Health Minister Dr James Reilly has welcomed an unpublished report that shows the three Dublin children's hospitals are significantly under-using their operating theatres.
It also shows that the shortfall is not due to a lack of money or staff.
The Health Service Executive review also said that wide-ranging reforms in the planning and management of operations at Temple Street, Our Lady's Children's Hospital in Crumlin and Tallaght Hospital would reduce waiting lists for children.
Speaking on RTÉ's News At One, Dr Reilly said it would be advisable to learn lessons about what is not working, before the move to a single paediatric hospital.
He said the wider adult health service would also have to be accountable.
Minister Reilly also warned that there will be consequences for anyone resisting change in the health service in the current times of austerity in public spending.
The report says that Temple Street is under-using theatre time by 28%, Our Lady's Children's Hospital in Crumlin by 28% and Tallaght by 17%.
The 207-page report, seen by RTÉ News, found it was not uncommon for theatre sessions to start late, start early, finish late or finish early.
It says that there is a significant shortfall in operations that could be performed, which is not generally due to a lack of resources or staffing.
However, a medical spokesperson for the three childrens’ hospital in Dublin has said that the number of operations has increased by 12% in the last year.
Dr Colm Costigan said that when the review was conducted over a week in 2009 hospitals were battling with the winter vomiting bug and had to close beds.
The review by Meridian Productivity was completed last year in advance of the building of the new national children's hospital, which will bring all three facilities onto the one site.
None of the hospitals had a dedicated emergency theatre and as a result, emergency cases were put into slots for planned operations, which affected waiting lists.
Latest figures show that the waiting lists for planned operations for children at the hospitals are: Crumlin 422 patients, Temple Street 66 patients and Tallaght 42 patients.
Some children are waiting over two years for an operation.
The report found that no hospital systematically operated a manual or computerised theatre management system.
Hospitals used 'block booking' theatre allocation to a fixed surgeon and speciality, so that if the operation did not happen on time, the operating slot was lost forever, never to be recouped.
No departmental budgets or forecasts were being used to plan the use of resources.
