Royal College of Surgeons in Ireland Coláiste Ríoga na Máinleá in Éirinn

Theatre Quality Improvement Programme

The National Clinical Programme (NCP) in Surgery and National Clinical Programme in Anaesthesia previously ran a programme called The Productive Operating Theatre Programme (TPOT). A new programme has been launched as The Theatre Quality Improvement Programme (TQIP) which aims to improve patient outcomes and operating theatre performance.

It provides a systematic proven methodology Lean, to enable theatre teams transform the way they work to deliver significant improvements to quality of patient care, clinical outcomes and theatre utilisation.


The Programme commenced in Ireland in 2010 with the initial training of five pilot sites. The pilot theatres alone, delivered annual productivity savings of €3 million and inventory savings of €300,000. Today, there are 13 sites active within the Programme whose four main objectives are to continuously improve across four quality domains:

  • Patient experience and outcomes
  • Safety and reliability of care
  • Team performance and staff well being
  • Value and efficiency.

Benefits to you and your patients

  • Improve quality of patient care and clinical outcomes
    • Improved multi-disciplinary team communication
    • Increased awareness of potential issues that may impact patient safety
    • Improved scheduling and patient flow
    • Increased adherence to care bundles
  • Improve staff morale and multi-disciplinary teamwork
  • Empower staff to identify and resolve day to day issues
  • Achieve substantial gains in productivity and efficiency
    • Extra theatre sessions
    • Increased patient throughput
    • Reduction in cancellations
    • Improved turn-around time
  • Reduced errors, cancellations, avoid costs of harm through error
  • Improved scheduling and utilisation, stock control.

Rebrand to TQIP

2016 saw a TPOT focus site project in collaboration with University Hospital Waterford (UHW) (PDF, 300KB), which began in January 2016 and was completed in October 2016.

Following this, RCSI’s Quality & Process and Improvement Centre (QPIC) was launched, and the TPOT programme became part of their remit as the TQIP. The TQIP approach includes on-site QI training facilitation and certification, MDT team involvement, appointment of a dedicated project lead, perioperative governance, standardised KPIs, a Memorandum of Understanding and review by senior management following the project.

Theatre Quality Improvement Programme (TQIP) 2017 -

While much success was achieved one of the challenges and lesson learned from the TPOT programme experience was that sites found it difficult to embark on the improvement journey without Improvement facilitation. In 2017 the HSE, NCPS and NCPA collaborated with RCSI's Quality and Process Improvement Centre (QPIC) to deliver a Quality and Process Improvement programme where onsite facilitation and coaching was central component. The programme is currently piloting in 2 sites and further sites will be invited to participate in 2018.

The TQIP approach includes on-site QI training facilitation and certification, MDT team involvement, appointment of a dedicated project lead, perioperative governance and standardised KPIs.

TQIP focus areas in the perioperative journey

Pre-Operative Intra-Operative Post-Operative

Demand and capacity planning

  • Scheduling
  • Protected beds
  • Elective day and inpatient pathway

Theatre utilisation and list planning

  • Patient transfer
  • Session on-time start
  • Elective day and inpatient pathway
  • Session on-time start
  • Anaesthetic start time
  • Surgery start time
  • Turnaround time
  • Intraoperative interval
  • Session finish time
  • List overruns
  • Inventory management
  • 5S

Post-operative pathway

  • Handover
  • Recovery: Delayed admissions
  • Recovery: Delayed discharges
  • Post-operative bed management


  • Pre-admission assessment
  • Discharge planning

Surgical safety checklist

  • Briefing/de-briefing

Enhanced recovery

Enhanced recovery

  • Patient preparation

Visual management


  • Discharge planning
  • Visual management
  • Visual management