The given case study is on the rate of surgery cancellations in Australia that headlined the front page of Sydney Morning Herald on 28th February, 2011 that stated “Thousands Hit as Hospitals Cancel Surgery”. The report indicated that the number of cancellations for same day surgery was three times higher than the acceptable standards, as a result of which many patients who were expecting to go to the operating room were sent home after they had fasted in preparation of the surgery and their blood samples being sent to the lab. In some cases, the cancellation of surgery was due to the non availability of hospital beds for the patient for post surgical care (Wallace, 2011; McLaughlin et al., 2009).
The health ministry of Australia revised the minimum target for surgery can cancellations from 5% to an ‘aspiring’ goal of 2% or less (Gheysari et al., 2016). However, many hospitals are unable to achieve the new target of 2% or even the old target of 5% in some cases. Statistics from NSW department of health showed that the Key Surgical Performance Indicator (surgery cancellations) at State Level was less than 2% and 0.5% of cancellation was due to patient not showing up. According to the chairperson of Australian Medical Association, the problem was worse than indicated by the figure since the patients who wanted surgery but were not booked for surgery was not recorded in the data, thus suggesting the actual rate of cancellations was higher than indicated by the NSW data (Wallace, 2011; McLaughlin et al., 2009).
Additionally, it was also stated that even though 2% benchmark was rather ambitious considering the current scenario, it was still unacceptable to have cancellation rates that was two or three times higher than the benchmark and the decision to add 400 beds was not sufficient. According to deputy director-general of NSW Health, 40% to 45% of the cancellation was due to patient reasons and some cancellations was also due to the non availability of ICU beds and necessary supplies and equipments. However, most of the hospitals were able to meet the old target of 5% and few did achieve the 2% or less target. Moreover in six out of nine hospitals in NSW, the same day cancellation was about 4% amounting to 9000 cases which was typical of other Australian states, while 91% of the elective surgeries was completed on time (McLaughlin et al., 2009).
a. The title of the case “Australian Surgery Indicator Makes the Front Page” is somewhat ambiguous as it does not clarify whether it is a good or a bad news. However, the headline “Thousands Hit as Hospitals Cancel Surgery” shows how patents were affected by the cancellation rates for surgery.
b. The table showed that at the state level, the cancellation rates was less than 2% for booked patient cancellations and less than 1% for cancellations due to medical conditions. Also the average waiting times for general preadmission was 2 hours and for multidisciplinary admissions was 4 hours which was higher than the benchmark of 30 minutes to 2 hours. The table also showed that 0.5% of cancellations of surgery was due to patient not showing up (McLaughlin et al., 2009).
c. The avoidable cases of canceled surgeries in my opinion was mainly due to unavailability of ICU hospital beds for post surgical care or medical equipments/supplies on the part of the hospital as well as no show on the part of the patient. Indicators such as the number of cancellations due to unavailability of ICU beds or medical equipments/supplies and number of patients who wanted surgeries but never booked can help to get a better picture of the situation.
d. Biasness of the doctors as well as NSW health can be identified by the non inclusion of unbooked patient’s surgery cancellation rates as well as surgery cancellations due to the unavailability of ICU beds due to which the data does not depic the exact ground scenario. Moreover, the focus on surgery cancellations due to patient not showing up tends to divert the focus away from the failure of the healthcare organization to the perspective of medical reasons and patient’s fault, both of which are beyond the control of the healthcare organization (McLaughlin et al., 2009).
e. Even though increasing the benchmark for surgical cancellations to 2% or less would result in the increase of reporting of failures to the public, it can be highlighted that the 2% target is an ‘aspirational’ one intended to further stretch the previous and more realistic goal of 5%. It is would also be important to highlight to the public that by setting up the 2% benchmark will help to aspire better standards of care and prevent some of the avoidable cases of cancellations related to the unavailability of ICU beds or medical equipments/supplies for surgery (Kinnear et al., 2017). Additionally, keeping an aspirational benchmark would also put pressure on the healthcare organization to further improve its services which in turn can help to further improve the health and wellbeing of the people and thus would be beneficial to the public (Kyei et al., 2017).
f. In Australia, private and public hospitals provides overlapping services due to which patients have the choice of choosing whether they want to be treated in the private or public hospitals (Schadewaldt et al., 2016). The private and public hospitals moreover has overlapping roles in public healthcare that can allow patients to switch between public and private hospital care based on their condition as well as situations (Ward et al., 2015). The private hospitals provide the patients with more choice for care and the waiting times as well as cancellation for surgeries are usually less than public hospitals. However, the quality of care is usually better in public hospitals and costs of care are free as well as being more accessible then private hospitals. As a result the key performance indicators also vary between private and public hospitals thereby complicating the process of performance evaluation and improvement (Meyer, 2015). In NSW, the department of health regulates the private facilities and manages the public ones as a result of which it allows better assessment of the key performance indices across private and public hospitals as well as supports the overlapping services between the two. However, a weakness of such arrangement is that it challenges the process of comparing the performances between private and public hospitals due to their inherently different KPI values (Roehrich et al., 2014).
References:
Gheysari, E., Yousefi, H., Soleymani, H., & Mojdeh, S. (2016). Effect of six sigma program on the number of surgeries cancellation. Iranian journal of nursing and midwifery research, 21(2), 191.
Kinnear, N., Britten?Jones, P., Hennessey, D., Lin, D., Lituri, D., Prasannan, S., & Otto, G. (2017). Impact of an acute surgical unit on patient outcomes in South Australia. ANZ journal of surgery, 87(10), 825-829.
Kyei, M. Y., Mensah, J. E., Bray, L. D., Ashiagbor, F., & Toboh, J. A. A. B. (2017). Day of Surgery Cancellation in Urology at a Public Tertiary Hospital and a Private Specialist Hospital. Open Journal of Urology, 7(01), 22.
McLaughlin, C. P., Craig, D., & McLaughlin, M. J. (2009). Health policy analysis: An interdisciplinary approach. Jones & Bartlett Publishers.
Meyer, S. B. (2015). Investigations of trust in public and private healthcare in Australia: a qualitative study of patients with heart disease. Journal of Sociology, 51(2), 221-235.
Roehrich, J. K., Lewis, M. A., & George, G. (2014). Are public–private partnerships a healthy option? A systematic literature review. Social Science & Medicine, 113, 110-119.
Schadewaldt, V., McInnes, E., Hiller, J. E., & Gardner, A. (2016). Experiences of nurse practitioners and medical practitioners working in collaborative practice models in primary healthcare in Australia–a multiple case study using mixed methods. BMC family practice, 17(1), 99.
Wallace, N. (2011). Thousands hit as hospitals cancel surgery. Retrieved from https://www.smh.com.au/national/nsw/thousands-hit-as-hospitals-cancel-surgery-20110227-1ba0r.html
Ward, P. R., Rokkas, P., Cenko, C., Pulvirenti, M., Dean, N., Carney, S., … & Meyer, S. (2015). A qualitative study of patient (dis) trust in public and private hospitals: the importance of choice and pragmatic acceptance for trust considerations in South Australia. BMC health services research, 15(1), 297.
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