Improving the productivity of elective surgery through a new ‘package of care’

Ashton, Toni; Bramley, Dale; Armstrong, Delwyn

doi:10.1016/j.healthpol.2012.08.007

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…This can also be supported through identifying points where efficiencies are redistributed throughout the system [32]. It was proposed that focusing on productivity, savings, waste reduction and resource maximization together can promote efficiency and quality outcomes concurrently [34,47]. One study suggested that productivity is less frequently used as a measure of efficiency than other efficiency-related measures [37].…”

Section: Central Support and Leadership For System-wide Efficiency Im...mentioning

confidence: 99%

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Walters¹,

Sharma

Malica³

et al. 2022

BMC Health Serv Res

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Background Public health systems internationally are under pressure to meet increasing demand for healthcare in the context of increasing financial resource constraint. There is therefore a need to maximise health outcomes achieved with public healthcare expenditure. This paper aims to establish and synthesize the contemporary evidence base for approaches taken at a system management level to improve efficiency. Methods Rapid Evidence Assessment (REA) methodology was employed. A search strategy was developed and applied (PUBMED, MEDLINE) returning 5,377 unique titles. 172 full-text articles were screened to determine relevance with 82 publications included in the final review. Data regarding country, study design, key findings and approaches to efficiency improvement were extracted and a narrative synthesis produced. Publications covering health systems from developed countries were included. Results Identified study designs included policy reviews, qualitative reviews, mixed methods reviews, systematic reviews, literature reviews, retrospective analyses, scoping reviews, narrative papers, regression analyses and opinion papers. While findings revealed no comprehensive frameworks for system-wide efficiency improvement, a range of specific centrally led improvement approaches were identified. Elements associated with success in current approaches included dedicated central functions to drive system-wide efficiency improvement, managing efficiency in tandem with quality and value, and inclusive stakeholder engagement. Conclusions The requirement for public health systems to improve efficiency is likely to continue to increase. Reactive cost-cutting measures and short-term initiatives aimed only at reducing expenditure are unlikely to deliver sustainable efficiency improvement. By providing dedicated central system-wide efficiency improvement support, public health system management entities can deliver improved financial, health service and stakeholder outcomes.

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Section: Central Support and Leadership For System-wide Efficiency Im...mentioning

confidence: 99%

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Walters¹,

Sharma

Malica³

et al. 2022

BMC Health Serv Res

View full text Add to dashboard Cite

show abstract

“…This can also be supported through gaining an understanding of the points where efficiencies are redistributed throughout the system (31) . It has also been suggested that focusing on productivity, savings, waste reduction and resource maximization together when managing health services can promote efficiency and quality outcomes concurrently (32,33) . Of these measures it has been suggested that productivity is less frequently used than other performance and operational efficiency measures, making productivity an area where additional insight may be generated (34) .…”

Section: Central Support and Leadership For System-wide Efficiency Improvementmentioning

confidence: 99%

Supporting Efficiency Improvement in Public Health Systems: a Rapid Systematic Review of Current Evidence

Walters¹,

Harrison²,

Sharma³

et al. 2020

Preprint

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Rationale, aims and objectives Public health systems are under pressure to meet increasing demand for health care in environments of increasing financial resource constraint. There is therefore a need to maximise health outcomes given limited public healthcare expenditure. This paper aims to establish the extent of literature and approaches to efficiency improvement in public health systems of developed countries. Methods The Rapid Evidence Assessment model was used to address the review question. Two database searches returned a result of 3,526 unique titles, which were individually screened for potential relevance. 144 titles were selected for full review to determine relevance. 73 papers were included in the final review. Results Data on country, study design, key findings and links to efficiency improvement were extracted and synthesized. Synthesis of findings revealed that the literature on this topic is disparate and non-cohesive. A range of isolated approaches were described, and no evidence or consensus on a single best-practice approach to efficiency improvement was identified. Conclusions Combining the factors identified in this review has the potential to inform a framework for supporting efficiency improvement in public health systems. By considering these factors central health system management bodies can support efficiency improvement to deliver both financial and health services benefits.

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“…Cullen, Bramley, Armstrong, Butler, Rouse et al (2012) claim a new model of care for total hip and knee arthroscopies by Waitemata DHB significantly increased productivity and reduced overall costs for non-complex elective surgery. Waitemata DHB also introduced a new package of care, which included incentive-based, risk-sharing contracts, throughput targets, and the use of patient cohorts (Ashton, 2010;Ashton, Bramley, and Armstrong, 2012). According to Gorman and Horn (2012, p. 606) the key elements of process that underpinned Waitemata's success were a clinical champion to lead the programme, the recruitment of surgical teams from a "coalition of the willing", and the use of other core tactical measures, (such as operating at a new campus, and the exclusion of student doctors from surgical teams).…”

Section: Service Redesignmentioning

confidence: 99%

How a government strategy of active performance management has influenced District Health Boards' delivery of publicly funded elective services

Gower‐Rousseau¹

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<p>New Zealand, like most countries, is limited in the amount of publicly funded non-emergency (elective) medical and surgical services that it can provide to its population. In 2000, the ‘Reduced Waiting Times for Public Hospital Elective Services: Government Strategy’ outlined the systematic approach New Zealand would take with elective service waiting time management. The approach included the Government’s use of active performance management, namely, the setting of accountability and clear performance expectations; the ongoing monitoring, measurement, and reporting of performance; and the management of system change using facilitative networks. Since 2001, District Health Boards (DHBs) have been accountable for implementing government electives policy. The thesis examines how the Government’s strategic use of active performance management has influenced DHBs in their delivery of publicly funded elective services. In order to better understand and evaluate elective service delivery outcomes, (in particular that equity of service access has been achieved), and to evaluate the improvement of health service decision-making, there is a need to understand how decision-makers at the macro, meso, and micro levels of the health system are influenced by performance management practices. The research has examined influence from a multi-stakeholder and performance management system perspective. Methods include interviews with DHB and government stakeholders, review of Nationwide Service Framework and government policy documents, and the analysis of ten years of publicly available DHB performance reports to understand compliance patterns. The research narrative synthesised from study data is interpreted using a blend of neo-institutional meta-theories and institutional logics. The research found the government uses two performance models: an administrative control performance model which relies on information collection, control logic and performance feedback, and a professional services performance model which relies on the management of change using networks. Each DHB has established organisational practices in response to active performance management which are largely concerned with the promotion of DHB legitimacy. The influence of the two performance models and the interests of multiple DHB stakeholders is explained by considering the interplay between fifteen organisational practices, the government institutional logics of Active Performance Management and Service Improvement and the organisational field-level institutional logics of Population Health Management, Service Management, Medical Professional, and Integrated Care. Overall, the research concludes that ‘Active Performance Management’ has made a significant contribution reducing public hospital waiting times. It focuses the attention of DHB service managers who are concerned with mitigating risks of financial penalties and loss of leadership legitimacy. However, there are different ‘supply’ decision-making agendas and criteria operating at different levels of the health system. In particular, it is difficult to lock in appropriate accountability arrangements with primary care, and the strategic use of active performance management has led to tensions between DHB management and hospital specialists. If New Zealand wishes to expand its evaluation of health service delivery to take into account outcomes measures, there needs to be a better understanding of the aggregated impact of performance management practices on the health system.</p>

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Improving the productivity of elective surgery through a new ‘package of care’

Cited by 5 publications

References 9 publications

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Supporting efficiency improvement in public health systems: a rapid evidence synthesis

Supporting Efficiency Improvement in Public Health Systems: a Rapid Systematic Review of Current Evidence

How a government strategy of active performance management has influenced District Health Boards' delivery of publicly funded elective services

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