The recent publicity around bed shortages and elective surgery delays in Auckland and Dunedin Hospitals highlights the challenges for those managing in the health sector. There is nothing new about any of this and it's highly likely that all large public hospitals are having the same issues. Running a public hospital in the New Zealand Health Service has to be the ultimate ''hospital pass''.
All district health boards admitting acute surgical patients will have a good historical idea of the number of acute surgical admissions they can expect every day and the procedures they are likely to require. They report this data to the Ministry of Health so it should enable hospitals to allocate the required amount of acute surgical time to the predicted ''incoming'' flows.
Typically, this is done via the Master Surgical Schedule (MSS) a ''production planning'' document that allocates surgeons regular theatre time to complete procedures that are planned for. As a rule of thumb, the MSS should contain an allocation of acute theatre time to clear 80% of acute surgical bookings within 24 hours, and 100% in 48 hours.
The focus of surgical service performance is elective surgical volumes, but it is not generally realised that it is the smooth handling of acute surgical patients that is the key to achieving contracted elective service volumes.
Operationally it's ''Look after the Acutes and the Electives will take care of themselves''. It reflects the reality that if acute patients are not dealt with promptly, they await care in the inpatient wards, preventing the admission of elective patients - resulting in the postponement of their procedures that has been the subject of media comment.
The elective operating theatre time thus freed up becomes available to clear the acute backlog and free up the ''blocked'' beds. This enables the elective system to resume, or reset. The whole system is essentially ''self-managing'' with operational managers simply responding to the latest manifestation of the ''crisis''.
The recent public focus has been on bed availability, or lack thereof. The assumption is that patients occupying hospital beds are recuperating from a medical or surgical event, but they may be in a queue for an acute operating theatre, X-rays or some other investigation - perhaps waiting for a care plan, or discharge decision, at the next ward round.
Unfortunately, the management of surgical services in a public hospital is ''Book and Hope'' - tell a lot of patients to come to the hospital and hope the resources to treat them will be available. If not, send them away and repeat the process. Nobody - patients, funders and providers - is happy with this approach.
Moving to a ''Predict and Plan'' environment - in which the current capacity of the hospitals is known and matched with the requirements of incoming patients - has proved elusive and challenging. The clinical skill of the doctors, nurses and allied health professionals in New Zealand public hospitals are generally as good as you find anywhere in the world.
Unfortunately, the operational management of the public hospitals has not kept pace with the growing capability of clinical services. Correcting this requires an agreed understanding of the prevailing operational management paradigm, a commitment to service quality and investment in operational management techniques.
There are numerous examples of excellent operational management in other industries that can be adapted to healthcare. Until we do that, managing a public hospital will remain a ''hospital pass''.
-Rob Ebert is a specialist anaesthetist at Waikato Hospital.
