Decommissioning Theatre Space

A large acute Trust was considering a significant operational and estate decision at one of its largest hospital sites: the potential decommissioning of a dedicated trauma theatre. This raised a critical strategic question for the Trust. Could orthopaedics absorb an additional 10 trauma theatre sessions per week into its existing elective capacity while still meeting forecast demand for 2026/27? And, if not, what changes would be required to make this achievable?

At first glance, this could have been framed as a simple theatre capacity question. In practice, however, the Trust recognised that the issue was more complex. The answer depended not only on the number of theatres available, but on how demand, workforce, estate, productivity, and shared hospital resources interacted in the real world. The Trust therefore needed a rapid but robust analysis to understand the true art of the possible.

APPROACH

The Trust partnered with collabor8 Ltd, using the FLOORPLAN® strategic modelling platform to undertake a comprehensive gap analysis and scenario modelling exercise. The objective was not simply to test whether the additional trauma workload could be absorbed, but to understand the operational conditions under which it could be delivered safely and sustainably.

A key strength of the approach was the ability of FLOORPLAN® to model real-world service complexity in a way that typical spreadsheet-based analyses or standard demand-and-capacity models cannot. The analysis considered not only orthopaedic demand and elective capacity, but also the multiple confounding factors that influence delivery in practice, both within and beyond the direct control of the orthopaedics service. This included shared resources across the hospital and trust-wide constraints that materially affected performance.

CHALLENGES

The work showed that the challenge was not defined by one variable alone. Instead, the feasibility of absorbing the additional trauma activity was shaped by a series of interdependent constraints across the wider system. These included estate limitations, access to X-ray facilities, pre-assessment capacity, booking capacity, case mix, and the operational implications of surgeon availability during holiday periods. The analysis also highlighted inefficiencies in the use of premium laminar flow facilities by specialties that did not require them, reducing flexibility elsewhere in the theatre estate.

These issues demonstrated why conventional modelling approaches often struggle to gain clinical traction. In reality, services operate within a web of practical constraints, specialty preferences, and shared-resource dependencies. If these are not reflected in the analysis, the conclusions rarely feel credible to the clinical and operational teams expected to deliver the change.

SOLUTIONS

Using FLOORPLAN®, the Trust was able to test multiple scenarios and establish a much clearer view of what would be required to absorb the additional trauma activity. The analysis set out the performance metrics and utilisation assumptions needed, while also identifying the operational interventions that would have to be addressed if the Trust wished to proceed.

This moved the conversation beyond a binary yes-or-no answer and towards a more useful question: what would need to change to make this possible?

The modelling provided clarity on the role of several practical interventions, including better use of specialist facilities, improved pre-assessment and booking capacity, and greater surgeon pooling to enable cross-cover during seasonal leave periods. Most importantly, it showed how these factors combined across the system, giving executives and service leaders a realistic basis for decision-making.

OUTCOMES

The work provided the Trust with an evidence-based answer to the executive hypotheses

that had prompted the exercise. It gave clear visibility of the relationship between demand, performance, and required capacity, and identified the bottlenecks most likely to limit delivery. In doing so, it provided the Trust with a realistic understanding of the art of the possible rather than a simplified theoretical model.

The strategic impact was broader than the initial question. By demonstrating both the depth of the analysis and the forecasting capability of the FLOORPLAN® tool, the work led the Trust to widen the scope of the project beyond orthopaedics alone. What began as a focused assessment of one trauma-related question developed into a much wider conversation about rightsizing the hospital’s elective footprint as a whole.

This created the foundation for a comprehensive rightsizing options appraisal across all specialties within the hospital, positioned as a significant change management exercise informed by the rapid analytical and scenario modelling capability of FLOORPLAN®. The result was not simply an answer to a single operational question, but a stronger strategic basis for trust-wide decision-making.