Appraising workload and the scope for change in orthopaedics

This paper describes a method of appraising general workload in any Orthopaedic Department and can be used by Surgeons themselves as well as management to assess performance. During the period 1983-1986, the Author undertook research in three different Orthopaedic Departments in one Region. In each department a standard initial phase of work was carried out to assess the potential for improvements in the way resources were used. This initial approach became a useful standard method of appraising the main areas of workload and their inter-relationships. The approach described uses official hospital data supplemented as far as possible by data collection locally. As well as helping the Author to identify specific areas of investigation amenable to further economic evaluation (e.g. See CHE Discussion Paper 14) a general picture of a ‘typical’ orthopaedic department was built up during this process. Relationships between one part of the Orthopaedic ‘system’ and another were carefully enumerated at hospital level and knowledge of these can also help other departments engage in the process of ‘self-audit’. Some departments moreover may which to refine the data locally and therefore the method of calculation and the sources of data are provided in the appendices. The second part of this paper deals with the implications for workload of different organisational arrangements. For example, what impact could the provision of an overnight stay ward have on the throughput of in-patient beds? Is it better to separate cold and trauma orthopaedic beds formally or leave this flexible? Using the model of an orthopaedic department described it is possible for those influencing the pattern of Orthopaedic care at a district level to anticipate the effects of policy changes before actual implementation. Specific changes of policy, however, require further analysis to assess the effects on costs and outcome; these can be provided with the help of a health economist.