Academic journal article Australian Health Review

Capital Planning for Operating Theatres Based on Projecting Future Theatre Requirements

Academic journal article Australian Health Review

Capital Planning for Operating Theatres Based on Projecting Future Theatre Requirements

Article excerpt


Capital planning for healthcare services provides a range of significant challenges for health planners and policy makers. Activity projections alone provide only part of the toolkit required to undertake service development and capital planning, with a key challenge being estimation of the effect of future service demand on capital requirements such as operating theatres.

The NSW Department of Health and ACT Health commissioned a project in 2006 to identify the underlying assumptions required for an effective process of determining capital requirements for operating theatres on the basis of inpatient activity projections.

Projections of inpatient demand reflect assumptions regarding the range of issues affecting utilisation of inpatient health services, such as: population growth and ageing, trends in health status of the population, the effect of healthcare technology, and changes to models of care. Projections thus reflect a range of assumptions about the movements in each of the components.

Long-term projections of acute inpatient activity inNewSouth Wales (NSW) are currently based on a software program called aIM2005. This program is based on regression analysis of trends in speciality service and age-specific trends in admission rates and length of stay.1

The aIM2005 program allows health service planners to project future activity by taking into account the main drivers of future demand for health services - trends in hospital admissions, population growth and population ageing. The methodology used is broadly consistent with that of long-term projection tools used in other jurisdictions in Australia and internationally, including the USA, Canada and the UK.2-5 The base case assumes that the pattern of service provision remains broadly similar to the current pattern of service delivery (e.g. location of services, patient flows). Projections from aIM2005 provide an agreed base (estimate) for clinical and capital service planning at the whole-of-hospital level. The program also enables health service planners to undertake scenario modelling at the local level to model the possible effects to changes in service provision such as the opening of a new hospital, or providing new clinical services at existing hospitals.

Prior to the development of this operating theatre capital planning model, the translation of these estimates into projected requirements for operating theatres was on the basis of a classification of acute inpatient activity into a medical/surgical/ procedural activity within the aIM2005 projections. Assumptions were made by planners regarding the number of operations and procedures performed per theatre session, the number of theatre sessions held per day and the number of days theatres were open in 1 year. The approach attempted to synthesise the 'existing policies and plans, the views of and visions of key stakeholders, evidence of best practice, the skills and work practices of key personnel, changes in technology and equipment, service standards and benchmarks, and the capital and recurrent funds.'6

The existing methodology was relatively crude and was neither widely understood nor accepted among health planners and clinicians. The supporting information to inform key planning parameters such as service standards, benchmarks and evidence of best practice was not always available, creating the potential for inconsistency in the planning approach and assumptions for different settings.

In response to these concerns, the NSW Department of Health in partnership with ACT Health engaged KPMG in 2006 to develop a new method for projecting future requirements for operating theatres, resulting in an Operating Theatres Requirements Projection Model and an accompanying capital planning guideline for operating theatres.

Consultation and process

The project was overseen by a Project Reference Group comprising senior officials of the NSW Health and ACT Health Departments, surgeons nominated by the NSW Surgical Services Taskforce and senior health planners from NSW Area Health Services and the Australian Capital Territory (ACT). …

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