Surgeons cop backlog fire

00:36, Aug 27 2014

Surgeons taking unplanned leave or prioritising who to operate on are contributing to elective surgery backlogs, says a health board manager.

Nelson Marlborough District Health Board clinical services general manager Peter Bramley also raised the case of one surgeon who picked patients to operate on depending on his ability to follow up with them afterwards.

His criticism of surgeons came at a board meeting yesterday as it discussed another dip in its elective surgery performance.

Bramley described the backslide as "somewhat bad and disturbing news". He said until early this month, management had thought they were 21 discharges ahead of the Government's health target last month, but it turned out that they had been counting the discharges incorrectly. The board ended the month 20 discharges behind target.

"The practical reality is that we failed to count properly during our delivery," Bramley said. "There's been lots of slippage everywhere."

Chief executive Chris Fleming said staff were aware last month that this month was going to be tight, but they were reassured by what appeared at the time to be positive results. Bramley said the board now anticipated it would finish August with 77 discharges behind target.


In response to a question from board member Gerald Hope, he said he was concerned that the tardiness could become a recurring problem. He said the problems which kept cropping up around elective surgeries were to do with complex and long-standing issues which were not being tackled.

"We lurch from succeeding to slipping behind and succeeding to slipping behind, and we've got to fix some of this stuff under the hood."

As well as the counting mistake, Bramley said the elective targets had been affected by the board's push to reach its end-of-year quota at the end of the last financial year. This had "scooped up" all the surgeries which could be quickly completed, leaving only long and complex cases which could take whole days or surgical lists to complete.

Among other problems Bramley identified were: a shortage of anaesthetists; high pressure on the clerical team leading to a high staff turnover; manual systems subject to error; monitoring and control reduced; and a high acute workload. This workload meant that high numbers of acute presentations coupled with high occupancy impacted on theatre availability, and some elective surgeries had been cancelled due to lack of beds.

Every day last week, Bramley said, Nelson Hospital was at more than 100 per cent capacity.

"When you're living on the margins everywhere, it's amazing how a few things combining can expose us."

Bramley criticised long-standing behaviour from surgeons, describing one who picked patients to operate on depending on his ability to follow up with them afterwards - and the weather. He read out an email from another who argued passionately for their right to prioritise acute patients.

"A lot of this is driven by personal clinical decisions of their own world without considering the ramifications across the rest of the system."

He said management was also getting caught out by surgeons who took unplanned leave by saying things like, "Oh, I'm not going to be here [tomorrow]."

The Nelson Mail sought comment from the NZ Association of General Surgeons but was unable to get a response this morning.

Bramley said management planned to get back on track with its elective surgery quota by the end of next month.

To achieve this, Bramley said he needed an improved booking system and alignment to production plan; surgeon engagement and agreement to let them book visits from further out; and fast-tracked IT enablers so that management had full visibility of how the surgeries were tracking. Consultant Helen Telford has been engaged to help.

If all worked out, he said, the board should end up ahead by 34 discharges by then.

The Nelson Mail