Elective services reform

WA Elective Services Target (WEST)

In January 2016, WA Health adopted a new WA Elective Services Target (WEST) which aims to ensure timely access to public elective surgical services. This replaces the National Elective Surgery Target (NEST) following the expiry of the National Partnership Agreement on Improving Public Hospital Services in 2015.

In the first quarter of 2016, WEST will maintain the 2015 performance targets for access to elective services. From 1 April 2016, WEST will focus on the percentage of over boundary cases (i.e. those waiting longer than the clinically recommended time) on the waiting list, with a target of 0%.

Further information on elective waiting lists for Western Australian public hospitals is available in the Elective Surgery Wait List Reports.

WA Health’s policy on elective surgery

The Elective Surgery Access and Waiting List Management Policy (2015) (OD 0618/15) (external site) clearly defines the process to register patients onto the elective surgery waitlist (ESWL) in any WA public hospital or health care facility as well as the principles underpinning this activity. These are:
  • Waiting lists are managed to ensure all patients are treated in clinically appropriate timeframes; this management is transparent and client-focused.
  • Only patients who are ready for care will be counted and reported as cases on the ESWL.
  • The hospital has a duty of care to ensure patients are treated within the assigned urgency category boundary.
  • Patients are provided with meaningful information about ESWL; informed consent; and information is routinely shared with the patient’s nominated GP (unless the patient does not consent).
  • There is equity of access. All patients will be prioritised based on clinical urgency. Where no clinical urgency differentiation exists, patients will be treated in order of their registration onto the waiting list (first on, first off).

Further information regarding access to surgical procedures for the management of obesity is available in the WA Health Bariatric Surgery Plan (PDF 815KB).

National Elective Surgery Urgency Categorisation

At the request of the COAG Health Council (Health Ministers), the Royal Australasian College of Surgeons (RACS) and the Australian Institute of Health and Welfare (AIHW) have developed national definitions for elective surgery urgency categories.

As well as defining the usual clinical urgency categories for a selection of high volume procedures, the National Elective Surgery Categorisation Guideline (April 2015) (external site) also simplifies the urgency category definitions as follows:

  • Category 1: Procedures that are clinically indicated within 30 days
  • Category 2: Procedures that are clinically indicated within 90 days
  • Category 3: Procedures that are clinically indicated within 365 days.
The national definitions are expected to facilitate access to elective surgery according to clinical need, maximise equity of access, minimise harm associated with delayed access and support an appropriate balance between consistency of practice and clinical decision making.

Current initiatives

Theatre Efficiency Reform Program

The Health System Improvement Unit (HSIU) is leading a Theatre Efficiency Reform Program in response to the recent audit by the Office of the Auditor General (OAG) of Operating Theatre Efficiency at five public hospitals within WA Health (NMHS and WACHS) for delivery of elective surgery from 2009 to 2014.

The report details performance against six measures of operating theatre efficiency, issues with scheduling, and how operating theatre efficiency can be improved. The recommendations include establishing performance monitoring and reporting, improving Theatre Management System functionality, regular review of operating theatre schedules, increased cross site sharing of improvement strategies and provision of direction and guidance to hospitals on how to improve operating theatre efficiency.

WA Health has accepted all recommendations in the report.

The theatre reform program has been developed comprising two interdependent streams run in parallel. The site level stream will use Clinical Service Redesign (CSR) to review workflows and practices to identify potential theatre efficiency improvements for implementation.

The system level stream, which aligns with and supports the site level objectives, focuses on the recommendations relating to the implementation of a system-wide performance monitoring and reporting framework that includes standardised performance measures and targets. Consultation with sites across the system will inform theatre indicator and definition development for performance and operational reporting.

Related links

WA Health

External Resources

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Clinical Support Directorate