Another missive was received today. Our surgical wait list had 35 patients (out of a total waiting list of 1600) who had not been operated on within the recommended time. Unless this was dealt with, St Anywhere would have funding removed as a penalty.
This apparently is supposed to provoke the hospital to provide an even better service. Apparently, some bureaucrat thinks that by penalising overwhelmed institutions, morale will improve, efficiencies will develop and staff will be attracted to come and work in a marketplace with almost infinite options. Dictates and threats are the tools usually employed to bludgeon the change.
Surgical waiting lists are comprised of two elements. There is, of course, the list of patients seen, assessed and awaiting their planned surgery. This is often complicated by the unpredictable inconvenience of emergency cases that may require 20 minutes of operating time or 8–10 hours, leading to either cancellations of elective patients or unsafe working hours, neither particularly desirable.
The other hidden waiting list is the time it takes for a patient to be seen by the surgeon after they have been referred to the clinic or surgery by the general practitioner. Obviously, urgent cases are seen promptly. Less urgent presentations may take weeks, months or even years to be seen by the relevant surgeon.
One way St Anywhere could respond to the offensive and ill-considered missive received would be to see less patients in the surgical clinic. Currently, the wait time only starts the moment the patient is considered suitable for surgery. While the politicians and bureaucrats may like this definition, the real waiting time is from the moment the hospital receives the referral. This is what needs to be reported.
St Anywhere prides itself on trying to see all relevant referrals as soon as possible and places them on the waiting list if appropriate. One could imagine one hospital may have an extremely short waiting list for surgery and be showered with extra funds in recognition while another, anxious not to let referrals wait too long for assessment, could be overwhelmed by its diligence.
Government needs to measure appropriate care and appropriate waiting times from referral to first assessment and from referral to surgery or discharge. This means the true and meaningful waiting time that actually reflects how well patients are cared for and how well an organisation is performing.
Threaten them back by suggesting you could meet their criteria by cancelling the waiting list…
I saw my GP in Jan 06 for referral. I Saw the Neurosurgeon in February and was sent for MRI etc in March. I was in RNSH by Anzac day for essential surgery. It worked. I was able to survive the system but I’m sure others have not been so lucky.
You discreetly don’t mention how and why some waiting lists are organised. There’s a hidden assumption in much media reporting that everyone in the public health system has the right to equal access to services regardless. Aunty Mary derserves her hip operation regardless if the other foot is in the grave and an anaesthetic and major surgery are enough to push her into it.
DavidK obviously presented a clinical picture and window of opportunity which required swift(-ish) action, and that was pursued. But a large portion of surgical waiting lists comprise people who are poor candidates – frail elderly, those seriously ill with other conditions, or others with less chance of surviving long after major operations: the morbidly obese, heavy smokers, or people with other indicators of bad circulatory health.
There’s a public health advertising campaign we won’t see in a hurry: Keep fit or you won’t get that operation.