Auditor General Report Released


Managing operating theatre efficiency for elective surgery.

The NSW Auditor General this week released a report entitled Managing operating theatre efficiency for elective surgery.  The below link is to the full report and recommendations. When releasing the report, the Auditor General, Mr Achterstraat summarised the situation as follows:

“Elective surgery costs NSW public hospitals about $1.3 billion per annum.  Using the same money we can achieve a lot more.  We just need to make sure someone is clearly in charge of each operating theatre and make sure operations start and stay on time.  Health professionals also need better information to make the right decisions.  The hospital’s engine room needs a tune up.  With more efficient management practices, more elective surgery can be achieved.” ^

The Minister, whilst accepting all the recommendations made, nonetheless dwelled upon the significant improvements achieved as follows:

“Public hospitals are now treating patients from waiting lists substantially within clinical timeframes. This is a significant achievement ... After two years in office we are well and truly going to meet and exceed this target.  NSW hospitals have performed more than 9,000 additional surgeries in that time ... Thanks to this increase in activity and the great effort of our clinicians, NSW has recorded one of the best results nationally on treating patients within clinically recommended timeframes (National Elective Surgery Target) and will be receiving Commonwealth reward funding for meeting national targets.” ^^

But as always, when reviewing the report, some care needs to be taken before making generalised conclusions or relying upon some of the ‘report cards’ prepared showing average costs for certain procedures.  As the report itself correctly notes:

“The Ministry has pointed out the difficulties in estimating costs accurately for individual procedures and components of a surgical patient’s journey, and therefore the importance of careful interpretation of any cost variations reported. We accept this.

There can be considerable and legitimate variations in the services required by individual patients, even for similar procedures. Teaching hospitals have different resource levels and staffing costs than others. Larger hospitals (and larger operating theatre suites) can generate greater economies of scale and specialisation, for example with separate procedure rooms. Specialist hospitals, for children for example, have different treatment, length of stay and therefore cost profiles. Recording practices and cost allocation processes may also vary.

These factors are likely to explain many of the differences in the costs of surgical episodes between LHDs and hospitals. However, without more detail on the reasons for ‘legitimate’ cost differences, it is difficult for the Ministry to reflect them in budgets and funding; and for hospitals to isolate and address remaining inefficiencies. The scale of the differences now in reported costs emphasises the importance of doing so.” ^^^

To check out the full report (posted on the Audit Office of NSW's website), click here.

^          Media Release, Auditor General, 17 July 2013

^^        Media Release, Minister for Health, 17 July 2013

^^^     Managing operating theatre efficiency for elective surgery, Auditor General, pp 27.