ARCHIVED - Conference Presentation
The following is a text version of the presentation given at the Conference on Timely Access To Health Care, held February 8-9, 2007 in Toronto, Ontario.
Lessons Learned: Saskatchewan Surgical Care Network
Presentation Outline
- Surgical Change Awareness Issues
- What Facilitated the Change?
- Surgical Access Strategies for Saskatchewan
- Wait List Strategy
- Pulling the Strategy Together
- SSCN Mandate
- Surgical Patient Registry
- Policy Considerations
- Surgical Patient Registry - Policy Considerations
- Surgeon's Perspective
- Wait List Strategies
- Lessons Learned
- Applying Lessons Learned-DI & Cancer
- Applying Lessons Learned
Presentation: Key Topics
- Getting Started
- Strategic Elements
- Considerations
- Lessons Learned
- Model Application
Surgical Change Awareness Issues
History
- There have been three significant reports released in Saskatchewan, all of which make recommendations regarding the surgical care system:
- The Commission on Medicare - Saskatchewan (2001)
- The Provincial Wait List Strategy Team (2002)
- The Action Plan for Saskatchewan Health Care (2001)
What Facilitated the Change?
- Provinces and territories all face challenges to improve access to surgical services times and resources for surgery.
- Increasing resources alone is not the solution. System processes and approaches require revision.
Surgical Access Strategies for Saskatchewan
- Strategy components included the following elements:
Wait List Strategy
Action Plan for Saskatchewan Health Care (2001)listed several priority initiatives, including the establishment of:
- The Saskatchewan Surgical Care Network (SSCN);
- A Surgical Patient Registry;
- A Clinical Prioritization Process & Target Time Frames for Surgery;
- A Waiting List Web Site; and
- Surgical Care Coordinators and Regional Contacts
- 3 Year Provincial Surgical Plan developed
Pulling the Strategy Together
- To oversee development and implementation of the initiatives, the Saskatchewan Surgical Care Network (SSCN) was established as an advisory body to Saskatchewan Health in March 2002.
- 15 members representing surgeons, Health Regions, regulatory bodies and Saskatchewan Health.
- Two subcommittees: Surgical Services and Registry Operations
- SSCN's vision is:
"Timely and appropriate surgical care for all Saskatchewan residents".
SSCN Mandate
- Surgical system planning and process improvements
- Target Time Frame development and management
- System information analysis and reporting
- Real time evaluation and monitoring outcomes
Surgical Patient Registry
Policy Considerations
- To achieve the initiatives outlined in The Action Plan for Saskatchewan Health Care it was necessary to allocate resources to:
- Establish the Network (SSCN)
- Expertise Needed-for development of assessment tools and Registry (e.g.) consultants
- Surgical Registry Office-To support day to day operations and address policy questions.
- Saskatchewan Health-Increased focus and support for initiatives.
- Regulatory support for the Registry was required. New regulations under The Regional Health Services Act were developed.
- The regulations identify the surgical related information that needed to be submitted by the Regional Health Authorities and prescribe the time frames for submitting this information to the Registry.
Surgical Patient Registry - Policy Considerations
- Throughout the development of the Registry, the SSCN was faced with many policy considerations. Some of the key policies include:
- All patients needing surgery must be added to the Registry.
- Patients will be entered on the Registry only once for a specific procedure.
- Patients who refuse dates for surgery on three occasions are referred back to their surgeon.
- Regions are accountable for wait list management and access to surgery.
Surgeon's Perspective
Key Points
- The effect of management on the waiting time
- The orthopedic issue
- Short term options
- Long term options
- What is achievable?
Wait List Strategies
- The goal is to have major joint replacement surgery performed with a maximum wait time of six months
- Identify
- Current status
- Short term options
- Long term options
- Orthopedic surgery, and in particular major joint surgery make up a significant part of our waiting list
- A portion of these patients have been waiting for more then 18 months for their surgery
- The waiting list in orthopedics is not equally divided among surgeons
- Short term
- Recruitment successes will even the waiting list among surgeons
- Better management of queues will decrease wait time but not increase capacity
- A targeted increase of OR capacity to those surgeons with the most patients will reduce the actual list
- Medium / Long term
- Redesigning the business processes will lead to a significant increase in throughput, but will take time to implement
Lessons Learned
- Managing surgical wait lists with accurate, comprehensive data along with newly established targets based on need, represents a significant shift in culture, responsibilities and business processes for the department, regions and surgeons.
- Leadership from Government, RHA's, and surgeon community.
- Communication of the Vision, Strategies, and Plan
- Commitment of resources and support by all stakeholders
- Effective organizational structure and communications system to facilitate change (e.g.) Minister's Forum, Leadership Council, SSCN, etc.
- Need for Information Technology involvement early in the initiative.
- Need to improve surgical access process and reduce system variations
- OR booking & scheduling
- OR allocation
- Challenge spreading change learning and information contained in the Registry
- Need for better communication system within the surgical community
- Need to educate physicians on better management of their waiting lists (e.g.) queuing theory and urgency management.
- Continuous learning of facilitating cultural change to new business process and management.
Applying Lessons Learned-DI & Cancer
- Conducted a Provincial Review for Diagnostic Imaging (04) and Cancer (05)
- Announced Diagnostic Imaging Network (January 05) and Oncology Collaborative (06)
- Established an DI Equipment data base
- Established a 4 year Strategic Plan
- Implementing a Provincial RIS/PAC's system
Applying Lessons Learned
- Have developed 4 levels for DI target time frames.
- Developing a multi-year capital equipment replacement plan
- Modeling demand and queue management.
- Developing a DI Web site for the public.
- Developing partnership agreements between Sask. Cancer Agency and RHA's.
- Integrated planning for Provincial cancer service delivery. (e.g.) oncology pharmacy services.
- Improving patient flow between Regions and SCA.
- Strengthening community oncology services.
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