Improving the productivity of elective surgery through a new 'package of care'

In response to a need to improve the productivity and throughput of elective surgical services, one district health board (DHB) in New Zealand has introduced a 'package of care' (POC) in which incentive-based, risk-sharing contracts were developed collaboratively between DHB managers, surgeons and anaesthetists. The POC includes throughput targets and facilitates consistent surgical teams and the cohorting of patients. Whilst many staff are very supportive of the POC, some are of the view that it conflicts with the ideals and principles of working in a public health system, and creates inequities amongst the hospital staff. Analysis indicates that, after controlling for age, casemix and complexity the POC has resulted in shorter theatre times, shorter lengths of stay and lower average inpatient event costs compared with standard care at the public hospital. An unintended consequence could be that the POC may encourage throughput of less complex cases at the expense of more complex cases. The average complexity and range of cases performed publicly should be carefully monitored to ensure this does not occur.