Enhancing Surgical Care in BC - British Columbia Medical Association

Part 3: Process Improvement Initiatives in Other
Jurisdictions
While many individual hospitals, particularly those in the United States, have implemented
perioperative process improvement initiatives, only a few jurisdictions have attempted to take a more
comprehensive and coordinated approach by implementing such initiatives in multiple hospitals
across a particular region or country. Experiences from these jurisdictions, which include Australia, the
United Kingdom, and parts of Canada, provide insight into how a coordinated perioperative process
improvement initiative can be successfully implemented in British Columbia.
I. The Experience of Other Jurisdictions
Australia
In 1994 the Australian Department of Health and Family Services established the National Demonstration Hospitals
Program (NDHP), which focused on improving patient pre-admission and admission processes, operating suite
management, and discharge planning and post-acute care (Alexander, 2000; Australian Department of Health and
Family Services, 1997).
Under the NDHP, 38 public hospitals were grouped into seven consortia, and major metropolitan hospitals with
experience and expertise in developing best practice models were identified to lead each. The process to develop and
use best practice models involved multiple stakeholders, including patients, clinical staff, hospital executives, consumer
groups, professional bodies, and funding agencies. The lead hospitals then worked with and supported the other
hospitals within their consortium group to transfer the use of best practice service delivery models.
The key steps of the NDHP included a needs analysis of existing services, collection of data and performance indicators,
implementation of best practice models, and consolidation/continuation of the new models of service delivery. At
the end of the NDHP initiative an external performance evaluation was conducted. The following are some of the key
outcomes:
• Average hospital stays reduced 6% overall, and by more than 10% in 23% of hospitals.
• Unplanned readmissions within a month of discharge reduced by nearly 27%.
• Operating room utilization improved 3.1% for hospitals reporting the measure. More than 50% of hospitals
achieved utilization greater than 90%.
• Cancellations on the day of surgery reduced by 20% in 28% of NDHP hospitals.
• Estimated net savings from all hospitals participating in the initiative between $51.5 million and $72 million
per year. According to the review, the savings are substantial against the input of $11 million used to fund the
program.
21 Enhancing Surgical Care in BC – Part 3: Process Improvement Initiatives in Other Jurisdictions