Table 3 Case study: intervening with short-term gains but potential unforeseen negative side effects

“Some of the strategies we have from elective perspective, if we are looking to be very short from an elective bed perspective, it's like, can recovery staff the recovery suite overnight? It's not great from a patient experience perspective because recovery is designed as recovery, there's no functioning bathrooms or anything down there. But to balance that, it prevents us cancelling an operation. And the patients are usually very grateful to have spent a night in recovery because they've got their operation and not had to be sent home…

They know there's a bed crisis, because patients in surgical reception are very aware of the communication and everything that's going on. So some patients are just so grateful that they have had their operation. Other patients aren't, and they get frustrated by the lack of facilities, mainly, the access to food, although, we have greatly improved that, we do try to make sure that our patients get well fed if they are outside of a ward area…

But when you are co-locating patients who are going to spend overnight in recovery next to patients who are just coming out of theatre, post anaesthetic, they’re very different environments. You've got a patient that's recovered, and you've got a patient who's just about to start their recovery journey. And they're very different environments…If you're a patient that's been there for four hours, you're completely aware of what's going on around you, visually, you see patients coming through with tubes in their mouth, and drips and drains, and it's not a very nice experience…

And sometimes for the staff in recovery, it's actually quite difficult, because they are used to looking after patients who are asleep, essentially, who will then become drowsy and awake and will go to a ward…And that's a real challenge then for the staff to be able to manage. So there's lots of downsides, but there's lots of upsides, for want of a better word, as well, because patients have been able to have their procedure.” [Ward Matron]