Snakes and ladders: The barriers and facilitators of elective hip and knee-replacement surgery in Australian public hospitals

• Published in: Australian health review Vol. 37; no. 2; pp. 166 - 171
• Main Authors: Walters, Julie L, Mackintosh, Shylie F, Sheppard, Lorraine
• Format: Journal Article
• Language: English
• Published: Australia CSIRO 01.01.2013
• Subjects: Arthroplasty, Replacement, Hip; Arthroplasty, Replacement, Knee; Australasia; Data collection; Elective surgery; Elective Surgical Procedures; Health administration; Health Services Accessibility; Hospitals; Hospitals, Public; Humans; Interviews; Joint replacement surgery; Medical policy; Medical Staff, Hospital - psychology; Medical waiting lists; Nonprofit hospitals; Orthopedics; Qualitative Research; Studies; Success; Surgery, Elective; System theory; Total hip replacement; Total knee replacement; Waiting Lists; Waiting period; Workloads; Australia; Australasia
• ISSN: 0156-5788; 1449-8944
• DOI: 10.1071/AH12177

Objectives. Waiting lists for elective surgery are a persistent problem faced by health systems. The progression through elective surgery waiting lists can be likened to a game of snakes and ladders where barriers (snakes) delay access to surgery and facilitators (ladders) expedite access. The aim of the present study was to describe the barriers and facilitators to delivery of total hip- and total knee-replacement surgery in South Australian public-funded hospitals. Methods. Semistructured interviews with staff, direct observation of administrative processes and documentation analysis were combined under a systems theory framework. Results. System barriers (snakes) were grouped into five categories: resources, workload, hospital engagement, community engagement and system processes. Inadequate resources was the most prominent barrier, patient cancellations resulted in one-third of administrative tasks being repeated and there was a perceived lack of engagement to maximising efficiency. Interestingly, despite a lack of resources being perceived to be the biggest problem, additional resources without system change was not considered an effective long-term strategy. Conclusions. Given the complexity of the elective surgery system, it is not surprising that single-item reforms have not created lasting reductions in waiting times. Multifaceted, whole-system reforms may be more successful.