Department of Surgery. Quarterly Progress Report on Strategic Goals

Transcription

1 Department of Surgery Quarterly Progress Report on Strategic Goals

2 Strategic Priorities The Department of Surgery has three priorities that were set at a visioning session almost one year ago. These include: 1. The creation and implementation of a quality management system for the Department of Surgery. It was recommended that that the Department of Surgery adopt the American College of Surgery NSQIP program. 2. Adoption of a transparent physician resource allocation process. This would include both a physician recruitment and retirement process. 3. The Saskatchewan Surgical Initiative has been completed, with most of the backlog of patients waiting being completed. The strategic goal was to move from backlog reduction to flow mode, while maintaining a minimum of long waiting patients. Provincial / Regional Strategies The Saskatchewan Surgical Initiative has been completed, and the focus has now changed to Primary Care. At the same time, there has been a dramatic change in the economic climate, due to changes in resource funding both provincially and globally. This has resulted in dramatic changes in funding for healthcare, with the RQHR expected to find $38 M in funding cuts in the upcoming fiscal year. The goal has changed from one of growth, to one where contraction of services in order to meet a reduced target is the overall goal. This will clearly affect our strategic goals. We have been given clear direction that no new programs are to be considered. This precludes the RQHR from joining the NSQIP program. There is an opportunity to do a less formal program within our region, integrating with such programs as the Appropriateness Working Group, led by Dr. Kopriva and Dr. Groot. This has been presented to the Department, who feel that this work is essential, but should not be done off the side of a desk, but rather by someone with a quality focus. There are individuals who have an interest in this work, but there is an expectation of some funding to be set in place, and in this environment, this is unlikely to occur. The physician resources plan has been moving along well, particularly with the release of the Peachy Report. The Department of Surgery has proceeded with significant recruitment since the last report, with several members set to join in the upcoming months. The end of the Surgical Initiative coincides with most of our backlog reduction completion. Significant effort to identify needed resources has set new performance targets, and a change in wording, with the goal being around three months, rather than a hard target of three months. New allocation methodologies have been put in place to assure that those with incoming demand will be given OR time to deal with that demand. Work Since Last Update The implementation of a Quality Strategy has had little work since the last report. There continues to be very good data and analysis of performance metrics, with some work being done on individual surgeon performance management, but little work has occurred on the overall goal of the establishment of a Quality Program. There has been significant work on recruitment, with the release of the Peachy Report which will act as a guide for future recruitment. The department has been actively recruiting, with several members starting shortly. There are new members in multiple sections, having already started in some cases, with others starting shortly.

3 There has been significant work on allocation to meet incoming demand, with the allocation methodology matching supply and demand so that flow is achieved. Since the last report, Analysis Works has completed an allocation cycle. They continue with our ongoing demand based allocation, so that those surgeons/services that have increased demand end up with increased OR time. The down side of this process is that there is an incentive to develop a waitlist, as this will result in further OR time allocation. The surgical backlog has essentially been eradicated. There are a small number of cases in the hands of a small number of surgeons who did not meet the target. The goal now is to use the allocation put forth by Analysis Works to meet the incoming demand without developing a waiting list again. To do this, we are looking at a dynamic allocation process that would see ongoing changes on a rolling basis, where time from those surgeons who cannot fill their time is moved to those surgeons who are not meeting their allocation targets for a finite period of time. This process, although agreed to, has yet to be implemented. The first is to be done shortly, with changes being done once a month. What is working The concept of What is Working is both easy and difficult to answer. The Saskatchewan Surgical Initiative is now complete, and there was considerable success achieved in meeting the targets. With regard to the three targets, the receipt of the Peachy report is a welcome blueprint for the future. It outlines the needs of the department, and there have been recent successful recruitment efforts to meet the identified need. The targets put forward in the Peachy Report will remain our blueprint for future recruitment. The goal of transitioning from backlog reduction to one of Flow has received much attention at all levels. The Ministry has modelled the supply and demand, and linked with the financial situation, has provided funding for around 1000 cases less than last year with the expectation that we maintain flow of incoming demand. Appendix 1 presents an analysis of our current patients waiting, and identifies those surgeons who will have patients waiting more than three months, based on current OR time utilization patterns. The two columns that need attention are those labeled Slates and # Patients. This analysis looks at each surgeon, and the patients waiting. It removes time needed for urgent surgery, and looks at the remaining time that is used for the provision of surgery for elective surgery. It calculates if, for each surgeon, there is enough time allocated to meet the demand on that surgeons list. The Slates column is a measure that indicates whether that need will be met. A number greater than zero indicates that more time is needed for that surgeon if all demand currently on the waiting list is to be met within three months. Appendix 2 presents the same data, but sorted by service rather than by surgeon. As can be seen, each service has challenges, but also has individuals who have easily met the targets, and could potentially give up some time, and still meet targets. Figure 1 is a measure of waiting list growth for each surgeon in the region. A line in red, to the right, indicates that the slope of the waiting list over time is positive, meaning that the waiting list is growing. The longer the line, the faster the growth. A green line, to the left, indicates that the waiting list is decreasing, and again, the longer the line, the faster it is decreasing. Appendix 1 presents data around our current waiting list, while Figure 1 presents data to suggest those surgeons who are going to be problematic in the near future if that growth is not accounted for. On comparison to the last report, there are more surgeons with waiting lists that are growing, and as can be seen, the majority of surgeons have lists that are growing at this time.

4 Growth by Surgeon Hnenny, Luke Shawush, Mohamed Avram, Dan C Akinbiyi, Amos A Sivasundaram, Ramanan Redwan, Hani Arwini, Mohamed Tse, Edward T Fraser, James M Ogrady, Mark J Meiers, Suzanne Fritz, James R Pillay, Lenny Zwai, Akram Kopriva, David Thiel, John A Pooler, Stephen Briggs, M Judelson, Jeffrey Ekong, Christopher E Rodwan, Kahled Ledding, Kris Kurtz, Ingrid L Jones, Alan W Garcia, Raul Moustapha, Ahmad Abed, Mohammed M Buwembo, Joseph E Onasanya, O Patel, Satyam Jabs, Corrine F Eidsness, Ryan De Jager, Jacobus F Ghremida, S Kamencic, Huse Moyer, W L Aspe Lucero, Carlos Rattray, Darrien Tcherni, Marly Al-Hayki, Maryam Chowdhary, Zimran Kumar, Anil Carter, James W Chang, Peter S Lett, Christine Alshrif, Moustfha Coupal, Dustin J Tin, W Abuhjar, Abdussalam Kaban, Gord Cardoso, Reynaldo Poole, Angela Mccarville, Donald J Crichlow, Michael W Beggs, Alan Souf, Shawki A Brough, Michael L Suri, Ryan Butler, Matthew Cuddington, Gordon W White, K Mahmood, Tahir Knoblauch, Warren G Tsang, John C Jeena, Vinesh Wagner, Robert Avram, Darrell R Ailsby, Ronald L Korkola, S Chikukwa, Tineyi Reed, Jeremy Jacob, Sanjay Ong-Tone, Lindsay Mervitz, Michael D Varma, Renatta Lekic, C Yue, Christopher Regression Slope This represents the slope of the regression line for the active waiting list for each surgeon. In summary, it represents whether the waiting list is growing or shrinking. A value in red means that that surgeons waiting list is growing, while a value in green means that the list is decreasing. Figure 1: Waiting List Growth

5 Figure 2: Waiting List Growth by Service Figure 2 is a compilation of the individual surgeon data in Figure 1. It is obvious from this data that some services are growing rapidly, while others have rapidly decreasing waiting list demand. Realizing that the allocation is for an extended period of time, there is a need to account for this growth on a much more nimble basis if flow is to be achieved. Challenges Engagement Engagement is an issue throughout each of the major departments, with several of the smaller departments leading the way in achieving good scores. Having said that, there has been an improvement in engagement in the Department of Surgery in the recent past. There needs to be further work done here, with the members of the department developing a sense of ownership of their destiny that comes only with true engagement at all levels. Change fatigue The Department of Surgery, and the Section of Orthopedics in particular, have endured significant change in the last four years. Orthopedics in particular has received so much attention, with so many meetings, that the surgeons no longer attend all the meetings due to the volume of meetings. Leadership The Section of General Surgery is in the process of selecting a section head, with one individual applying for the position. The Section of Orthopedics is also recruiting, again, with one applicant. Recruitment has been ongoing in this area. The implementation of the DYAD model has yet to be completed, but plans to have this implemented early in 2016 have been put forward. Flow As outlined above, our current methodology of allocating OR time for extended periods will result in the creation of waiting lists. There is a need to become much more nimble in this allocation process if the elusive flow is to be achieved. Strategic Vision and implementation of that vision Now that the Surgical Initiative is over, there is a need to create a vision that everyone can work towards. The creation of that vision will give opportunity for increased engagement, as we work towards achieving that vision. Financial challenges The Ministry, by their own calculations, realizes that maintaining a strict three month target is going to be a challenge, based on projected availability of Surgical Resources. Having said that, flow can be achieved, such that all surgeons / services have the same performance, and work needs to be done to achieve that. Measures of Quality

6 Safety The Stop the Line is not yet completely implemented. The difficult decisions around those items that constitute a Stop the Line need to be created and the process confirmed. There is a reluctance to have a nurse calling a Stop the Line, only to have them face the consequences of that action. The implementation of the surgical check list is not yet complete. There continue to be individual surgeons who do not routinely employ this process, and work on this is ongoing. Effective Care The lack of quality measures makes it impossible to know if the care we are delivering is effective. The use of mortality and morbidity as the sole measure is not good enough to identify those measures of quality. There continues to significant effort to develop an appropriateness agenda. We look forward to working on this with the previously identified processes. The implementation of pooled referrals in orthopedics was done on a trial basis, with the end of the trial coming shortly. There continue to be concerns from the surgeons around this process. Family centered Care ly There is good data to suggest that there have been major improvements in the timeliness of care, but significant work needs to be done if this is to be sustained. Efficient The efficiency of care provided is not measured in a reliable way. The only concern here is the lack of buy in from the physicians for LEAN and it s benefits Equal Care Next Steps With new leadership at the program level, many of these challenges are being addressed. As we move out of the Surgical Initiative era, new strategic goals are being created and implemented. Each of the above challenges needs further discussion and prioritization, with effort to deal with each issue needing different support. Once a strategic vision is completed, the Department will be in a better position of identifying needed resources.

7 Surgeon Service # Patients Waiting # Minutes OR Scheduled Urgent Elective Remaining Slates Average Case Duration # Patients Remaining Prior Slates Variance Meiers, Suzanne General Surgery Ghremida, S Plastic Surgery Kumar, Anil Neurosurgery Zwai, Akram Neurosurgery De Jager, Jacobus F Orthopedics Pillay, Poogendren (Lenny) Otolaryngology Tse, Edward T Urology Souf, Shawki A Plastic Surgery Chikukwa, Tineyi Otolaryngology Hnenny, Luke Neurosurgery Yue, Christopher Dental Surgery Ledding, Kris Plastic Surgery Kaban, Gord General Surgery Mervitz, Michael D Ophthalmology Lekic, C Dental Surgery Brough, Michael L Dental Surgery Avram, Dan C Dental Surgery Sivasundaram, Ramanan Orthopedics Chowdhary, Zimran General Surgery Ekong, Christopher E Neurosurgery Tin, W General Surgery Korkola, S Cardiac Surgery Thiel, John A Gynecology Pooler, Stephen General Surgery Aspe Lucero, Carlos Gynecology Al-Hayki, Maryam Gynecology Wagner, Robert Dental Surgery Buwembo, Joseph E Neurosurgery Rodwan, Kahled Orthopedics Fraser, James M Orthopedics Shawush, Mohamed Orthopedics Alshrif, Moustfha Orthopedics Jones, Alan W Orthopedics Mahmood, Tahir Orthopedics Avram, Darrell R Ophthalmology Patel, Satyam Orthopedics Akinbiyi, Amos A Gynecology Eidsness, Ryan Ophthalmology Chang, Peter S Plastic Surgery Beggs, Alan Orthopedics Fritz, James R Otolaryngology Abed, Mohammed M Gynecology Rattray, Darrien Gynecology Judelson, Jeffrey Ophthalmology Onasanya, O Gynecology Jabs, Corrine F Gynecology Reed, Jeremy Orthopedics Ogrady, Mark J Otolaryngology Garcia, Raul Ophthalmology Cardoso, Reynaldo Gynecology Kurtz, Ingrid L General Surgery Carter, James W General Surgery Cuddington, Gordon W General Surgery Suri, Ryan General Surgery Coupal, Dustin J Ophthalmology Ailsby, Ronald L Orthopedics Kamencic, Huse Gynecology Crichlow, Michael W Urology Abuhjar, Abdussalam Urology Ong-Tone, Lindsay Ophthalmology Briggs, M Gynecology Varma, Renatta Ophthalmology Butler, Matthew General Surgery Tcherni, Marly General Surgery Lett, Christine Gynecology Jeena, Vinesh Pediatric Surgery Moyer, W L Dental Surgery Moustapha, Ahmad Cardiac Surgery Poole, Angela Gynecology Tsang, John C Cardiac Surgery Arwini, Mohamed Urology Redwan, Hani General Surgery Bhargava, Rashmi Gynecology Knoblauch, Warren G Dental Surgery Shepherd, Debra J Gynecology White, K Dental Surgery Haq, Mohammad M Oncology Kopriva, David Vascular Surgery

8 # Patients Waiting OR Scheduled Urgent Elective Remaining Slates Average Case Duration # Patients Remaining Prior Slates Surgeon Service # Minutes Cardiac Surgery Korkola, S Cardiac Surgery Moustapha, Ahmad Cardiac Surgery Tsang, John C Cardiac Surgery Dental Surgery Yue, Christopher Dental Surgery Lekic, C Dental Surgery Brough, Michael L Dental Surgery Avram, Dan C Dental Surgery Wagner, Robert Dental Surgery Moyer, W L Dental Surgery Knoblauch, Warren G Dental Surgery White, K Dental Surgery General Surgery Meiers, Suzanne General Surgery Kaban, Gord General Surgery Chowdhary, Zimran General Surgery Tin, W General Surgery Pooler, Stephen General Surgery Kurtz, Ingrid L General Surgery Carter, James W General Surgery Cuddington, Gordon W General Surgery Suri, Ryan General Surgery Butler, Matthew General Surgery Tcherni, Marly General Surgery Redwan, Hani General Surgery Gynecology Thiel, John A Gynecology Aspe Lucero, Carlos Gynecology Al-Hayki, Maryam Gynecology Akinbiyi, Amos A Gynecology Abed, Mohammed M Gynecology Rattray, Darrien Gynecology Onasanya, O Gynecology Jabs, Corrine F Gynecology Cardoso, Reynaldo Gynecology Kamencic, Huse Gynecology Briggs, M Gynecology Lett, Christine Gynecology Poole, Angela Gynecology Bhargava, Rashmi Gynecology Shepherd, Debra J Gynecology Neurosurgery Kumar, Anil Neurosurgery Zwai, Akram Neurosurgery Hnenny, Luke Neurosurgery Ekong, Christopher E Neurosurgery Buwembo, Joseph E Neurosurgery Oncology Haq, Mohammad M Oncology Ophthalmology Mervitz, Michael D Ophthalmology Avram, Darrell R Ophthalmology Eidsness, Ryan Ophthalmology Judelson, Jeffrey Ophthalmology Garcia, Raul Ophthalmology Coupal, Dustin J Ophthalmology Ong-Tone, Lindsay Ophthalmology Varma, Renatta Ophthalmology Orthopedics De Jager, Jacobus F Orthopedics Sivasundaram, Ramanan Orthopedics Rodwan, Kahled Orthopedics Fraser, James M Orthopedics Shawush, Mohamed Orthopedics Alshrif, Moustfha Orthopedics Jones, Alan W Orthopedics Mahmood, Tahir Orthopedics Patel, Satyam Orthopedics Beggs, Alan Orthopedics Reed, Jeremy Orthopedics Ailsby, Ronald L Orthopedics Otolaryngology Pillay, Poogendren (Lenny) Otolaryngology Chikukwa, Tineyi Otolaryngology Fritz, James R Otolaryngology Ogrady, Mark J Otolaryngology Pediatric General Surgery Jeena, Vinesh Pediatric Surgery Plastic Surgery Ghremida, S Plastic Surgery Souf, Shawki A Plastic Surgery Ledding, Kris Plastic Surgery Chang, Peter S Plastic Surgery Urology Tse, Edward T Urology Crichlow, Michael W Urology Abuhjar, Abdussalam Urology Arwini, Mohamed Urology Vascular Surgery Kopriva, David Vascular Surgery Variance