VIRUS SLOWDOWN PAVES WAY FOR B.C.’S SURGICAL RENEWAL
Pandemic provides health system impetus to transform how procedures are managed
As B.C. clears a backlog of thousands of cancelled surgeries, the chairs of the health authorities have written open letters on how the effort is supposed to play out in their communities.
“The most massive and ambitious surgical project we have ever attempted,” said the recent letter from the chairs of Vancouver Coastal, Fraser Health and the Provincial Health Services Authority. “It will dramatically change how we deliver surgeries in B.C.”
That last sentence is significant because Health Minister Adrian Dix says the goal of surgical renewal is not simply to go back to the way things were before the novel coronavirus pandemic struck.
Rather, he sees the crisis as an opportunity to transform how the province accumulates surgical waiting lists and delivers scheduled surgeries.
By referring to “dramatic change,” board chairs Dr. Penny Ballem of Vancouver Coastal, Jim Sinclair of Fraser Health and Tim Manning of Provincial Health signalled (in their letter published last week in The Vancouver Sun) that they shared the minister’s ambitions for surgical renewal.
When renewal got underway on May 19, Dix estimated the pandemic-driven reduction in hospital operations led to the cancellation of 14,000 scheduled surgeries, plus postponement of another 16,000 that never made it onto the schedule in the first place.
Rescheduling all 30,000 would entail a formidable exercise in priority-setting, as the board chairs noted in their letter.
The first priority is “patients whose surgeries must occur in less than four weeks, patients who have had their surgery postponed, and patients who have waited more than twice their targeted waiting time.”
Cataract removal and other day surgeries are also ticketed for early clearance. But other procedures are moving further back in the line.
“This will include postponing some dental and hip-and-knee surgeries,” acknowledged the board chairs. “This is difficult news for patients and for their surgeons, too.”
No doubt the chairs were aware that some orthopedic surgeons had been alerting their patients to the delays, perhaps hoping to provoke a backlash.
Overall, the board chairs maintained that “surgery renewal is well underway, and the results so far are very encouraging.”
Dix has been providing weekly progress reports on a provincewide basis, pledging there will be “no gaming of the stats” on surgical renewal. He says the system has exceeded the pre-pandemic level of 6,000 surgeries per week for four weeks running.
Also well underway is recruitment of additional health care workers and a drive to build up the stockpile of personal protective equipment.
“I don’t think there’s a jurisdiction in Canada that has been as successful” as B.C. “in procuring PPE in this period,” says Dix, responding to complaints from the nurses union and others.
But all that is prelude to “even more significant changes to come,” according to the board chairs.
“Over the summer, we will add additional resources and capacity by extending daily operating room hours,” they pledged. “We are adding Saturdays and Sundays to the operating schedules. We are opening new operating rooms, too.”
Hence, dramatic change: “The surgery renewal commitment to patients and the significant changes it requires will do much more than just get us back to the number of surgeries performed pre-COVID-19.
“It will enable us to keep up with new demands for surgery and complete the surgeries lost to COVID-19 within approximately 17 to 24 months.”
From the day that Dix launched surgical renewal, there were doubts that the health authorities would go along with the goals of increased output and procedural streamlining.
But the three chairs came on board on that score as well. While I’ve quoted their letter (which was also signed by chairman Eric Harris of Providence Health), board chairs Doug Cochrane of Interior Health, Leah Hollins of Island Health and Colleen Nyce of Northern Health, have weighed in with similar commitments to their communities.
One of Dix’s masterstrokes was recruiting Michael Marchbank, the former CEO of Fraser Health, to oversee surgical renewal and to advise on what the system could accomplish with the appropriate resources and the right amount of pushing.
Dix has committed $250 million in additional funding this year and probably the same will be forthcoming in 2021. He has also committed to recruit staff to overcome obstacles — such as hiring nurse anesthetists to backstop established anesthetists, who have sometimes been a bottleneck in the past.
While together this constitutes a formidable commitment to clear the backlog, there is a significant if valid escape clause.
“As Dr. Bonnie Henry and health officials around the globe have indicated, we are likely to see a second wave of COVID-19 this fall,” wrote the board chairs. “That, or a surge in new cases over the summer, will again impact our hospitals and the number of surgeries that can be safely performed.”
All the more reason to stockpile resources and maximize the opportunity to perform as many surgeries as possible over the summer and into the fall. In the absence of an edict from Dr. Henry to put on the brakes, it should be full speed ahead on surgical renewal.
With the board chairs having committed themselves to the goals of surgical renewal, they have also made their authorities accountable for the outcomes.
If the stats in Dix’s periodic updates don’t show the necessary progress to clearing the backlog in the weeks ahead, the public can reasonably expect that he and the board chairs will explain why.
In the absence of an edict from Dr. Henry to put on the brakes, it should be full speed ahead on surgical renewal.