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Table 7 Factors for success, sustainability and suitability for disinvestment in the SHARE pilot project

From: Sustainability in Health care by Allocating Resources Effectively (SHARE) 6: investigating methods to identify, prioritise, implement and evaluate disinvestment projects in a local healthcare setting

SUCCESS
A proposal is more likely to be successful if it meets the following criteria
Based on sound evidence or expert consensus
Systematic review of multiple RCTs; surgeons, nurses and allied health staff in agreement with findings
Presented by credible organisation
Review undertaken by the Australian Safety and Efficiency Register of New Interventional Procedures – Surgical (Royal Australasian College of Surgeons)
Able to be tested and adapted
There was limited opportunity to test and adapt as the VPACT funding required complete roll out
Relative advantage is evident
Clear evidence of multiple improved patient and health service outcomes; increased safety and effectiveness, reduced costs
Low complexity
The new technology is easy to use
Compatible with status quo
Referrers use the same referral process but divide patients into those eligible for the new procedure and those who should still undergo the old procedure
The new service was provided at a different campus and patients and staff had to adapt
There is some impact on other departments that also have to adapt
Attractive and accessible format
The new procedure is attractive to patients as it replaces surgery with an outpatient/bedside procedure
SUSTAINABILITY
A proposal is more likely to be sustainable if it has appropriate and adequate provision in each category
Structure
The new procedure is carried out within existing nursing and allied health structures with appropriate governance and supports
Skills
Nursing and allied health staff were upskilled in the new procedure; changes in scope of practice were documented and approved
Clinical project team leaders attended training and welcomed support and direction in project management, implementation and evaluation
Resources
Funding was provided for staffing, equipment and consumables
Final funding was less than the amount approved in the application process leaving the project short of one machine and associated consumables
Assistance from the Capacity Building and Project Support Services was provided
Commitment
The project had organisational commitment from the Technology/Clinical Practice Committee, and program and departmental commitment from clinical leaders and managers
Leadership
The clinical project team demonstrated effective leadership
SUITABILITY FOR DISINVESTMENT
Factors in the pilot project considered likely to be favourable for a disinvestment project at Monash Health
The current practice to be replaced and the new practice to be implemented were clear and patient eligibility was determined
The proposal for change was clear with clear objectives
Department and Program heads endorsed the change
External funding was available
The clinical pathway and referral process were documented
Detailed data collection and reporting was a requirement of the external funding
Baseline data had been collected and supporting data on patient group, burden of disease and impact of the new technology was available
There was strong local ownership and clinical champions
‘Win-win’ scenario for adopters where nursing and allied health staff were keen to take on new procedural skills and surgeons were happy to relinquish these cases to make operating theatre time available for other patients
Surgeons were allowed to keep the theatre time released by the changes and reduce their own waiting lists (rather than reallocation to other surgical specialties or closing theatres to realise savings)
Potential ‘quick win’ scenario for a disinvestment demonstration project as the proposal was already fully developed, funding had been approved, and deadlines were in place.
Key: Positive factors ✗ Negative factors