can be more accurately managed.
• It pays to get the advice of an architect who has deep experience in hospital design. In fact if you know of a hospital which has been built well within budget it is more than worth your while to spend time visiting and talking to the team which designed and managed the building project. From our experience the best designed hospitals were designed by theatre nurses.
• Investing in technology to improve the availability of information is wise. For example, online real-time bed availability system, resource tracking devices and accurate scheduling systems.

All health organisations will have to become more efficient in some form or another. It is not a question of if, but a question of when. When will you start to take action, when will you become more efficient and when will you start to see the benefits of the projects you implement? The ball is in your court - you can be a leader or follower, it’s your choice. We hope this short article has been of interest and has provided you with a few avenues to explore. If you would like help to generate more ideas, or to develop the framework of a project or implement an efficiency gains project, please do not hesitate to contact us.