IMPLEMENTATION OF GOVERNANCE AND INCREASED THROUGHPUT IN AN ORTHOPAEDIC SPINAL CLINIC – ARE THEY MUTUALLY EXCLUSIVE?

Abstract

Healthcare organisations are accountable for improving the quality of their services, safeguarding high standards of care and meeting shorter waiting time targets. This presents a challenge of how to achieve such targets with limited resources. This paper looks at the hypothesis that adequate and appropriate clinical governance can be undertaken while increasing orthopaedic spinal clinic throughput in order to decrease outpatient waiting times.

A spinal outpatient clinic was used as the test bed for the hypothesis of the project. The theoretical number of patients an individual consultant can see per session was calculated from recommended British Orthopaedic Association consultation times for new and follow-up cases. Patients were asked to complete the MODEMS (Musculoskeletal Outcomes Data Evaluation and Management System) questionnaire. A prospective randomised trial utilising a touch-screen computerised version of the questionnaire was also used. Time taken for outcome data management is included in the analysis. The time taken to see new and follow up patients was 31–42 and 24–35 minutes respectively. These times have implications in terms of waiting times and Director of Performance Management targets. The shortfall is calculated in terms of additional support necessary to reach these targets. Salary costs and infrastructural support costs are projected. The figure is likely to represent that required by any specialist clinic to realise the ideals of clinical governance and conservatively estimated to be £35, 000 per year.

Total clinical governance and patient outcomes are inextricably linked. This is true of orthopaedic spinal surgery in that important information about clinical practice can be obtained. The organizational infrastructure and methods to implement data collection is technically feasible however is not without cost. In terms of economic evaluation the correct price for a resource is its opportunity cost. ‘Don’t just buy more healthcare, invent new healthcare’ is as incongruous as total clinical governance and increased capacity without support.