Table 7 Case 5 (Central Canada) - Factors affecting WTMS sustainability and unintended consequences
Organizational factors | |
|---|---|
Governance | - Surgeons, staff and middle and top managers aligned toward the same goal: treating people in as excellent a way as possible - Integrated clinical-administrative governance along the continuum of care: “A balance between staff members that are upstream and downstream must be attempted. The entire staff must feel involved in decision-making because, at each key stage of the continuum, each person has an impact on others. Everyone is interdependent.” (I.5.3) - Committees to coordinate strategy and to sustain ongoing work |
Culture | - Culture of innovation and managers’ sense of responsibility to the population and patients: “We have a desire within the organization to see how we can improve this continuum of care, to build on each program skill to better serve clients.” (I.5.3) - Team cohesiveness, staff and managers (middle and top): “This is a solid team. Our orthopedists are involved, too. Of course, the team is very united, nursing, orderlies, nurses, as well as orthopedists.” (I.5.2) |
Methods and tools | - Letter of non-availability; standardized preadmission form - Shared software application used to plan OR surgical activities - Computerized care plan developed for post-operative care - Dashboards and audits designed to monitor wait times and volume of activity: “We realized that some of our patients could go home after two days. So then we thought, ‘Well, we’re going to try to reduce the duration of our stays down to 3 days, making it the new target that we want to look at.’ We had meetings every month, with data from our archives. Archives provide us with the percentage of returns to home, which we compare with our target…. Then, we try to see how we can make things better in order to really manage to decrease stay durations, and increase returns to home. If there is a decrease, we analyze why.” (I.5.6) |
Resources | - Increased staffing (nurses and physical rehabilitation technicians) allocated: “So, having consolidated the examinations in one day, collaboration is required ... for example, we had privileged access for blood tests, for radiology, for the electrocardiogram, ... So we notify the electrocardiogram that, that day, they will have eight orthopedic patients, so they can plan to have enough staff. It means having Unit Leaders who allocate resources.” (I.5.1) |
Main contextual factors | |
- Significant government funding to increase the volume of TJR | |
Unintended consequences | |
Serendipities | - Strengthening of collaboration between clinical and administrative management throughout the establishment: “The goal, I always say, is to engage them [doctors]. And it’s all about the power of influence. Over time, in surgery, we managed to have a great power of influence because they saw it as a win-win. We were with them, and I had a stake in them operating more; and for me, we were all in this together. You have to understand that there is a connection that happens between the administration and the medical team, through which we have a common goal. And that’s, for me, one of the cornerstones of success.” (I.5.6) - Better cost control (for prosthesis purchasing) thanks to improved collaboration |