Access to Hip & Knee Replacement Surgery:
A major accomplishment of the past decade has been the achievement of consensus regarding the National Core Model of Care for Hip and Knee Replacement Surgery and the development of a Toolkit to guide implementation across the country. The development has taken place over four phases, from engagement in Phase I to implementation in Phase IV. With the support of BJD, this work has made a measureable difference in the quality and efficiency of Canadian healthcare.
Phase I: Engaging the National Knowledge Translation Network
In the first phase of the project, leaders from across the country were engaged to shape the change. Orthopaedic surgeons were first engaged; they invited their hospital administrators, not-for-profit and patient organizations, and regional health authorities, who engaged provincial governments. The Network determined that their goal was to develop a sustainable system of accountable, patient-centred health care delivery that would efficiently provide the best quality and timely bone and joint care and prevention to all Canadians. This phase set the stage for the work that followed, which would lead to the development of the Toolkit.
Phase II: Consensus on the National Core Model of Care
This phase saw the establishment of a framework/model of best practices to capture and communicate innovative ideas, methodologies and processes while being flexible enough to allow it to be applied in individual jurisdictions. To ensure sustainability, the model was built on the three pillars of Access, Quality and Cost. In April of 2008, consensus was reached on a National Core Model of Care for Hip & Knee Replacement Surgery that would address Pre-Operative, Surgical, and Post-Operative processes and considerations, while ensuring continuous evaluation.
Phase III: Developing the Toolkit
Phase III saw the development of the Toolkit to guide implementation of the Model across the country. More than 400 stakeholders from across the country were engaged in the process of amalgamating best practices, which were then synthesized into a Toolkit and website (http://www.boneandjointcanada.com) where specific tools could be shared with clinicians across the country. The Toolkit, which is based on the best available evidence, outlines the model of care and provides practical tips on application of the model.
Phase IV: Implementing the Toolkit
Bone and Joint Canada now finds itself in Phase IV. Having just completed a planning meeting on March 20th in Toronto, Ontario, the Bone and Joint team will implement a national communication strategy to ensure that surgical sites across the country are familiar with the Model and the Toolkit. Select sites will be supported in rolling out their implementation strategies. Using forecast modeling, we will study the health human resource implications of variations on the model. And we will work to ensure consistent data collection that will enable more effective resource planning and outcome comparisons across the country.