Clinician Connect

Taking a value-based approach to surgical care

By Dr Jean-Frédéric Levesque, Chief Executive, Agency for Clinical Innovation

26 Apr 2022 Reading time approximately

Dr Jean-Frédéric Levesque reflects on the importance of aligning surgery in NSW with patients’ needs; and how the Agency for Clinical Innovation is working with clinicians and key partners to drive initiatives that deliver better value surgical care.

While COVID-19 continues to challenge us all, it now also presents us with opportunities to develop new ways of responding to the challenges and circumstances around us. For the health system, this has given clinicians and health services an opportunity to review how we have been operating; and identify if there are opportunities to improve and add value for patients and to the health system.

Many health services have been impacted by COVID-19; in particular, elective surgery, which was halted or slowed as the system prioritised the pandemic response. As the system now addresses the backlog, we must ensure that surgery in NSW is aligned with patients’ needs. For example:

  • Is there an opportunity for patients to benefit from care that will optimise their health while they wait for surgery?
  • Can we avoid surgery altogether for some patients?
  • Can we deliver surgery in a way that enables more patients to access care?

These questions relate to the essence of value-based surgical care.

Optimising access to elective surgery

The Agency for Clinical Innovation (ACI) is working closely with expert clinicians to drive key projects and initiatives that deliver better value surgical care.

Our Surgical Services Taskforce (SST) brings together clinicians and health managers to collaborate with the Ministry of Health and key stakeholders on progressing new approaches to surgical care.

The SST drives the delivery of key initiatives in the NSW Health Elective Surgery Action Plan that are supporting the health system to optimise access to elective surgery for patients across NSW Health. Some of our work that supports the Action Plan includes:

  • implementing the Extended Day Only model of care
  • disseminating evidence-based clinical advice on the key principles for clinicians implementing same-day hip and knee joint replacement surgery
  • delivering a first-of-its-kind toolkit for clinicians caring for patients with breast implants, or considering breast implants
  • developing key principles to enhance recovery after surgery, based on evidence-based interventions during the pre-, peri- and post-operative phase (currently out for consultation)
  • encouraging local use of the Operating Theatre Efficiency Guidelines.

You can read more about the SST from the Chair, Professor Arthur Richardson, in our feature story.

Addressing low value care

Recently, the ACI has partnered with the Royal Australian College of Surgeons (RACS) to deliver a webinar series to inform and collaborate with surgeons. The aim is to mobilise surgeons across NSW to progress different surgical reforms.

Together with my colleagues from the ACI and the NSW surgical field, we recently presented to the RACS community about how we can truly begin to address a value-based surgical care approach in NSW.

Value-driven care is not just about cost reduction. It considers the health experiences and outcomes for patients, as well as the sustainable use of healthcare resources.

Value can be enhanced at various stages of the care pathway, from diagnosis to care delivery and follow-up. As such, the assessment of low and high value care should include a whole-of-system assessment of the patient’s journey, ensuring that the right care is provided in the right way using the right resources.

Across NSW (and Australia), we have highly skilled surgeons who have the ability be drivers of change. To achieve value-driven care, consideration needs to be given to:

  • providing the right care to the right patient, based on clear clinical indication and guidelines
  • providing care that minimises hospital stay and maximises early recovery
  • putting emphasis on quality improvement and surgical proficiency
  • using resources effectively through optimal use of theatres
  • ensuring procurement is appropriate.

Partnerships between clinicians and policy makers will be key to taking a value-based approach to surgical care. This will allow better crisis response while maintaining safe, sustainable and equitable healthcare delivery.

Read more about this important topic in our guest editorial from surgeons Professor Mohamed Khadra and Professor Neil Merrett.

I hope you enjoy reading this issue of Clinician Connect.

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