wellington hospital

The Wellington Hospital is owned and operated by HCA International and is the largest independent hospital in the UK. It has 266 registered beds, 15 intensive care unit beds, 19 high dependency unit beds and 11 operating theatres.

Senior management at The Wellington Hospital were convinced that there was room to improve efficiency in the organisation of its Operating Theatres. Some of the specialisms were being performed in two separate buildings and the original organisational structure was still in place, even though the number of operating theatres had increased.

Staff at The Wellington Hospital asked us to appraise the department and highlight the nature and extent of departmental inefficiencies. Although the operating theatres revenue had increased, costs were disproportionately high and it had proven difficult for management to ascertain how savings could be made.

Approach/methodology

The objectives of the review of the operating theatre services were to:

  • address management and delivery issues relating to the operational effectiveness and commercial efficiency
  • assess staffing establishments and human resource management in the context of the current theatre service provision
  • examine current stock management, control systems and reporting procedures
  • provide recommendations for improving the management and delivery of theatre services.
  • At the outset, our Transformation Team were provided with a preview of works and then held discussions with the Theatre Manager and her Deputy. This enabled them to complete the scoping review and present some initial findings.
  • Following the successful scoping review we were commissioned to conduct a detailed analysis of service provision. This was based upon the key work streams that we had identified in the scoping review and involved:
    • establishing a detailed understanding of the organisational processes
    • reviewing the budget and financial reporting procedures for each cost centre
    • undertaking a study of the theatres utilisation and skills mix.

Our review of the operating theatres review entailed a combination of desk-top analysis and semi-structured interviews. Desk-top analysis focused on staff budgets, theatre scheduling and information provided by the Theatre Manager.

Semi-structured interviews conducted with staff from each of the grades employed were designed to give a clear understanding of the organisational and operational procedures.

The review also involved analysis of key roles such as Theatre Manager, Deputy Theatre Manager, Theatre Coordinator and Service Manager and served to illustrate how ‘key performance indicators’ could be used to improve performance.

Our  initial review indicated that there was a high degree of centralisation of management data and recommended that responsibility for reporting was devolved down the organisation to improve accountability.

Due to the complexity of the Operating Theatres environment it had not been immediately obvious which services were providing the greatest contribution to the profitability of the group. As a result, our Team recommended that additional financial analysis was made available that split actual income and costs by Specialty, Complexity, Consultant, HRG/DRG and individual patients.

We then demonstrated how this further interrogation of financial information could be used to inform and support change.

Outcome

Our Transformation Team presented their recommendations to the Theatre Manager, Deputy Theatre Manager and Chief Nursing Officer and this was followed by presentations to the Executive and other theatre staff.

The recommendations were well received and we are continuing to assist management with the restructuring process so that the benefits can be realised as quickly as possible.

Comments from the Client

“We invited GK Transformation to undertake a review of our operating theatres so we could get a global and external view. We were very pleased with the way GK Transformation conducted the review and work has already started on implementing their recommendations.”

Andrea Costello, Theatre Manager

“The GK Transformation review was thorough and in-depth and covered many facets of a very complicated department, which is spread out over 5 floors and two sites. While conducting the review, GK Transformation personnel kept us fully appraised at every stage and I felt it was a real consensual approach to improving our theatre facility. All staff felt that the GK Transformation reviewers were approachable and we are now very keen to implement the recommendations.”

Kim Handel, Chief Nursing Officer

Conclusion

This case study demonstrates our capability and experience in reviewing complex services, such as Operating Theatres. It also illustrates our ability to consider issues from both a strategic and functional perspective. This ability to analyse both hard and soft issues in tandem enables us to deliver workable recommendations that lead to quantifiable and sustainable benefits.