Enhancing Surgical Care in BC - British Columbia Medical Association


Enhancing Surgical Care in BC - British Columbia Medical Association

Establish Provincial Implementation Support

The PSAC should establish a provincial implementation support unit that will work with each of the

approximately 40 hospital surgical programs, as well as community surgical facilities in the province. The

implementation unit will work collaboratively with the local perioperative improvement teams in each hospital

to compare the practices and processes outlined in the framework with those of each facility and jointly develop

an action plan. The implementation support unit will also note new processes or ideas used in individual

hospitals that could be spread provincially. This body will subsequently review the experience and progress of

each facility at an agreed-upon time.

Measure Performance

The PIP must develop standardized quality and efficiency performance indicators that will measure the effect

of process improvement provincially. Perioperative performance indicators (e.g., turnover times between

cases) will need to be measured before and after an improvement cycle, and will guide the local perioperative

improvement teams as well as inform the implementation support unit and the PSAC. Indirect measurement

of the local OR processes will also be encouraged by feedback from outcome measures such as the American

College of Surgeon’s National Surgical Quality Improvement Program (NSQIP) or from patient-reported outcomemeasurement

scores (PROMs).

Involve Patients

As recipients of surgical care, surgical patients must be included in perioperative performance improvement.

Patient representation will be included in relevant venues (e.g., the Process Improvement Panel, health authority


Maximize Utilization of Resources

To maximize OR capacity in the province, a review of each health authority’s policy concerning extended

holiday and summer closures of ORs should be conducted to recapture unused OR time. This may be achievable

by agreement of local perioperative personnel and through activity-based funding supported by the Health

Services Purchasing Organization.

This initiative will require initial funding to support implementation. However, based on the experiences, best practices,

and lessons learned from other jurisdictions, the initial investment required to support process improvement in BC

hospitals can create dividends by improving quality and efficiency, decreasing cost, improving the experience and

outcome of surgical patients, and enhancing staff satisfaction.

Enhancing Surgical Care in BC – Executive Summary 2

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