OP E R ATING THEATR E S
Theatres: working smarter not harder
How can theatres work smarter, not harder? The Operating Theatres show recently brought together healthcare leaders and clinicians to discuss how productivity and efficiency can be improved, in an effort to tackle the unprecedented backlog. Louise Frampton reports.
According to NHS Improvement, over 291,000 more routine operations could be carried out per year by improving the scheduling of surgical lists. Variation in theatre productivity between different Trusts and different specialties has been evident – including late starts, early finishes and delays between operations. In the wake of the enormous backlog created by COVID-19, productivity and efficiency are coming under increasing scrutiny and the health service will need to look closely at how it can reduce waiting lists and maximise valuable theatre time. With this challenge at the forefront, the Operating Theatres show, organised by the Institute of Government and Public Policy, brought together thought leaders and healthcare professionals to discuss key strategies for reducing waiting times in operating theatres, improving safety and outcomes of surgical services, and achieving greater productivity and capacity.
Tackling the backlog
Opening the debate was a special address by Professor Tim Briggs CBE, National Director for Clinical Quality and Efficiency, NHS. He emphasised that we need to reduce waiting times by improving theatre productivity, but we must all own the problem: “We can no longer look at things in silos. Unless we get the whole system right, we will fail. We need to work in a very different way,” he asserted.
In November 2018, 2,432 patients were on the waiting list for over one year, compared to 587,000 in 2007. Hardworking staff have already increased productivity, therefore. “We have done it before; the question is ‘how can we do it again?’” Prof Briggs commented.
He highlighted some of the key factors required to improve productivity and
JANUARY 2022
efficiency – including implementing better standardisation, ensuring effective team working, valuing and developing staff, tackling variation in length of stay, improved management of late starts and early finishes, reducing complications and readmissions, maximising day case surgery, “getting the evidence-based treatments right” and “shared decision-making”. This needs to include discussion with patients of the pros and cons and what they can expect from surgery.
Getting it Right First Time He explained that the National programme ‘Getting it Right First Time’ (GIRFT) is designed to improve the treatment and care of patients through in-depth review of services, benchmarking, and presenting a data-driven evidence base to support change. The programme undertakes clinically led reviews of specialties, combining wide-ranging data analysis with
the input and professional knowledge of senior clinicians to examine how things are currently being done and how they could be improved. The programme demonstrates “what good looks like” and the findings of these reviews will be vital, going forward, to reducing the backlog. “GIRFT started out in orthopaedics and, although it was voluntary, we have seen significant change,” commented Prof Briggs. This has included significant reductions in inappropriate surgery, resulting in better use of theatre lists, for example. For example, Briggs showed some historical figures (2010-2014) for patients who had undergone arthroscopy at age 60 or over, who went on to have a joint replacement within a year. Significant improvements were achieved by implementing best practice and, by 2014- 2016, the rate was reduced from 20% for some Trusts, to between 0% and 4%. A GIRFT national report in 2019 found that, despite NICE guidance, a significant
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