CASE STUDY: Improvements in the Obstetrics & Gynaecology Department at Hunter New England Health


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Todd McEwan, Director of Acute Networks & Brett Locker, Director Obstetrics & Gynaecology, from Hunter New England Health delivered this presentation at the 2012 Elective Surgery Redesign Conference. For more information about our wide range of medical and health events covering a broad range of industry issues, please visit

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CASE STUDY: Improvements in the Obstetrics & Gynaecology Department at Hunter New England Health

  1. 1. Collaboration, Culture and Outcome 11 am- 11: 40 Tuesday 13th November Todd McEwan Director Operations Acute Hospital Network Hunter New Englad Local Health District
  2. 2. Metaphor for Waiting List Management
  3. 3. It’s managements problem! • Waiting lists are an artificial political construct • I won’t recategorise • Just give me more time • You don’t listen too me I know whats right for my patients • It’s your problem because you wont resource us to the level the community expects
  4. 4. Managements issues • Medical autonomy is Dead • There is significant variation in what you and your colleagues do in managing your waiting list • I agree waiting lists are an artificaial political construct, but surely getting the patient done on time is in the patients interest • Don’t use the patient as a pawn • Excellence Every Patient Every Time
  5. 5. Gynaecology Services around Newcastle • JHH/ RNC: – 12 OT theatres – 1208 elective gynae cases – 439 emergency gynae cases – 1057 Obstetric Cases – AAAA Clinic Attendances • Belmont Hospital – 4 OT theatres – 600 elective gynae cases – 13 emergency gynae cases • Maitland Hospital – 4 OT theatres – 497 elective gynae cases – 144 emergency gynae cases – 684 Obstetric cases • Peripheral primary and community hospitals – Singleton, Cessnock etc – 220 elective gynae cases
  6. 6. Strategy
  7. 7. Challenges faced • Medical staff had fractional appointments • Consequently their work schedule was inflexible  Additional OT sessions and leave relief were difficult to schedule. • Imbalance between surgeons with OT capacity and surgeons with waiting list challenges • Although the majority of surgeons were agreeable to the idea of pooling patients it did not work in practice as the bureaucratic and practical barriers were insurmountable. • Wide division between gynaecology and gynaecology oncology service • Relationship between the neighbouring facilities
  8. 8. Risk Management
  9. 9. Collaboration • There were significant internal issues not readily apparent • The tangible a intangible issues had to be dealt with
  10. 10. Clinical and management changes implemented • Clinical Leadership Model • Change in surgeon staff profile • Enhanced flexibility • Close relationships with “satellite” facilities • Additional OT time • Administrative and booking staff support
  11. 11. Additional OT time • 20% increase in OT time since 2009 • Although the Department could not initially see how the additional OT time could be accommodated, it was initially absorbed by utilising VMOs who primarily worked in Obstetrics but were willing to accept elective patients from other AMO’s gynae lists. • As time has gone on and a number of specialists went part time and more specialists were employed the new surgeons accepted these lists
  12. 12. Additional OT time We have done approximately 40 hours of surgery a month more (approximately 10 sessions a month across BDH and JHH)
  13. 13. Not surprisingly, providing OT access alone was not the solution Discussion of the non-tangable and cultural aspects
  14. 14. All washed up!
  15. 15. Culture • Leadership drives change • Accountability delivers outcomes
  16. 16. The Clinical Leadership Model • Rather than just one Clinical Director and a Service Manager there is now a leadership team representing facility management, foetal medicine, gynaecology, obstetrics, gynaecology oncology, registrar training supervisor • Focused Accountability
  17. 17. Common Messages • Key messages from the leadership team are – Enthusiasm for working in the public sector – Acceptance that there will always be differences between the public and private sector – A commitment to finding professional satisfaction not just hip pocket satisfaction.
  18. 18. Change in staff profile • Staff specialist v VMO: it is not employment model but the cultural model that is important. • Introduction of Post Graduate Fellow: resulted in significant service provision improvements. Also able to provide training opportunities • Enthusiasm for the public sector.
  19. 19. Administrative and booking staff support • Waiting List Manager • Manager of Outpatient Clinics • Admissions staff • Theatre Manager • Administration and administrative staff within the department.
  20. 20. Flexibility • Incorporate increased flexibility into work patterns – Surgeons – Clinics – Administrative and waiting list staff – Patients • This has also required a realistic assessment of medico legal risk over such things as transferring care between clinicians.
  21. 21. Movement between sites Close relationship between facilities and surgeons allowed patients to be operated on at the clinically appropriate site which allowed the most rapid admission
  22. 22. So it’s a game of Chess?
  23. 23. What do the changes feel like on the ground? • Admission staff no longer fear the routine auditing of the gynae list as now when there are enquiries about waiting time, positive expectations and viable alternatives can be expressed. • There is a reported reduction in the number of patients ringing with enquiries (and greater reduction in disgruntled enquiries) • It can look like a headache for the waiting list, admissions, clinic and operating theatre staff
  24. 24. What do the changes feel like on the ground • The Surgeon’s perspective – “Feels like admissions aren’t always on your back about lists” – I’m not in McEwan’s Office every week, that’s better for me and him!
  25. 25. What have we achieved across BDH and JHH. • July 2009: 732 pts. On list an average of 142 days, • Jan 2011, 760 pts. On list an average of 192 days. • Sept 2012 702 pts On list an average of 113 days.
  26. 26. The referrals did not stop And our number of additions and removals remained reasonably aligned.
  27. 27. Composition of the Waiting List During this time, the relative contributions from each urgency category remained essentially unchanged
  28. 28. Common Goals / Accountability
  29. 29. • Manage the change over of post graduate fellow • Some surgeons with specific demand problems exist, but these are increasingly seen as a departmental problem requiring whole of department solutions • Potential introduction of a mechanism of creating a “free agent” surgeon. Challenges ahead still?