Field note · 2025-11-04
Utilisation figures that count a consulting room as busy whenever a clinic is booked on the estate system miss the hours when the clinician is in theatre, on leave, or covering another site.
Outpatient groups inherit rooms from older buildings. A four-room suite looks like capacity. On a Tuesday it may hold one list because the second consultant is operating, the third room is used for dressings, and the fourth is a fire-exit store in all but name.
Estate systems book the room. Rotas book the person. The two diaries are often maintained by different offices. We have sat in meetings where a director asked why rooms were ‘only 60% used’ while the nursing team was running a full list in the one room that had a working couch and a computer that could print.
A usable chart for this problem is a simple grid: hours the room was physically available, hours a clinician was rostered, hours a patient was in the chair. The gaps between those three rows are where groups leak time. Filling the room with a different specialty for a half-day is a management decision, not a charting trick, and it needs the list lead in the room when it is discussed.
Teaching lists complicate the picture. A registrar seeing patients with a consultant in the same room will look inefficient on a per-room measure and may be the only way the group trains. Those lists should be labelled, not averaged away.
If you only take one extract from the estate system, take the cancellations of room bookings as well as the bookings. Ghost clinics — rooms reserved and never used — are common after a consultant’s job plan changes and nobody tells facilities.