Western NSW Local Health District is adopting a system-wide view of elective surgery, to ensure that our patients are prioritised based on clinical need rather than administrative boundaries.
Western New South Wales Local Health District (WNSWLHD) faces persistent challenges in meeting key performance indicators for elective surgery due to a misalignment of demand and capacity. Patients are not receiving care within clinically appropriate timeframes as evidenced by overdue volumes.
There is significant variation in wait times for patients undergoing the same procedures, often performed by the same surgeons, depending on the facility where the surgery is scheduled. This inequity of access is largely driven by a siloed approach to managing elective surgery services across the district’s 7 surgical facilities. Wait lists are managed at the facility level, instead of the district level.
This results in delayed access to necessary procedures, which negatively impacts population health outcomes and patient experience. Our project aims to improve timely and equitable access to planned surgical services for our communities.
Addressing barriers to accessing elective surgery
Access to safe and quality elective surgical procedures in WNSWLHD is challenging due to the regions size and higher disease burden. Additionally, workforce shortages, a mix of different skill levels and the delineation of roles between facilities also impact and determine how patients access and flow through our system.
From 2023-2024, the misalignment between elective surgery demand and available capacity became evident in the number of patients not receiving care within clinically recommended timeframes. Sustained under-performance against Key Performance Indicators demonstrated this as an issue for WNSWLHD.
As of February 2025, performance data revealed that 326 patients were overdue for surgery, with 227 of these patients on the Dubbo Hospital wait list alone. Available capacity in other facilities across the district highlighted the inefficiencies caused by a fragmented and non-integrated service delivery model.
The diagnostic phase of this project revealed that surgeons may operate at multiple sites within the WNSWLHD network, but their wait lists are managed independently at each facility. This site-specific management approach leads to patients being treated out of turn when viewed from a system-wide perspective. Staff at each facility focus solely on the Recommendation for Admission forms received at their location, without considering broader network capacity or urgency across the district. This contributes to inconsistent prioritisation and scheduling, further exacerbating inequity of access.
We are also challenged by increasing demand on our system. Across WNSWLHD, elective surgery activity has increased by approximately 8.9% between 2022-23 and 2023-24, and by 7.1% between 2023-24 and 2024-25. To address these challenges, WNSWLHD must transition to a district-wide and integrated approach to elective surgery service delivery.
This involves:
- centralising wait list management
- enabling cross-facility scheduling
- leveraging available capacity across the district to meet demand more effectively.
Aligning implementation with system priorities
We adopted a systematic and collaborative approach to ensure all stakeholders were actively engaged throughout this project. Establishing robust communication networks was essential to address the siloed management of elective surgery services across the district.
The diagnostic phase was critical in validating assumptions and understanding the challenges faced at each facility. This involved both qualitative data collection — such as process mapping, one-on-one interviews, staff forums and attendance at existing meetings, and quantitative analysis using existing performance and scheduling platforms. Data limitations identified during this process informed the need for improved reporting systems and data governance.
We shared our findings through staff forums and executive presentations, to promote transparency and build a shared understanding of the problem. We also undertook a targeted literature review to ensure proposed strategies were evidence-based and aligned with NSW Health policy direction. The release of the updated NSW Health policy directive on Planned Surgery Access (PD2025_036) coincided with this project, providing an opportunity to align local implementation with system-wide reform priorities.
Our team held collaborative solution-design workshops with key stakeholders to identify, refine and prioritise interventions. This participatory approach strengthened engagement and ownership as the project transitioned into implementation.
We have commenced the initial implementation phase with:
- a detailed review of the new policy requirements
- the development of a governance framework to oversee district-wide elective surgery reform
- a review of processes related to the acceptance and management of Recommendation for Admissions forms.
These foundational steps will support the transition to an integrated, networked model of elective surgery service delivery across WNSWLHD.
Learnings instrumental in shaping implementation
The learnings we have gained during the diagnostic and engagement phases of this project have been instrumental in shaping the project’s direction and will continue to guide implementation as WNSWLHD transitions to a more integrated model for elective surgery management. These include:
Avoid assumptions until diagnostics confirm the problem
An important lesson was the need to resist forming assumptions about the causes of under-performance or potential solutions before completing a comprehensive diagnostic process. Initial perceptions about the reasons for overdue volumes or inequitable access often differed from the realities uncovered through data analysis and staff feedback. Taking time to validate issues through both quantitative and qualitative methods ensured the project targeted the right problems and avoided implementing solutions that might have addressed symptoms rather than root causes.
Effective communication networks are critical for engagement
Establishing robust and consistent communication networks was essential to overcoming the siloed nature of elective surgery management across the district. Regular updates, structured forums and transparent reporting helped to build trust and alignment among clinical, operational and executive stakeholders. This focus on open communication strengthened collaboration across facilities and fostered a shared understanding of the district-wide challenges and priorities.
Co-design builds ownership and sustainability
Actively involving staff in developing and prioritising solutions created a sense of ownership and accountability for change. By engaging frontline clinicians, managers and administrative staff in the design process, proposed strategies were grounded in operational reality and more likely to be embraced during implementation. This collaborative approach has laid the foundation for sustainable change and strengthened the culture of continuous improvement across the network.
