Table 1 Examples of strategies used by surgical teams to increase and flex resources
Theme | Strategy | Example |
|---|---|---|
Adaptations to staffing and skill mix | ||
Anticipatory | Increasing numbers of incoming staff that are already skilled | Work closely with the local university to develop and adapt teaching courses (e.g. additional bespoke module in anaesthetics for scrub/recovery nurses) Increase final year placements to improve skills and experience of nursing students, thereby reducing supernumerary period for new starters |
Diversifying job roles to shift the workload away from the consultants | Recruiting and training more physician associates to run their own lists (overseen by consultant anaesthetist). Maximise efficiency by allowing anaesthetist to support activity in more than one theatre Specialist nursing associates and junior doctors trained to independently run clinics, pre-assessments and initial consultations with patients, freeing up surgeons or anaesthetists to spend more time in theatre | |
Improving skill mix in theatre through staff rota planning | Requirement that senior nursing staff are available to supervise and teach new staff assisting in surgery. Rotational plan of newly qualified and international recruits in surgery to ensure adequate support can be given by senior nurses | |
Pooling patients (operated on by any surgeon or any surgeon within a specialty) | The cases under a specific surgeon who are approaching the maximum wait time are assessed to see if they can be pooled, and if a different surgeon is willing to take the case | |
On-the-day | Task-shifting or extension of responsibilities to share workload | Junior doctors starting a list while the consultant is busy with a patient or resolving scheduling issues Communicating with families delegated to who is available so that senior surgeon and anaesthetist can remain in theatre Nursing staff taking on the role of junior doctors, or healthcare assistants taking on the role of a scrub nurse |
Flexing staff to address numbers or skill mix issues | Scrub nurses sent to help sterile services process instruments quickly to prevent delays and disruption Senior nurses in non-clinical roles provide patient care to cover sickness and absences Staff asked to help with an emergency case if their elective list has finished early | |
Adaptations of space, beds, services and equipment | ||
Anticipatory | Providing more services to reduce high patient numbers by organising extra clinics or surgical lists | Adding extra patients into clinics (reducing appointment time/accept overrunning) or organising additional clinics and surgical lists to help with the backlog (e.g. on a weekend). This often involved staff working overtime and was contingent on space and all the necessary staff being available to run it, which was not easy to organise |
Reorganising systems for the processing of instruments in advance to maximise efficiency on the day | Scrub nurses redeployed to the sterile services team to understand the process of packing instruments and to educate the sterile services team on which instruments are opened together for specific cases. Sterile services staff observe in theatre so they have context when prepping instruments for each surgical procedure. The aim being to have a better shared understanding of how to pack instruments in a way that fits with the flow of the surgical procedure and prevent delays and disruption on the day. Anything else required must be requested by the surgeon in advance | |
On-the-day | Flexing space by repurposing theatres for different types of surgery, described as “flipping theatres” or “ad hoc theatres” | Theatres being used for different types of surgery to the norm, providing the space and equipment was suitable. For instance, theatres for a list stood down due to staff unavailability would be given to a different specialty |
Providing care in non-standard areas when beds are unavailable on the ward | Due to a lack of bed space on the wards, patients might be kept in the recovery room for longer and sometimes cared for by the staff there overnight Staff might admit male patients to the female ward (and vice versa) when there were a lack of beds | |