Elective Surgery Success

“We tend to overestimate what can be achieved in one year, and vastly underestimate what can be achieved in five years.” Thanks to John who shared this thought-provoking quote, from Po Bronson’s book What Should I Do With My Life, on my blog last week. As John commented, it’s easy to get discouraged by the size of the challenges and the time it takes to effect change, but results are there when we look for them (even if there isn’t always a quick-fix).

This is particularly true of Counties Manukau Health and the journey we’re on to become the best healthcare provider in Australasia by 2015. There are certainly results happening as we steadily progress towards this goal. Nowhere is this clearer than at the Manukau Surgery Centre, where our elective surgery continues to go from strength to strength. Today I’m joined by Andrew Connolly, our Head of General Surgery, to blog about the extraordinary success of our elective surgery service at MSC and the plans to progress this as part of the Manukau Health Park.

A defining characteristic of our elective surgery service is the efficiency with which we provide high quality care to our patients. We have increased elective throughput by well over 70% over the last six years, and we do about 90% of the country’s publicly-funded bariatric surgery. We’ve also managed to keep waiting lists down, with all areas meeting at least a six month waiting time and General Surgery down to five months. That’s the equivalent of our Emergency Department meeting its six hour target and a fantastic reflection on the work ethic and dedication of Team Counties.

At the same time as we’re doing more surgery, we’ve also found ways to increase the quality of our work. An example of this is Enhanced Recovery After Surgery (ERAS) – a package of care that starts from the time a patient gets onto a waiting list and continues until they return home post-surgery. ERAS maximises a patient’s ability to get better through at least 20 components such as: involving patients in pre-operative education and a visit to the ward, getting the patient out of bed and eating soon after surgery, changing the required preparation for surgery and aiming to remove all tubes from a patient within 48 hours of their operation. It’s a nurse-led approach which has substantially improved the recovery of patients at MSC. To put it simply, they get better quicker, go home sooner and come back less often. As the first DHB to implement ERAS, CM Health is now the national lead for this initiative which has recently been rolled out to several other DHBs across New Zealand.

Our elective surgery service is not just gaining national attraction, however. Thanks to Andrew Hill, one of the most productive clinical researchers in General Surgery worldwide, we’re also producing some incredible research which is gaining international acclaim. At a recent European meeting, Professor Henrik Kehlet, a world-leading authority on Enhanced Recovered from Copenhagen University, lauded the research coming out of CM Health as world-class. This is a massive accolade and demonstrates how MSC has become both a great foundation to care for our community and an incredibly efficient model for other hospitals.

Inevitably, such a high-performing service also attracts and retains some of the very best up and coming talent. Trainees are hugely attracted by the high-quality research being produced at CM Health (at last count, Andrew Hill had generated four PhDs) and the chance to be fundamentally involved at the front line. They get opportunities to be trained in elective surgery at a dedicated, stand-alone facility. This is key to our objective of achieving a balance between excellence and sustainability. We need excellent clinicians to treat our patients today, but their families are also going to require excellent clinicians tomorrow and into the future.

Our next step is to increase theatre capacity and offer better diagnostic support at MSC with the development of the Manukau Health Park. There are also linkages for elective surgery with the 20,000 Days campaign and with Localities, which will break down barriers with primary care and potentially reduce clinical demand on secondary services in areas like chronic disease management. They’re exciting steps which will help progress our journey towards becoming the best healthcare system in Australasia by 2015.

Another example of the progress we are making in this direction featured on One News this week. If you haven’t seen it, check out this fantastic story about our success with childhood immunizations in Counties Manukau. It’s a great example of the excellent care we are delivering. On a totally different note, I received an email from Dr Harry Pert, the President of the Royal New Zealand College of General Practitioners, this week recommending Ben Goldacre’s Bad Pharma as an addition to the reading list I shared a few weeks ago. Apparently it’s well worth a read. 

Chairperson of CMDHB, Professor Gregor Coster, competing at the World Championship Triathlon

And finally, warm congratulations to our Board chairperson, Professor Gregor Coster, on his outstanding result in the recent World Championship Triathlon held in Auckland. He was the 5th Kiwi to finish in his age group and achieved a 17th world title ranking. Magnificent stuff!

Geraint and Andrew

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Author: Geraint Martin

Geraint Martin was appointed Chief Executive Officer of Counties Manukau DHB in December 2006. It is one of the largest District Health Boards in New Zealand and services a population of half a million. He has significant experience over 30 years in national policy & in managing both primary and secondary care . Previously, he was Director of Health and Social Care Strategy at the Welsh Government .He authored a radical 10 year strategy of reform, including the successful “Saving 1000 lives” Campaign.Until 2004, he was CEO at Kettering General Hospital & had held senior positions in London & Birmingham.He has worked closely with clinicians in improving clinical standards,patient safety,chronic disease management & managing acute care to reduce hospital demand.In NZ, He has promoted clinical quality and leadership as central to improving patientcare. This has led to a significant increases in productivity and access, whilst maintaining financial balance. CMH has completed in 2014 a $500 m capital redevelopment programme, the largest in New Zealand. A central part of this is the establishment of Ko Awatea,the Centre for Innovation and Research which will underpin CMH as one of the the leading health systems in Australasia.In 2008, he chaired the Ministerial Review of Emergency Care in New Zealand, and in 2013 was an member of the Expert Advisory Panel on Health Sector Performance. Geraint has an MSc in Health Policy from Birmingham University .His post-graduate work has focused on health economics and Corporate Strategy . He is adjunct Professor of Healthcare Management at AUT and Victoria University, Wellington Elected in 2006 as a Companion of the Institute of Healthcare Management, previously he was an Associate Fellow at Birmingham University.He is is Chair of the Auckland Philharmonia Orchestra, a member of the Institute of Directors, on the Board of the NZ Institute of Health Management & previously the Board of The NZ Health Quality and Safety Commission.

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