Friday, February 03, 2006

Knee, hip plan a step forward for health care

VICTORIA - There’s much to praise in the government’s plans to reduce the wait for knee and hip surgery.
The problem has been terrible. Every time I write about the issue, I hear from people with stories of suffering, economic hardship and physical deterioration as they wait for surgery that keeps getting pushed farther and farther away.
Now the government has announced a plan that should make a significant long-term difference.
And at the same time it offers a model that can be used to deal with other, similar problems.
The plan has five elements.
At the centre is a new Centre for Surgical Innovation at UBC, with two operating rooms dedicated to knee and hip work. The centre will be able to do about 1,600 operations a year. That alone should take care of the wait problem for the next few years.
The problem, on one level, is simple. Wait lists grow because the government won’t pay for treatment for people who need it. The health care system has received enough funding to allow about 7,000 knee and hip procedures a year. About 7,300 people require the operation each year, so wait times grow. The extra capacity at the new centre should reverse the trend.
That’s not the only advantage. The new centre is a kind of ‘Hips and Knees R Us.’ That’s all the centre will do, so it will become very good at prepping people, operating on them and sending them on their way with a good rehab plan. As it learns better ways of sticking in a new hip and helping people recover, it will pass them on to hospitals around the province.
It makes imminent sense. Mr. Muffler finds efficiency in doing one thing; so can hospitals.
The government has also come up with $5.5 million more for the Research Centre for Hip Health at Vancouver General Hospital, the first institute in the world that’s looking at ways of avoiding hip problems and improving outcomes.
And another $5 million will be spent to set up a proper waiting list, or ‘provincial surgical patient registry.’
It’s discouraging that only now is government starting to try get a handle on the basic task of managing the wait for treatment. Only by 2007 will patients be ranked by urgency, and given some idea of how long they can expect to wait. Only then will the health authorities have basic wait list data. It’s a confession of mismanagement, but at least the problem is being addressed.
Finally, there’s $25 million to be split among the health authorities to fund extra operations in an effort to cut into waiting lists.
Again, one could argue - I certainly would - that the province could and should have provided that funding years earlier. Fixing knees and hips, relieving peoples’ suffering, getting them back into life seem both a good investment and a moral imperative. But at least it is now happening.
The other encouraging element is the way this whole initiative was developed.
The idea of a knee and hip centre was tested at Richmond Hospital by the Vancouver Coastal Health Authority. By running two operating rooms and other measures, the pilot project was able to double the number of operations surgical teams could do in a day, from three to six. It knocked a day off the average four to five-day hospital stay, and cut waiting lists. (The UBC centre is now supposed to take those lessons across the province.)
The chance to learn from small, regional experiments - on wait times, and addictions and employment training - is too rarely seized.
It’s amazing how unmanaged our health care system really is. Despite an extraordinary number of bright people looking at the issues there is almost no useful data for making decisions and setting priorities.
The knee and hip project is a step towards smarter, better managed, more effective public health care.
Footnote: Give some credit to the departing Paul Martin for this effort. The First Ministers' agreement to address wait times in five critical areas in return for more money helped drive this initiative. B.C. does well in cardiac, cancer and cataract care, but was spurred to deal with orthopedic wait problem by agreement.

1 comment:

Anonymous said...

I'm one of those folks waiting for a hip replacement, at least I think I am. I say think, because I've never actually met the surgeon yet after 8 months with the x rays clutched under my arm. First estimate was late this fall 2006, next estimate is end February 2006. Date of the operation is, who knows?
Alberta did around 1200 hips at the total cost of 50 millions of dollars. Using CP numbers, there are over 19,000 on wait lists for assorted medical procedures in BC. Can BC do better with a similar amount?
The BC government shows wait times of 15 weeks but fail to mention the clock doesn't start till the surgeon goes to book the event.

The wait time is really well over one year, to get to the surgeon right now. So any improvement is good for us.

It is interesting that about 1900 opening by two dedicated operating rooms and providing staff can do a year. We read of doctors being allowed to work only one day a week.

You are very correct it saying that skills develop by doing the same job regularly, be it your carburetor or your hip, reduces time and improves the results. If a GP has x-rays showing arthritic hips why does one require a few others to get into the process? They liaise with the specialist, he gets the time, and he operates.
The surgeon does amend lists by shuffling patients back and forth depending on his or her view of who should go first or wait. The Wisdom of Solomon is alive and well in the medical system.