08. Feb. 2010

Reducing Delays Through Cross-Training

by Kimball Fink-Jensen

"This is a great case of cross-training leading to reduced delays and more effective utilisation of scarce resources in the New Zealand health system."

New Zealand's public health system is a double-edged sword. On the one hand universal health care means every New Zealand resident is entitled to free hospital-based medical care so in theory no-one misses out. On the other hand, the processes and resources in the system are not well balanced, frequently leading to delays and procedures being carried out in resource-stressed hospitals where more flexible general practitioners could carry those out instead.

On 6 February 2010 the Christchurch Press carried a story about how one region of New Zealand, covering 10% of the population, had carried out 4,000 procedures to remove skin lesions in general practices rather than in hospitals.

Sixty-four GPs have been trained by plastic surgeons to remove the lesions at their own practices rather than take up specialists' time. The programme is part of the Canterbury District Health Board's focus on care in the community to keep people away from expensive hospital beds. In the past, patients had to be referred to a hospital specialist, which could take up to six months, and then wait many months for an operation.

The queue for specialists is so long that even removal of a simple skin lesion was being substantially delayed leading sometimes to the lesion becoming cancerous, causing needless suffering to the patient and their family and substantially increasing the costs to the health system.

With new training introduced in October 2008, GPs can now perform non-complex operations or refer patients to a GP who has been trained. Dr Graham McGeoch said he was removing up to five skin lesions a week at his Barrington practice in Christchurch.

The training was relatively quick and simple and the procedure in simple cases is also quick so general practices can get through significant numbers of them.

The complex cases [Dr McGeoch] referred for surgery were being seen faster and were referred back to him for checkups rather than having to visit the hospital a second time.

So the benefits list grows - now the complex cases where the delay in being seen by a specialist can be critical were now being handled more successfully as well.

This is a great case of cross-training leading to reduced delays and more effective utilisation of scarce resources in the New Zealand health system.

The same principles apply in all industries. Wherever bottlenecks and queues build up, wherever there are interruptions to flow, there are always ways to improve the process and reduce delay to the customer (patient).

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