1. Title of the Change Project
Student ID.
MSc in Healthcare Management,
Institute of Leadership, Royal College of Surgeons in Ireland
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Scheduling Unscheduled Care (Emergency) requirements in an Operating Theatre in a Level 4 Hospital
Mark Jeffrey
MSc Leadership
Abstract
One of the most resource intensive services for a hospital to deliver is the provision of operating theatres. It is therefore essential that their utilisation and throughput are maximised to ensure patients are treated within an appropriate time frame, cancellations are limited and the service is cost effective.
The proposal for change is to separate scheduled and unscheduled care from current theatre lists to create capacity for a designated emergency theatre and orthopaedic trauma theatre in line with the national programmes for scheduled and unscheduled care.
Aims:
To create greater efficiencies in the overall patient throughput in a busy Level 4 operating theatre environment through careful capacity planning and managing business continuity.
To establish a clear, fair and equitable set of metrics, protocols and procedures to ensure that theatre allocation is fit for purpose.
The HSE Change Model is an Organisational Development Model of change suitable for the constantly changing health care environment and is therefore the chosen model for the outlined change proposal.

2. Organisational Impact
Scheduling Unscheduled Care (Emergency) requirements in an Operating Theatre in a Level 4 Hospital
Mark Jeffrey
MSc Leadership
Introduction
Methodology
Evaluation
This project is part of a wider governance structure for Peri-Operative care that is being developed across the health care group in line with the national TPOT Programme. This involves capacity and surge planning while being aware that as a level 4 organisation it is a tertiary referral centre for emergencies and national programmes for cancer care.
Current theatre operating time is allocated to a surgeon based on a mixture of history, specialty, contracted hours and available space.
The proposal for change is to separate scheduled and unscheduled care from current theatre lists to create capacity for a designated emergency theatre and orthopaedic trauma theatre in line with the national programmes for scheduled and unscheduled care.
The appeal of the HSE model (HSE, 2008b) is that it outlines the journey that enables people to move from the current situation to the desired future through four phases of initiating, planning, implementing and mainstreaming.
Initiating
communicate and engage with the department
Planning
stakeholder analysis
Implementing
implementing and monitoring
Mainstreaming
show people how these new behaviours and attitudes have helped improve their performance
The overall aim and each objective will be evaluated using a process, outcome and impact framework.
There has been a reduction in procedures completed outside of core hours compared to 2013.
Figure 1: HSE Change Model 1
Organisational Impact
1. Improved the communication between stakeholders.
2. The burden of administration is reduced.
3. Maximised utilisation within core working hours.
4. Reduction in out of hour’s operations.
5. Staff morale is heightened.
Aims & Objectives
Conclusion
The development of an Emergency Theatre that will allow capacity planning and continuation of daily business.
Greater access to theatre and protected beds ensures that patients leave the emergency department rather than wait on trolleys.
Combined with the Acute Surgical Unit, it will ensure that scheduled care is not interrupted by unscheduled patients occupying those beds. This will ensure the service is cost effective by reducing cancellations, increasing patient satisfaction, allowing the money to follow the patient and by allowing us to be benchmarked against other institutions.
There is little doubt that one of the biggest challenges facing today’s healthcare organisations is change management. By understanding the key principles all staff were able to see the benefits to patients. Efficiencies will serve to enhance the overall productivity of the organisation through improved patient flow
References
HSE (2008). Improving our services; A users guide to changing the health service executive. Naas: Health Service Executive.
TPOT Programme. HSE