Sector Spotlight

Making elective surgery decision-making easier

In April last year we advised that we’d be working with the elective surgery sector to help make the surgery decision-making process easier to understand and more effective. Better for medical professionals and better for patients. And that’s just what we’ve been doing.

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We agreed to complete a number of tasks to ensure that we make the best of our elective surgery resources; improve the quality of clinical information provided to ACC; strengthen decision-making processes; and improve communication and relationships with the sector.

There’s still work to be done, but we’re making progress on having a more accessible and easier-to-understand process for deciding on elective surgery applications. A close working relationship with the sector has been fundamental to these changes.

We’ve run the ruler over our progress, and here’s our report card to date.

Better use of resources

To make the best use of resources, we’ve introduced a streamlined end-to-end elective surgery process.

This brings in case-by-case triage which allocates cases by their complexity. We’ve addressed the accurate tracking of surgery requests – including the timeframes between each stage of the process so that patients know where they stand – and created better access to ACC Medical Advisors. We have also expanded the criteria for applications that can be referred to branches for decisions.

Improved information

To improve the quality of the clinical information on which we base our decisions, we’ve introduced mandatory use of the ACC surgery request template. We’ve established a dedicated 0800 number (0800 222 020) that surgeons can use to obtain patients’ claims histories before lodging surgery requests, and we’ve introduced tighter timeframes in which surgeons need to provide additional clinical information.

Strengthened decision-making

The elective surgery decision-making process has also been strengthened. Progress reporting on applications has been introduced, better more informative surgery decline decision letters (including a summary of clinical information used to reach the decision) are now used, and we’ve introduced a process for cases where there isn’t enough information to make decisions on surgery.

The decision-making process is still a work in progress; there is more to be done. We have yet to finalise a client brochure on elective surgery and we are working on providing web-based resources for surgeons and clients.

In October you can have your say. We will approach those of you in the sector for your views on how we are doing. Your responses will provide us with not only a benchmark but also an indication of where we may need to focus in the future. Ultimately, we all share the same objective of providing a transparent and effective process that leads to the best possible results for patients. We will be in touch in due course to let you know how you can get involved.

 

Published 01/10/2012

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