Waitemata District Health Board (WDHB) is contracted through public funding to achieve approximately 500 total hip arthroplasties per year. A pilot was established to increase productivity and reduce costs in these surgical procedures. Current barriers to efficiency in elective surgery are slow patient turnover, increase in costs of consumables and staff employment issues.

This pilot introduced: A change in drivers and incentives so remuneration and rewards were related to productivity (replaced medical salaries), an alliance contracting concept (1), encouraged productivity, contained costs (consumables) increase surgeon and anaesthetist involvement in overall patient care (reduce need for additional medical staff), reduced length of hospital stay, shortened patient journey, established surgeon/anaesthetist/nurse team.

Inclusion criteria:1. Hip replacements in DRG103C: Hip replacement W/O catastrophic or severe CC. 2. ASA grade <4. 3. Cases July to November 2010

Comparison of baseline data was then carried out between this pilot and compared with data from the main campus (both sites had dedicated elective operating lists). Theatre time was reduced from 167.5 to 97 minutes (42%), length of stay 5.58 days to 3.46 days (38%), OR costs $3830 to $2708 (29%). There was an increase in medical costs but a 12% saving was achieved overall.

The pilot has shown that it is possible to significantly reduce costs in elective surgery through an increase in productivity. To reduce costs of elective surgery, the culture/environment needs to change to encourage the individual surgeons, anaesthetists, and other members of the team to increase productivity and decrease costs.