Elective Rightsizing Programme

Following an initial diagnostic assessment to decommission a dedicated trauma theatre at one of its main hospital sites, the analysis highlighted that doing so required more than a single-service solution. The Trust needed to answer a far more complex question:

Could the entire elective footprint be redesigned to absorb trauma activity, deliver performance targets, and remain within financial constraints?

This required a shift from local optimisation within orthopaedics to a system-wide transformation of elective services, balancing demand, capacity, workforce, estate, and operational performance across all specialties. The programme was positioned as a major change management exercise, requiring both analytical precision and practical deliverability.

APPROACH

Building on the initial analysis, collabor8 deployed FLOORPLAN® across the full elective footprint of the hospital. The platform was used to create a single, integrated view of elective demand and capacity, modelling all specialties together rather than in isolation. This enabled the Trust to understand how theatre resources, workforce, and estate could be reconfigured at system level to support both elective and trauma activity.

FLOORPLAN® was used iteratively to:

model future-state demand against 2026/27 targets

test multiple rightsizing scenarios across specialties

identify the optimal configuration of theatre capacity

quantify the performance improvements required

assess the financial implications of different options.

Critically, the modelling incorporated real-world constraints and service preferences, including shared resources, specialty-specific requirements, and workforce limitations. This ensured that the outputs were not only analytically robust, but clinically credible and operationally deliverable. The programme combined this analytical capability with structured engagement across clinical, operational, and executive stakeholders to align on the required changes.

CHALLENGES

Delivering a trust-wide rightsizing programme required addressing several deeply embedded challenges. The theatre estate had evolved over time, leading to variation in how different specialties used available capacity. There were inefficiencies in the allocation of specialist environments, such as laminar flow theatres, and inconsistent approaches to list planning and utilisation.

Operational constraints extended beyond theatres themselves. Pre-assessment capacity, booking processes, diagnostic availability, and workforce coordination all acted as limiting factors. In addition, there were natural tensions between specialties competing for shared resources, and a need to maintain morale and engagement across the workforce during a period of significant change. Perhaps the greatest challenge was ensuring that the proposed changes were seen as realistic and deliverable, rather than theoretical modelling outputs.

SOLUTION

FLOORPLAN® enabled the Trust to move from fragmented, specialty-level planning to a coordinated system-wide model of elective delivery. The analysis defined a clear future-state configuration of theatre capacity, enabling the safe decommissioning of the trauma theatre while maintaining sufficient capacity to deliver elective demand.

This was supported by a set of targeted operational changes, including:

optimisation of theatre allocation across specialties, ensuring appropriate use of specialist facilities

improved alignment of case mix to available capacity

strengthening of booking and pre-assessment processes to support forward planning

introduction of more flexible workforce models, including surgeon pooling and cross-cover arrangements

clearer utilisation expectations and performance standards across the theatre estate.

Importantly, these changes were not implemented in isolation. They were coordinated as part of a broader system redesign, ensuring that improvements in one area were not constrained by bottlenecks elsewhere.

OUTCOMES

The programme delivered a fully rightsized elective theatre footprint, enabling the Trust to safely decommission the trauma theatre while maintaining service performance.

Key outcomes included:

Successful absorption of trauma activity into the elective system without requiring additional theatre capacity

Delivery of elective activity in line with 2026/27 demand projections

Improved theatre utilisation and reduction in unproductive time, including late starts and early finishes

Increased alignment between demand, capacity, and workforce availability

Reduction in reliance on additional capacity measures such as waiting list initiatives and outsourcing.

Financially, the programme enabled the Trust to operate within its Cost Improvement Programme (CIP) envelope, avoiding the need for further investment in additional staffing or estate. The reconfiguration of services and improved productivity released significant efficiency savings while maintaining clinical safety and service quality. Beyond the metrics, the Trust achieved a more stable and predictable operating model, with greater confidence in its ability to plan and deliver elective care.

STRATEGIC IMPACT

The programme demonstrated that meaningful improvement in elective performance requires system-level change, not isolated interventions.

By combining advanced modelling with practical implementation, the Trust was able to:

make a major estate and service decision with confidence

align clinical and operational teams around a shared plan

embed a more disciplined and sustainable approach to theatre management.

FLOORPLAN® played a critical role in this process by providing the clarity, speed, and realism required to navigate complex decisions and deliver change at scale.