The Productive Operating Theatre

The Productive Operating Theatre (TPOT) offers a systematic way of delivering high quality, safe and consistent care to patients. It builds on learnings from best practice within healthcare and other industries and is a program of work that gives frontline staff the practical tools and knowledge they need to transform the operating department across the four key areas of the program.

TPOT is beneficial when there is:

  • Poor efficiency of operating theatres (over/under utilised, slow turn around between theatre cases, late starts/finishes, early finishes)
  • Poor team working environment within the operating theatres
  • High rates of clinical incidents
  • Low staff morale

Expected benefits

  • Increased productivity due to improved utilisation of theatre lists, reduced delays within scheduled sessions, less overruns and late starts
  • Financial savings attributed to better management of stock, reduced amounts of stock held and better rotation and ordering practices
  • Increased staff morale and lower sick leave levels
  • Improved patient experience
  • Improved team performance
  • Increased surgical activity


All Hospital and Health Services providing elective surgery, but may also be used for improving emergency surgery efficiency.

Key principles

The success of TPOT is attributable to implementation of lean principles, specifically related to clinical service redesign. This involves stakeholders at every step in the process to ensure high level clinical engagement.

  • Planning- each module is planned individually and tools are provided to assist with planning
  • Diagnostics – baseline performance is identified to provide a benchmark and enable identification of improvement. Tools are provided to assist with diagnostics
  • Solution Design – developed by the stakeholders to enable ownership and maintain sustainability
  • Implementation- changes can be implemented in a showcase theatre or throughout the department
  • Sustainability – stakeholders sustain changes as they helped to create the solutions, this leads to ownership and empowerment


  • Improve patient experience and outcomes
  • Increase safety and reliability of care
  • Increase team performance and staff wellbeing
  • Improve efficiency and add value within the operating room

Operational princples

A showcase theatre, to trial changes, is selected by the program team. The program uses a Plan, Do, Study, Act (PDSA) model of service improvement. This encourages participants to set SMART goals (simple, measurable, aspirational, realistic and time bound) and measure their improvements against these.

  • Introduce briefing and de-briefing as an effective safety measure and communication tool, allowing lists to run more smoothly, safely and with fewer errors
  • Financial savings can be made by eliminating waste and making processes more efficient
  • Improved communication between theatre staff contributes to safer and more efficient working practices and reduces errors
  • Improved start time, turnaround time, session uptake, utilisation and staff wellbeing
  • Time wasted searching for equipment is reduced by the "5S’s" and using visual aids
  • Real time ‘Operational status at a glance’ boards assist day to day management of operating theatre staff and workload.

Performance indicators

Key performance indicators are developed by the staff working in the operating rooms (this must be a multi-disciplinary team).


  • Increased theatre utilisation
  • Improved staff satisfaction
  • Decreased adverse events
  • Improved teamwork and communication

Also known as

  • TPOT
Last updated: 27 July 2017