Surgical reform partnership

A key component of Enhanced Recovery After
Surgery plus Prehabilitation (ERAS+) program is preoperative education which aims to inform and
empower patients about their care and recovery.
Pre-operative education via virtual surgery school
(VSS) is well established locally and internationally.
The collaboration between WCMICS and WMHSP
has contributed valuable project management
support and content expertise to enable the
planning, co-ordination, and delivery of the
initiative.
The WMHSP health services developed a total of
twenty-one VSS videos. The WMHSP leveraged five
existing general VSS videos developed by Peter
MacCallum Cancer Centre and expanded the video
set to a total of nine general videos. In addition,
twelve condition-specific videos were developed to
meet the specific needs of gynaecological,
orthopaedic, colorectal, and head and neck surgical
patients. Oncology educational topics covered are
diverse and include: tracheostomy, patient journeys
and pelvic floor training.

With demand for planned surgery at an all-time
high, the WMHSP has established multiple
partnerships across the region to enable the sharing
of available theatres and procedure rooms. These
initiatives will expand the available capacity across
the system and improve access to planned surgery
for patients.
A Rapid Access Hub was launched in March 2023 at
Mercy Health (Werribee), which has so far delivered
an additional 669 endoscopy procedures (as of 30
June 2023) for patients from Western Health, Royal
Melbourne Hospital and the Royal Children’s
Hospital. The hub has also freed up available
theatre capacity at WMH to enable RCH surgeons
to deliver 21 surgical procedures (as of 30 June
2023) closer to home for patients living in the
Wyndham LGA.
Additional procedures will be delivered for Gynaeoncology patients from the Women’s who will be
treated at Peter MacCallum Cancer Centre, utilising
available theatre capacity that is supported
through a cross credentialled workforce and
expanded short stay bed capacity.
Clinical, operational, legal and finance teams have
worked together to build the enabling infrastructure,
clinical models of care, systems and processes to
allow both patients and clinicians to cross
traditional boundaries to improve access to surgical
care.

A priority for the WMHSP’s elective surgery reform
program is reducing length of stay and readmission
rates, by increasing the rate of same day
procedures across the partnership. Health services
have individually commenced work in this space
and to add value the WMHSP have been looking for
ways to encourage and support the improvements
in same day surgery.
To improve clinician confidence in moving towards a
same day model of care, the project team are
exploring what is required in the after-hours period
to ensure patients continue to have access to safe
clinical support once discharged home. The first
phase of this work is to scope and design options
for after-hours model/s servicing the Royal
Melbourne Hospital, Royal Children’s Hospital, The
Women’s, Peter MacCallum Cancer Centre, Western
Health and Werribee Mercy.
Another component of this project is for the WMHSP
to support knowledge-sharing of same day
resources and project successes across the
partnership’s health services and clinicians.
Knowledge sharing is promoted through forums,
such as Safer Care Victoria’s ‘Expanding Day
Surgery: Lessons Learnt’ session. We have also
developed platforms to enable the sharing of
resources between health services to improve
collaboration across the partnership.
Finally, we are exploring opportunities for consumer
and primary health engagement in same day
surgery pathways. The WMHSP is engaging with the
North Western Primary Health Network to develop
communications for primary care to ensure GPs are
informed about the changes in same day surgery
and can discuss this with their patients who may be
referred for surgery.
By expanding the procedures that occur as day
cases, health services can increase the amount of
planned surgery provided, therefore reducing the
number of patients on waitlists and their waiting
time for surgery. Combined, the components of
project will aim to encourage health services in their
uptake of same day pathways and processes.

While demand for planned surgery is driven by a
range of factors, strong referral practices and
waitlist management can help us better manage
our surgical demand. The Waitlist Management
Improvement Project is working to improve the way
waitlists are managed, starting with reviewing
current waitlist management and referral practices
at each of our health services.
Phase 1 consisted of two components of work – the
Waitlist Forecasting Study and the Best Practice
Policy and Implementation Review. Participating
health services included Werribee Mercy Hospital,
Peter MacCallum Cancer Centre, Royal Melbourne
Hospital, Royal Children’s Hospital, Royal Women’s
Hospital and Western Health.
The Forecasting Study produced an interactive
data analysis tool projecting known and hidden
demand for planned surgery across the WMHSP, to
generate insight into system requirements for
addressing unmet and future needs. This forecasting
tool is being used by health services and the
WMHSP to understand how changes to demand
and surgical throughput rates could impact waitlists.
The Best Practice Policy & Implementation Review
examined health services’ current practices and
their alignment with the Government’s policy and
best practice guidelines, relevant to management
of waitlists across both specialist clinics and
planned surgery. The review has helped identify
common challenges and opportunities to strengthen
the way our health services manage planned
surgery waitlists.
Phase 2 of the project will focus on how to achieve a
regionalised approach to waitlist management
across the WMHSP. This work is in the early stages
and will align with one of the priorities in the
Department of Health Planned Surgery Reform
Blueprint which will be released later this month.

This West Metro HSP program aims to improve patient outcomes, experience, and
system sustainability using home-delivered and virtual care. Peter Mac @ Home has
expanded its daily care hours, with support from the Better at Home program. The
project comprised three distinct arms: Sub-acute, Surgical, and Medical/
Haematology Hospital In The Home (HITH) Projects.