Enhancing Surgical Care in BC - British Columbia Medical Association

Recommendation 8
To aid the implementation of the provincial framework, the PSAC should establish an
implementation support unit to assist hospitals and the perioperative improvement teams.
The implementation unit can work with hospitals and community surgical facilities to assess
their surgical programs and develop action plans to improve their perioperative processes
based on best practices identified by the PIP.
Implementation support can take the form of one provincial unit, or smaller regional implementation units that would
work in coordination with the PSAC, regional surgical advisory councils, and existing support services and expertise
within individual health authorities. Implementation unit members should consist of clinical and administrative leaders
with significant experience in managing surgical services and resources, as well as experts in process improvement.
Implementation support should also include information technology and management assistance, and data analysis
expertise to help hospitals set up performance management reporting systems that will facilitate the collection and
analysis of perioperative performance information.
Consideration should also be given to initiating forums and conferences so that perioperative improvement champions and
perioperative improvement teams from individual hospitals have a venue to meet and discuss their perioperative quality
and efficiency issues, share best practices, and learn from each other about how best to improve surgical services.
The BC Patient Safety and Quality Council (BCPSQC) is initiating a Surgical Quality Action Network to facilitate provincial
collaboration and sharing of innovation and best practice in surgical quality in areas such as clinical care management (e.g.,
surgical checklist and surgical site infection), adoption of the National Surgical Quality Improvement Program (NSQIP), and
patient reported outcome measures. There is an opportunity to expand the scope of the Network to take on the role of
the implementation support unit as envisaged in this paper, in order to support both a quality and efficiency improvement
agenda.
VI. Information and Performance Measurement
Improving surgical quality and efficiency must be data-driven. In all of the major surgical improvement initiatives that
have been implemented, performance measurement has been a vital component. Collecting performance data on
surgical quality and efficiency can help organizations shift from managing by assumptions to managing on the basis
of demonstrated evidence. Measuring performance also allows implementers to determine if changes being made are
producing the intended results.
Ontario has implemented standardized OR performance indicators across all hospitals in the province, while several other
established surgical efficiency performance measurement programs are offered by private vendors (Mckesson; Sullivan
Healthcare Consulting Canada). Currently in BC, no standard measures of OR efficiency are collected consistently across all
hospitals. However, the Interior Health Authority has recently developed a suite of standardized OR efficiency performance
indicators (e.g., first case on-time start, turnover time, delays) that are being applied across all ORs within Interior Health.
The use of standardized efficiency indicators should be expanded across all hospitals in BC.
33 Enhancing Surgical Care in BC – Part 4: Best Practices, Lessons Learned, and Critical Success Factors