The Auditor General in a peformance audit ‘The Management of Elective Surgery Waiting Lists, ‘reported that prolonged intervention waiting times come at a cost for both the patient and Mater Dei Hospital (MDH). Excessive waiting times may also, in the near future, increase Government’s financial liability in terms of the Cross Border Health Directive.

The Report acknowledges the high levels of patient satisfaction with the services provided. However, it notes that despite the increase in the number of elective operations carried out at MDH over recent years, around one fifth of patients have been waiting for their intervention for over one year.

The Report said tht the rise in the demand for elective surgery is mainly brought about by the increasing healthcare requirements of an ageing population, the constant introduction of new operative technology dealing with previously untreated conditions, as well as the extent of facilities available at MDH. The demand for operations was alleviated by the increase in the number of interventions carried out at MDH and outsourcing initiatives. However, a number of strategic and operational issues are limiting MDH from increasing further its intervention throughput.

“Patient demand in the private sector coupled with the attraction of better remuneration packages make it more difficult for MDH to encourage its pool of consultants and other professionals to extend their working hours at the Hospital. Furthermore, MDH’s obligation to conform to the centralised Public Service recruitment procedures tends to prolong the engagement process of staff,” the Report said.

MDH is still in the process of computersing its waiting lists in a centralised system. This project, which commenced three years ago, has focused on the Cardiology, Ophthalmic, Orthopaedics and Surgical Departments. This System is considered as a pre-requisite to effective waiting lists management since it transfers the ownership of waiting lists to the Hospital’s Management. The project also helps to strengthen transparency and management oversight.

The report highlighted the fact that the management function of elective surgery waiting lists is “hampered by the non-integration of the relative stand-alone information systems. The resultant data fragmentation impinges on the administrative and management aspects of elective surgery. Despite the importance of integrating the various datasets, efforts to determine the feasibility of the Integrated Health Management System 2 (IHIS2) appear to have stalled. This state of affairs is prohibiting MDH from evaluating and investing in other IT alternatives.”

The Report showed that in July 2012 the 18 Main Operating Theatres and five Endoscopy theatres reviewed showed that, on average, each operating theatre is used for 31 and 27 hours per week respectively. The utilisation of the operating theatres is effected, amongst others, by bed-turnover limitations, especially due to a 12 per cent occupancy of the Hospital’s bed-stock by patients awaiting to be transferred to other healthcare institutions.

“This situation is limiting the daily number of operations carried out at MDH. At the operational level, a number of process inefficiencies were noted. In some cases interventions started later than scheduled, operation turnaround times were prolonged, and in some instances under-running surgery lists led to early session finishes. The lack of a central authority within the Operating Theatres Department to assume full responsibility for this function weakens management control over this critical and most valued asset within the Hospital.”

“To date, the increase in intervention throughput can be attributed to the Hospital identifying and addressing specific areas of inefficiencies. Although the continuous changes to work-practices have led to positive results, these efforts need to be complemented with the adoption of the strengthening of strategic, operational and public private partnerships policies, as well as the availability of comprehensive and integrated information systems. This will strengthen management direction and control over the elective surgery processes, as well as contribute to the sustainability of this sector,” the Report said.

The Report puts forth a number of recommendations based on the critical issues identified and other audit findings.

To view report (.PDF) please follow link

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