A Comprehensive Case Study of an Orthopaedic Surgery Central Intake Service in the Winnipeg Regional Health Authority: A Single-Entry Model to Manage Waiting Times for Total Joint Replacement Surgery of the Hip and Knee

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dc.contributor.advisorMarshall, Deborah A.
dc.contributor.authorDamani, Zaheed
dc.contributor.committeememberNoseworthy, Thomas Wm.
dc.contributor.committeememberQuan, Hude
dc.contributor.committeememberBohm, Éric Richard
dc.contributor.committeememberMacKean, Gail
dc.contributor.committeememberYelin, Edward H.
dc.contributor.committeememberHildebrand, Kevin A.
dc.date2018-11
dc.date.accessioned2018-09-05T14:45:44Z
dc.date.available2018-09-05T14:45:44Z
dc.date.issued2018-04-09
dc.description.abstractBackground: Single-entry is an increasingly prominent waiting time management strategy in healthcare but its impact on quality of care is poorly understood. We evaluated the Winnipeg Central Intake Service (WCIS) for total joint replacement (TJR) surgery of the hip or knee, a single-entry model (SEM) to manage patients referred for TJR surgery of the hip or knee. Methods: A pre/post mixed-methods case study approach was used to measure the WCIS' influence on six dimensions of quality of care: acceptability, accessibility, appropriateness, effectiveness, efficiency, safety. Qualitative interviews were used to assess experiences of patients, family physicians, orthopaedic surgeons, surgical office assistants and WCIS project team members. A pre/post intervention cross-sectional design was used to quantitatively assess changes in the six dimensions by comparing historical and prospective cohorts. Results: Our qualitative inquiry revealed that benefits of the WCIS included streamlined processes, greater patient access, improved measurement and monitoring of outcomes. Challenges included low awareness, change readiness, and initial participation among stakeholders. Unanticipated consequences included workload increases, confusion around stakeholder expectations, and under-reporting of data by surgeons' offices. Stakeholder acceptability was conditional, not universal. Assessment of capacity and readiness to change, and efforts to increase awareness, preparedness and uptake are critical. Factors for successful implementation include clear communication, robust data collection, physician leadership, and patience by all (especially implementation teams) allowing for an effective top-down, and bottom up approach. Our quantitative analysis revealed that the WCIS reduced variability across surgeon waiting times, with modest reductions in overall waits for surgery. There was improvement in some, but not all, dimensions of quality. Waiting time was significantly improved (WT) for consult for TJR of the hip (WT1) and all WTs for TJR of the knee. Total knee replacement surgeries performed within the nationally-recommended 26-week benchmark increased by 5.9% post-WCIS. Post-surgical complication rates (safety) were lower post-WCIS. Accessibility and safety were the only quality dimensions that changed (post-WCIS for TJR of the hip and knee). Conclusion: Overall, WCIS implementation contributed to improvement in some, but not all dimensions of quality of care. This is the first study to comprehensively assess the influence of SEMs on the delivery of TJRs across all dimensions of quality. Findings of this research are generally consistent with existing literature related to SEMs and change management in healthcare. SEMs show an ability to improve accessibility without adversely affecting other dimensions of quality, albeit with conditional, not universal stakeholder acceptability. Limitations of this study include non-longitudinal cohorts, and availability and quality of data. Findings from this research can help strengthen existing SEMs and inform development of new ones for improved patient experience and outcomes and system performance.en_US
dc.identifier.citationDamani, Z. (2018) A Comprehensive Case Study of an Orthopaedic Surgery Central Intake Service in the Winnipeg Regional Health Authority: A Single-Entry Model to Manage Waiting Times for Total Joint Replacement Surgery of the Hip and Knee (Doctoral thesis, University of Calgary, Calgary, Canada). Retrieved from https://prism.ucalgary.ca. doi:10.11575/PRISM/32878en_US
dc.identifier.doihttp://dx.doi.org/10.11575/PRISM/32878
dc.identifier.urihttp://hdl.handle.net/1880/107700
dc.language.isoeng
dc.publisher.facultyCumming School of Medicine
dc.publisher.facultyGraduate Studies
dc.publisher.institutionUniversity of Calgaryen
dc.publisher.placeCalgaryen
dc.rightsUniversity of Calgary graduate students retain copyright ownership and moral rights for their thesis. You may use this material in any way that is permitted by the Copyright Act or through licensing that has been assigned to the document. For uses that are not allowable under copyright legislation or licensing, you are required to seek permission.
dc.subjectHealth Services Research
dc.subjectQuality of care
dc.subjectSurgery
dc.subjectarthroplasty
dc.subjectwaiting times
dc.subjectwaiting list
dc.subjectwaiting time management
dc.subjectsingle-entry models
dc.subjectcentralized intake
dc.subjectpooled lists
dc.subject.classificationHealth Sciencesen_US
dc.subject.classificationHealth Care Managementen_US
dc.titleA Comprehensive Case Study of an Orthopaedic Surgery Central Intake Service in the Winnipeg Regional Health Authority: A Single-Entry Model to Manage Waiting Times for Total Joint Replacement Surgery of the Hip and Knee
dc.typedoctoral thesis
thesis.degree.disciplineCommunity Health Sciences
thesis.degree.grantorUniversity of Calgary
thesis.degree.nameDoctor of Philosophy (PhD)
ucalgary.item.requestcopytrue
ucalgary.thesis.checklistI confirm that I have submitted all of the required forms to Faculty of Graduate Studies.en_US
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