A team from Southern NSW Local Health District (SNSWLHD) is working to improve access to surgical services at Cooma Hospital and South East Regional Hospital in Bega. This project aims to increase consumer awareness of surgical services and their waiting times, establish clear governance processes and encourage collaboration with medical administration.
Across SNSWLHD, the target for operating room utilisation is 80%. The current rate of 70% falls below this target, and the district recognises the urgent need to increase this rate and improve theatre efficiency.
At the same time, the waiting list for surgery has reduced at Cooma Hospital and South East Regional Hospital, with patients receiving care outside of SNSWLHD.
When beginning this project, the team identified issues including:
- vacant and under-booked lists
- outpatient bottlenecks
- a lack of governance framework for perioperative services at these sites
- limited professional recognition of surgeons and anaesthetists
- poor communication between perioperative teams and assets for equipment repairs and replacement.
To address these issues and improve service delivery, SNSWLHD needs to ensure value for investment in surgical services, improve processes, and foster collaboration between perioperative teams and medical administration.
Improving efficiency in theatres
This project aimed to optimise access to surgery closer to home for those living in SNSWLHD at Cooma Hospital and South East Regional Hospital, promoting a better consumer experience and improving efficiency in theatres by July 2025. The aim to maintain surgical services in rural settings, together with NSW Health’s strategic priority for treating people close to home where possible, presented an opportunity to find out why the waiting list had not recovered following the COVID-19 pandemic.
Anecdotal feedback revealed that patients were being treated outside SNSWLHD, across the border in the ACT or in other nearby NSW LHDs. If patients were being treated outside the district for procedures that could safely be performed within SNSWLHD facilities, the project team wanted to learn why they were travelling, and why general practitioners (GP) were referring patients outside the district?
Via surveys and interviews, community members reported concern that if surgical services were not being utilised, services could be lost, and suggested promotion of surgical services more broadly. The facilities provide excellent access to services, within clinical timeframes, however activity had fallen in line with the waitlist decline. GPs reported via survey responses, that they needed access to waiting times to improve transparency in providing their patients with realistic expectations for treatment.
Increasing awareness of surgical services
The project team adopted a structured, step-by-step methodology to develop 4 solutions, with the aim of improving access to and awareness about surgical services in Cooma Hospital and South East Regional Hospital.
- Develop a training and onboarding package for surgical bookings staff to help build competencies, skills and processes required to fulfill their role. The project team collaborated with surgical bookings staff at each facility to review and develop training resources to improve skills and define training requirements. Corporate Services managers will now drive the implementation of this solution in collaboration with district surgical services. Benefits include improved compliance with the Elective Surgery Access Policy and improved monitoring and management of the waitlist. Longer term benefits will include improved succession planning and workforce wellbeing.
- Establish monthly perioperative governance meetings at each site to address risks and issues for perioperative services. The project team established surgical services governance committees at both hospitals, with a suggested terms of reference at both sites. This has built the foundations for monitoring performance, site-based operational risk escalation, planning and reviewing elective lists, and approval of site-based targets. Local governance for the perioperative service will be improved by this approach.
- Promote Surgical Services and develop a consumer-focused communications strategy. In March 2025, the project team produced a flyer to be distributed at general practice engagement dinners, the flyer directed GPs to online patient resources via a QR codes. The team developed a partnership with the Primary Health Network (PHN) for Southern NSW and the ACT HealthPathways, including a surgical theme to target general practice created for the PHN monthly newsletter 'In the Loop’. In addition, the team developed a communications and media plan to promote surgical services available at Cooma Hospital to the wider community. The plan incorporates print and social media, including surgeons’ stories of why they love working in a rural hospital.
- Develop strong relationships between surgical services and medical administration to improve processes, medical officer onboarding and service delivery for improved patient care.
Strengthened medical oversight and governance structures
As this project progressed through implementation, it resulted in improvements in oversight of the surgical schedule; system access requirements prior to onboarding; and understanding between medical administration and surgical services.
Weekly meetings now occur at Cooma Hospital to manage roster deficits and ensure service delivery. This project has built the foundations for improving performance and consumer satisfaction through strengthened medical oversight and governance structures, surgical bookings staff capacity building, improved collaboration, and a communications strategy.
Governance committees of both hospitals will monitor performance milestones each month, with support from the district surgical services team. Reporting by both hospitals to weekly executive forums has enabled greater oversight of the issues facing operating theatres. Facilities have implemented 3-step quality improvement plan process to optimise performance, improve efficiency, staff wellbeing and consumer satisfaction.
