The convention methods of approaching knee and hip replacement has been unable to meet the requirements for surgery, consequently leading to an increase in the number of patients who have been put on waiting lists for knee and hip replacement. This has led to an increase in backlogs which must be dealt with while accounting for increasing volumes. This has resulted from changes in demography such as aging and population growth.
The Alberta knee and Hip replacement Project aims to reduce the existing backlog while at the same time meeting the increasing need for knee and hip replacement surgeries. The project aims to increase the hospitals capacity through technologies and services which are cost effective and safe to both the patient and the hospital. The idea to implement the Alberta knee and hip replacement project has been charted with the endorsement of Patients, Alberta Bone and Joint Health Institute, Alberta Health and Wellness, health regions including David Thompson, Capita and Calgary and physicians in the province (Alberta Bone & Joint Health Institute, 2007).
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The video, ‘Finding a shortcut to better care’ starts with Sheila Reed from Calgary, a patient who had hip surgery three days previously; stating that she is walking around and feeling good. This opening statement reaffirms the hospitals initiative at finding quicker solutions to the provision of health care. The narrator indicates that finding a shortcut for better care is a team effort; where one facility has one case manager and one new pathway.
George Morley, a Knee replacement patient who had three surgeries previously from other hospitals states that the waiting time has been significantly reduced and has received a prompt response from doctors. He asserts that while previously he had waited for long periods between surgeries; this does not apply at Alberta Bone & Joint Health Institute, Calgary where he had to wait for only two weeks. The hospital has initiated a twenty million dollars pilot program aimed at realigning knee and hip replacement surgery. This pilot program is aimed at finding better methods of conducting surgeries while at the same time reducing backlogs.
Dr. CY Frank, the vice chairman of Alberta Bone & Joint Health Institute observes that the hospitals various functional systems were not operating harmoniously; therefore, in order to operate at optimal efficiency, there was a need to integrate the hospitals systems in the patient’s perspective. This aims at developing a patient oriented health facility; where he reiterates that the hospital aimed at making itself close to one stop shop as much as possible in the provision of qualitative health care.
The program intends to perform twelve hundred standard knee and hip replacement surgeries during the pilot phase. These work through predefined procedures; where an initial assessment is made by the treatment team comprising of a nurse who acts as the case manager, a physiotherapist and a surgeon. The treatment team works together in evaluating the optimal course of action. Subsequently, the case manager books all the essential appointments and ensures all preparations are in readiness for the surgery.
Meanwhile, the team incorporates the patients in their discussions; hence they are prepared for the surgery including possible outcomes of the surgery. The team sees the patients when they are admitted, during and after surgery to make sure no problems occur during this processes. Colleen Hann, RN who is the case manger addresses a patient’s problems while consulting the doctors on questions beyond her scope. This aspect extends to Maoliosa Donald who is the physiotherapist aiming at preparing patients both psychologically and physically for the possible outcomes of the surgery. In so doing, patients are more receptive of their treatment before, during and after the surgical procedures.
The success of the new pathway adopted by the hospital is attributed to a streamlined surgical process. This entails dedicated operating rooms, surgeons and surgical teams who only deal with knee and hip replacement surgeries. Dr. Jason Werle, an Orthopedic Surgeon, observes that a third more surgeries are done in the same operating room time because of increased efficiency and experience resulting from repetitive procedures. This creates safer outcomes while at the same time reducing instances of errors or the occurrence of complications.
These efficiencies have impacted patient waiting times significantly; where the average length of hospital stay has been reduced from 6.2 days to 4.3 days. Additionally, the average waiting time for surgical consults to surgery has been significantly reduced form 48 weeks to 4.7 weeks. Sheila Reed, a hip replacement patient, observes that the constant wear and tear of bad joints keeps worsening as the patient continues to wait. Therefore, the reduction in overall waiting is essential to easing the patient’s pain and discomfort. Dr. Jason Werle observes that they spend a significant amount of time counseling patients on long wait times in order to manage their condition; therefore, the reduced waiting time helps improved the qualitative aspects of their lives.
The pilot’s success is measured through an analysis of data on access, quality, safety, patient satisfaction and outcomes; which is captured in a central database. Dr. Frank asserts that, through data management, the hospital's management makes decisions based on the availability of good information. This prevents making decisions in a redundant and chaotic environment. Meanwhile, DR. Les Verteso of the Health Council of Canada affirms that among the activities of the council is attempting to get people to re-evaluate their approach towards business (Health Council of Canada, 2008). He observes that health care operates in treadmill mode where everyone is working extremely hard and fast. This has prevented health care providers from re-thinking their approach towards doing business. Dr Frank observes that it is more efficient to adopt a simple system; where case managers are assigned to manage patients than a complex system, where a patient is referred to various doctors for different diagnosis, recommendations and examinations. George Morley commends the hospitals efficiency and has consequently booked a second surgery after his final checkup in six weeks.
The adoption of case management system as practiced in Alberta Bone & Joint Health Institute pilot program is instrumental in the reduction of waiting times. This aims at prompt delivery of health care services; therefore, easing the patient’s discomfort, additionally, saving on time and resources spent in attending to a single patient.
Meanwhile, Alberta Bone & Joint Health Institute has designated twenty million dollars to the pilot program. However, the success of the pilot program will be a significant factor in determining whether the program will be fully adopted by the hospital and other health care providers. Additionally, the success of the pilot program will also determine the availability and allocation of funds to the program. These funds can be derived from the hospital’s budget, government grants and donations from individuals and institutions supporting the program.
Health information management is among the critical aspects of the Pilot program; therefore, the implementation of a centralized database is critical for the collection of data; which aids in decision making towards improving health care. Health Information management are essential since they provide an accurate representation of information regarding a patient’s health, response to health care and costs incurred in the provision of health care services. This is realized through the efficiency in data and information collection through management information systems such as the centralized Database. Therefore, these are significant in aiding the hospital's management in making decisions aimed at improving the patient’s health care. Consequently, team work has been a critical factor to the success of the pilot program (Alberta Bone & Joint Health Institute, 2007).
Teamwork has led to simplification of tasks and the provision of an inclusive treatment process, which reassures the patient and delivers qualitative health care (Holland & Hugate, 2012). The Health Council of Canada is one of the governmental organizations; that are of the view that the conduct of business in health care provision should be re-evaluated, to encompass patient oriented health care provision. The council is of the view that the adoption of new approached towards health care provision will solve considerable service delivery problems; associated with traditional approaches towards service delivery.
The net effect of the program is improved health care delivery to the community; therefore, reducing health care costs associated with in efficient health care services (Porter & Teisberg, 2006). Significantly, the implementation of the centralized database system is critical to health management professionals since they will be able to quantify the success of services offered. The availability of data is critical to health information management professionals; since the efficiency of the hospital systems will be evaluated against the efficiency of health information management. This determines the effectiveness of services provided and the costs incurred in implementing systematic structures and programs.
Alberta knee and hip replacement project is premised on delivering services in lieu of the best benchmarks; therefore, the project has conducted diagnosis, treatment and prevention based on the best information available. Consequently, decision making has been based on sound medical judgment and the best evidence at their disposal. In so doing, services are continually evaluated for quality while ensuring that value is created to the patients. Therefore, Patients and physicians have direct access to the surgeon’s they choose or the available surgeons. Meanwhile, constant interaction between participating partners made information readily available; therefore, enhancing the service delivery and patient outcomes.
These procedures led to a reduction in wait times, and hospital stays. Consequently, 85% of patients were able to stand and move about the day their surgeries were performed (NCBI, 2009). Additionally, patients reported less pain after undergoing surgery while their physical functions improved. Meanwhile, average surgery time reduced from 119 minutes to 109 minutes (Alberta Bone & Joint Health Institute, 2007). Significantly, operation costs reduced where there was a reduction of 15% in hospital costs and 2% in overall costs per case (Alberta Bone & Joint Health Institute, 2007). The patients in the new treatment method experienced a 28% improvement in their physical function in contrast to 23% in patients undergoing the conventional treatment. Therefore, there was a 34% improvement in pain for those patients under the new approach while those in the conventional treatment experienced a 29% improvement (Alberta Bone & Joint Health Institute, 2007). Additionally, patients under the new treatment method indicated a 21% improvement in their social function when compared to 17% indicated in patients under the conventional approach.
The Alberta Knee and Hip Replacement Project improved in effectiveness, efficiency, safety, acceptability and accessibility; therefore, the adoption of the methods employed is the optimal choice for health care providers. The 15% reduction in average hospital costs, led to 13 % increase in resources being allocated to the community (Hip Knee Scientific Report). As a result of the significant results realized after the adoption of the new methods, they initially adopted by the capital, David Thompson and Calgary regions; while the other six regions followed suit subsequently. Therefore all the cities in Alberta have adopted the new approach towards Hip and Knee replacement surgeries.