title: Increasing productivity, reducing cost and improving quality in elective surgery in New Zealand: the Waitemata District Health Board joint arthroplasty pilot.
abstract: BACKGROUND
  In 2010, Waitemata District Health Board piloted a new model of care for total hip and knee arthroplasties. The pilot was incentive based and clinically led. The participating surgeons and anaesthetists were responsible for increasing surgical throughput. The pilot aimed to increase productivity, reduce cost and increase quality for patients.
  
  
  OBJECTIVE
  To compare costs and outcomes for elective hip and knee arthroplasties carried out at the pilot site (Waitakere Hospital) compared with the main District Health Board hospital site (North Shore Hospital (NSH)).
  
  
  METHODS
  A retrospective matched cohort study of hip and knee replacements discharged between 1 July 2010 and 31 March 2011, comparing costs and outcomes at the pilot site compared with the NSH site. Only non-complex procedures were included, and routinely collected data were used.
  
  
  RESULTS
  One hundred and seventy-seven hip replacements (77 NSH, 100 pilot) and 158 knee replacements (88 NSH, 70 pilot) were analysed. Total inpatient event costs were 12% and 17% lower for hip and knee replacements, respectively, at the pilot site compared with NSH. Significant reduction in operation length (39% hip, 36% knee) and length of stay (38% hip, 39% knee) were found in the pilot groups compared with NSH.
  
  
  CONCLUSIONS
  Implementation of an innovative new model in a public hospital setting has produced significant increases in productivity and reduced overall costs. This model could potentially be used in other public healthcare settings for non-complex elective surgery.
authors.affiliation: Department of Surgery, Waitemata District Health Board, North Shore Hospital, Private Bag 93-503, Takapuna, Auckland, New Zealand. john.cullen@waitematadhb.govt.nz
authors.forename: J
authors.initials: J
authors.lastname: Cullen
authors.forename: D
authors.initials: D
authors.lastname: Bramley
authors.forename: D
authors.initials: D
authors.lastname: Armstrong
authors.forename: L
authors.initials: L
authors.lastname: Butler
authors.forename: P
authors.initials: P
authors.lastname: Rouse
authors.forename: T
authors.initials: T
authors.lastname: Ashton
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019644:Arthroplasty, Replacement, Hip / Q000191:economics* / Q000592:standards*; D019645:Arthroplasty, Replacement, Knee / Q000191:economics* / Q000592:standards*; D003695:Delivery of Health Care / Q000458:organization & administration* / Q000639:trends; D017558:Elective Surgical Procedures; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D016555:Matched-Pair Analysis; D008505:Medical Staff, Hospital; D008875:Middle Aged; D009520:New Zealand; D017063:Outcome Assessment, Health Care; D018579:Patient Selection; D017064:Process Assessment, Health Care; D011787:Quality of Health Care