Case Study Optimisation of booking scheduling and theatre session utilisation

Prism Improvement has supported an NHS Trust in the East of England to deliver a phase of work over 20 weeks that helped prepare plans for 2025. One key phase of the programme was the optimisation of booking, scheduling and theatre session utilisation.

Challenge and goals of the Trust

The overall goal for the Trust is to attain a sustainable 103% of 2019 activity whilst meeting the ICB utilisation target of 85%; however, coping with daily pressures continued to become a challenge.

What we did

As part of our work, we proposed recommendations to improve productivity and continue to decrease the number of patients awaiting surgery without a continuous increase in WLIs.

A review of the current processes was needed to help identify specific blockers to productivity and any cross-cutting themes to be addressed. These included reviewing:

Booking and Scheduling teams
8-4-2 model to support session management and scheduling
Long-term strategy – booking team investment – wrote the business case to increase staffing and link to long-term strategy

Impact

Business Case for an Increased Admin Workforce

One of the key results of the programme was the creation of the business case, which highlighted that adding additional workforce within the admin team would aim to achieve the following as a direct result of this investment:

Increased patient throughput, supporting national elective activity targets and reductions in long-waiting patients
Improved RTT performance, as team leaders will have more oversight of booked lists
Mitigation of risk on the risk register
Reduced OTD and late cancellations, as patients could be booked in for pre-assessment in advance, and medical issues would be picked up prior to the week/day of surgery
Improved theatre utilisation due to a reduction in cancellations and optimally booked lists
Improved staff wellbeing and retention rates

It was evident that the team at the Trust were engaged with the business case and, as such, achieved:

An increase in the staff establishment within the current booking team
Restructure of the team based on increased establishment

Structuring 8-4-2 for effective and productive theatre scheduling

The 8-4-2 theatre scheduling approach is a structured method designed to optimise operating theatre efficiency, minimise delays, and improve resource utilisation.

By restructuring this approach, the Trust team was able to focus on advanced planning, team coordination and timely execution to enhance surgical workflow and patient outcomes.

We also offered a long-term strategy for a proposed change to the current 8-4-2 and scheduling format that was able to:

To instill best practice 8-4-2 methodology
Split the meeting into a clear 8-4-2 and Scheduling meeting
Put specialty time slots in place, which is best practice for a scheduling meeting

An additional output of the programme was the development of a new operational guidance and methodology for booking and scheduling that the Trust has now implemented and is sustaining, which included a clear meeting structure with all of the information required for the meetings, establishing an escalation process, implementing best practices, and tracking and developing an 8-4-2 scheduling approach.

Although the business case highlighted the need for more staff, the improvements to the 8-4-2 process and restructure of meetings meant that the Trust were able to make implementations to the service that allowed the team to focus on advance planning, improving the surgical workflow and patient outcomes. If they were to implement the business case they would be able to improve the service further and reduce patient wait times significantly.