Surgery systems need to be better

00:58, Aug 29 2014
Chris Fleming
Nelson Marlborough District Health Board chief Chris Fleming.

Nelson Marlborough District Health Board is in total support of the skill and commitment of our surgical team.

It is regrettable that the message of  Wednesday's front page article in the Nelson Mail intimated that the key reason we are struggling to meet our elective discharges for our community was because of surgeon shortcomings. What in fact is the key challenge is to fix the systems that underpin our elective (planned) surgery.

Surgeons will be crucial in helping us improve our surgical systems and were not the cause of failure. As chief executive, I would like to apologise for any offence that our valued surgical team may have taken from the report.

The board continues to deliver one of the highest rates of elective surgery for the people of our community. We exceeded our health target in 2013/14. However, last month we struggled to meet the monthly target for elective surgical procedures; not because of the commitment or skill of our surgical team, but primarily because of underlying system issues that we need to fix.

The board meeting on Tuesday heard how the under-delivery of elective surgery during July 2014 was due to the same systemic problems that plagued elective surgery late in 2013.

For instance, we don't have a computerised theatre management system to help us both plan and monitor our surgical throughput. Our bookings systems are inadequate and do not allow us visibility of what is booked and the anticipated length of the procedures for a theatre list. All monitoring and planning is based on time consuming manual collating of information.


A key system issue that we need to tackle with the increasing demands for acute and elective surgery is how we can better organise the delivery of acute or emergency surgery without impacting on elective surgery. Too many elective patients are being cancelled on the day of surgery to accommodate the more pressing acute or emergency surgical demands. This results in major disruption to patients' lives and more work to rebook patients.

Another concern is that many bookings are being done very close to the surgery date, for example there are still people who will be getting elective surgery next week who have not yet been booked or advised of this. This again causes undue stress and disruption to patients and their families and at times means we waste precious theatre time where insufficient numbers of patients are booked.

An added tension is that to meet our targets last year many of the short, less-complex, elective surgery on the waiting lists were completed, and as a consequence we do not necessarily have the mix of patients to allow effective utilisation of our theatre time, which means that at times there is enough space on a list to do additional patients but no short procedures waiting for the specific specialty.

As with any system there are many variables, and many opportunities to improve the way we work. Our issue is not the dedication and commitment of our staff, but rather the way we are organised to deliver what our community asks of us.

There is opportunity everywhere to improve - but most importantly at this time we need to fix some of the underlying system issues, and ensure we have more robust processes, less variation in practice, and the resources to support our clinical teams.

We are very fortunate in this district to have the team of surgeons we do, and they, with our other frontline clinical staff, do a wonderful job of delivering both acute and elective surgery. Together we are committed to delivering the best possible surgery that is needed for patients in a timely fashion - that doesn't see patients wait unduly, and provides the best clinical outcomes we can for people.

Delivering to targets are not easy in the complexities of wider health care requirements. For instance, our surgical teams are daily making decisions around clinical priority and urgency. There is the daily need to deliver acute/emergency surgical procedures.

Every day our consultants are balancing the clinical needs of one patient over another in terms of when elective surgery is most appropriate.

In the midst of this there are the real challenges of ensuring we have the bed capacity and theatre resources to ensure we can support both the medical and surgical needs of our community. Hospitals are complex places and to deliver the best care we need good people, but also good systems.

It is important that the wider community realise that all involved in the delivery of elective surgery are committed to doing the best we can for our community. As an organisation we have openly acknowledged there are a number of improvements to make, but it would be totally inappropriate to single any staff group out as the reason for the challenges we currently face.

■ Chris Fleming is the chief executive officer at the Nelson Marlborough District Health Board.

The Mail story clearly outlined that the criticism of surgeons - from a senior board manager at a public meeting - was cited as a contributing factor to elective surgery struggles, not a "key reason". - Editor

The Nelson Mail