GIRFT guidance: reduce variation — not longer lists — to boost theatre productivity

GIRFT and NHS England improvement material makes a consistent point on theatre productivity: the fastest gains come from cutting variation in how lists run, not from asking teams to work longer. Current guidance points to late starts, poor sequencing, avoidable same-day cancellations and missing kit or implants as recurring causes of lost theatre time. July 2024 practical guides from Getting It Right First Time, or GIRFT, frame theatre productivity as a pathway issue that starts before the patient reaches the operating room. The guides say staff should focus on booking, list management, scheduling and start-up processes so that “the right activities are delivered at the right time.” ### Why are longer lists not the main answer? (gettingitrightfirsttime.co.uk) GIRFT’s theatre productivity programme says effective utilisation depends on reliable processes, including lists starting on time and patients being prepared in the right order. One guide says consistent on-time starts are a “fundamental requirement” for effective theatre use. NHS England improvement material makes a similar argument in operational terms. (gettingitrightfirsttime.co.uk) Its session start-up and patient change-over guide links late starts directly to overruns and cancellations, and says teams need clear leadership, correct equipment and the required resources in place before the session begins. ### Which bottlenecks does the guidance keep pointing to? (gettingitrightfirsttime.co.uk) The recurring bottlenecks are concrete and familiar: on-the-day cancellations, duplicated checks, mixed-complexity lists and unreliable equipment readiness. GIRFT’s scheduling guide says the “golden patient” should be agreed in advance in a scheduling meeting, using list-order principles from both operational and clinical perspectives. (england.nhs.uk) NHS England’s scheduling material says improvement work should aim at reducing waiting times, avoiding cancellations and unnecessary delays on the day of procedure, with the right team, equipment and information in the right place at the right time. That places implant and kit availability, as well as list construction, at the center of productivity work. ### What does GIRFT say teams should standardise first? (gettingitrightfirsttime.co.uk) GIRFT’s 2024 guides break the work into practical stages: booking patients correctly, managing the patient tracking list and list allocations, and sequencing lists so the agreed patient order can be delivered. The programme says each stage contributes to higher theatre productivity and better patient and staff experience. (england.nhs.uk) The orthopaedic elective surgery material adds a staffing point. GIRFT’s ambulatory hip and knee replacement guide says the core clinical theatre team for each list should be relatively consistent week to week, and that specialist orthopaedic scrub nurses who understand the procedure are important, especially for joint replacement. ### How should trusts measure whether changes are working? (gettingitrightfirsttime.co.uk) NHS England improvement resources have long tied delay reduction to managing variation in demand and capacity rather than treating waiting lists as a simple volume problem. One NHS improvement paper says stable backlogs often reflect temporary mismatches caused by variation in capacity and demand. A practical way to organise measures is across three domains used in current improvement work: demand management, flow, and discharge or recovery. (gettingitrightfirsttime.co.uk) Demand management covers issues such as list allocation and avoidable cancellations; flow covers start times and turnaround; discharge and recovery covers length of stay and whether post-operative pathways release beds reliably. GIRFT’s theatres and perioperative programme says its aim is to optimise theatres and surgical hubs to help manage the elective backlog. (england.nhs.uk) ### Where does this sit in the wider NHS recovery push? GIRFT says its theatres and perioperative medicine programme is intended to unlock the full potential of the perioperative pathway and optimise the use of theatres and surgical hubs. The programme sits alongside wider elective-care improvement work aimed at reducing waiting lists for routine planned care. The next step for trusts is practical rather than new policy. (gettingitrightfirsttime.co.uk) GIRFT’s theatre productivity guides, including the July 2024 scheduling, booking and list-management documents, are already published on the organisation’s website, while NHS England’s improvement hub continues to host related flow and scheduling tools for local teams. (gettingitrightfirsttime.co.uk)