Table 7 Factors for success, sustainability and suitability for disinvestment in the SHARE pilot project

A proposal is more likely to be successful if it meets the following criteria

Based on sound evidence or expert consensus

✓ Systematic review of multiple RCTs; surgeons, nurses and allied health staff in agreement with findings

Presented by credible organisation

✓ Review undertaken by the Australian Safety and Efficiency Register of New Interventional Procedures – Surgical (Royal Australasian College of Surgeons)

Able to be tested and adapted

✗ There was limited opportunity to test and adapt as the VPACT funding required complete roll out

Relative advantage is evident

✓ Clear evidence of multiple improved patient and health service outcomes; increased safety and effectiveness, reduced costs

Low complexity

✓ The new technology is easy to use

Compatible with status quo

✓ Referrers use the same referral process but divide patients into those eligible for the new procedure and those who should still undergo the old procedure

✗ The new service was provided at a different campus and patients and staff had to adapt

✗ There is some impact on other departments that also have to adapt

Attractive and accessible format

✓ The new procedure is attractive to patients as it replaces surgery with an outpatient/bedside procedure

A proposal is more likely to be sustainable if it has appropriate and adequate provision in each category

Structure

✓ The new procedure is carried out within existing nursing and allied health structures with appropriate governance and supports

Skills

✓ Nursing and allied health staff were upskilled in the new procedure; changes in scope of practice were documented and approved

✓ Clinical project team leaders attended training and welcomed support and direction in project management, implementation and evaluation

Resources

✓ Funding was provided for staffing, equipment and consumables

✗ Final funding was less than the amount approved in the application process leaving the project short of one machine and associated consumables

✓ Assistance from the Capacity Building and Project Support Services was provided

Commitment

✓ The project had organisational commitment from the Technology/Clinical Practice Committee, and program and departmental commitment from clinical leaders and managers

Leadership

✓ The clinical project team demonstrated effective leadership

Factors in the pilot project considered likely to be favourable for a disinvestment project at Monash Health

✓ The current practice to be replaced and the new practice to be implemented were clear and patient eligibility was determined

✓ The proposal for change was clear with clear objectives

✓ Department and Program heads endorsed the change

✓ External funding was available

✓ The clinical pathway and referral process were documented

✓ Detailed data collection and reporting was a requirement of the external funding

✓ Baseline data had been collected and supporting data on patient group, burden of disease and impact of the new technology was available

✓ There was strong local ownership and clinical champions

✓ ‘Win-win’ scenario for adopters where nursing and allied health staff were keen to take on new procedural skills and surgeons were happy to relinquish these cases to make operating theatre time available for other patients

✓ Surgeons were allowed to keep the theatre time released by the changes and reduce their own waiting lists (rather than reallocation to other surgical specialties or closing theatres to realise savings)

✓ Potential ‘quick win’ scenario for a disinvestment demonstration project as the proposal was already fully developed, funding had been approved, and deadlines were in place.

Key: ✓ Positive factors ✗ Negative factors