Theatre Management

We work directly with the Clinical staff and Consultants to deliver a raft of improvements in Theatre management. Finding the time to competently deliver detailed Theatre Planning, KPI reporting, Utilisation Data and List Planning all require good management practices and minimal step processes to keep it simple and cost effective. SYSTEM 21 can provide this expertise though a participative approach that involves Clinicians and Theatre managers.

SYSTEM 21 List of service provision to improve Theatre Management techniques and control systems.


    Increased available theatre capacity – “Session  and In Session Utilisation”
    Improved Theatre List capacities
    Increased throughput of patients
    Consultant session scheduling in line with the ability of rest of hospital to deliver
    Most appropriate use of Clinicians fixed session availability
    Effective use of porters and ancillary crewing levels
    Improved procedure costing
    Improved scheduling / rotas
    Better planning/scheduling
    Improved matching of resources to workload
    Better forecasting of work up services e.g. pathology, bloods and      radiography
    Improved inventory/stock control
    Overtime control- reduced late starts/ late finishes/overruns

As further illustration of our success in this sector, the following CASE STUDY demonstrates our ability to assist in the setting up of cost efficient Planning and Reporting systems for professional Theatre Management.



The Trust in this project case study comprised a major teaching hospital and two smaller hospitals. Surgery was conducted at all three sites. There are 24 operating theatres excluding endoscopic facilities. Theatre Management information suggested that operating theatres were functioning at maximum capacity across the Trust, with utilisation figures in excess of 100% being achieved. This is not uncommon when we are first asked to review a hospital department.

However, hospital management personnel and the professionals involved in the theatres provided less positive perspectives. These were characterised by:

An overwhelming feeling of frustration that cancellations were high, and that an unacceptable amount of time was being wasted whilst staff were waiting unoccupied. Management information showed that cancellations (unavailable sessions) were running as high as 25% against the Master Theatre Timetable.

Recognition that cancellations of operations from lists took place as late as the day of surgery and even in the period immediately preceding admission.

An acknowledgement that entire sessions was being cancelled in the lead up to the week of surgery, during the week of surgery and even on the day before surgery.

Anecdotal evidence suggested a diversity of causes for these problems, including a shortage of anaesthetists, an undersupply of nurses, a deficit of beds, a lack of proper instrumentation and a tendency towards last minute announcements of surgeons' unavailability.

Moreover, a piece of work, which reviewed the time-line of surgical patients on their journey to, through and from theatre, had suggested further unacceptable levels of delays which impinged on theatre efficiency.

To add to these problems, there was evidence of excessive spending on out-of-hours theatre nursing and overtime.

The yardstick being used for measuring theatre efficiency was seriously flawed; hence the reason utilisation figures in excess of 100%. The real utilisation In-session figure was 70.8% which was thought to be 121% previously. The sessional utilisation for the whole year averaged 60% and reality it is much worse if all of the cancellations were taken into account.

There was also a mismatch of nursing resources. Some hours of the day suffered inadequate staffing numbers; at others times, numbers were higher than those actually required.

Surgeons' failure to provide timely notification of leave and other absences meant that a large number of sessions were scheduled to be staffed by nurses and anaesthetists, despite the fact that the surgeon had previously cancelled the session.


Following the completion and presentation of the findings of the Initial Study, an Implementation Programme was begun. The programme schedule covered a period of thirteen calendar weeks, followed by one year of Perpetuation (audit and follow-up). It consisted of the following areas:

A. Strategy and Goal Setting Programme

Any successful programme requires goals and targets against which to judge success. Working with the Medical Director and other members of the Executive Team, a full list of Project Deliverables was established including :

    The Target Utilisation
    Achieve full utilisation of Surgeon Time Available
    Produce a theatre schedule based on what is possible, rather than over a standard 52 weeks
    Allocate lists to surgical teams rather than just to consultants

B. Theatre List Preparation (by Consultant and teams)

Agreement was reached as to the determination and definition of "active time" to serve as a basis for measuring theatre utilisation. The basis for the calculation would therefore be the total of 1) Set-up and clean-up time, 2) Anaesthetic time and 3) Procedure time.

The methodology template that SYSTEM 21 introduced for Theatre List Preparation was clear and concise. Having been agreed by clinicians in previous Projects there was less suspicion of intent. There was also much better compliance with and use of the computerised surgery planning systems, whereas prior to this, the procedure times had all been set to "default".

C. Theatre Master Scheduling

This timetable contained all of the planned sessions for the coming year. Theatre Management had the responsibility of keeping the timetable live. Any leave or other planned downtime was identified on the schedule. The schedule was made available live on the Trust's intranet, so that everyone could be aware of sessions which were available in cases where a surgeon or specialty could not conduct session in the plan.

SYSTEM 21 provided Templates and procedure planning times to calculate the Annual and rolling monthly utilisation of all key members of Clinical Staff. As a result, Patient Cancellations reduced significantly and when they had to be made, much more notice was possible to those patients who were moved back in the schedule.

RESULTS : The savings deliverd 50% of the whole CIP target for that year.

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