The death of a baby and lobbying by doctors have led to a $1.4 million project at Waikato Hospital to overhaul its surgical services and reduce the $25m worth of planned surgeries outsourced each year.
In September the Herald revealed a baby died during delivery at Waikato Hospital last year after the mother was bumped from her elective caesarean because an emergency C-section took priority.
And earlier this year Waikato District Health Board was put on notice over the training of junior doctors in orthopaedics because of a serious imbalance in the types of surgeries they were learning.
Registrars were not performing enough elective surgeries to meet training requirements, putting the DHB at risk of losing accreditation in orthopaedics.
Clinical director for quality and patient safety Dr Doug Stephenson said the baby's death, a call by orthopaedic surgeons to maximise use of the hospital's 22 theatres, and a need to reduce the $25m spent on outsourcing elective surgeries resulted in the surgical services project.
The aim was to keep elective surgeries on schedule at Waikato Hospital, Stephenson said, instead of cancelling when an emergency situation presented, as was the case with the baby death.
Increased demand and pressure coupled with inadequate processes necessitated the overhaul, he said.
"This has grown exponentially on us and unless we change it ... we're looking at more and more [outsourcing]," Stephenson said.
Outsourcing meant sending patients to private hospitals in Hamilton and sometimes other public hospitals in different regions for their surgeries, paid for by Waikato DHB.
In total there were 22,249 surgeries for the 2016/17 financial year in Hamilton. Less than 2000 were outsourced to private hospitals in the city while the rest were performed at Waikato Hospital. Of the total, 14,573 were elective and 7676 were acute.
Part of the reason for the continued outsourcing was to meet Government health targets, which included increasing the volume of elective surgery by an average of 4000 discharges per year.
DHBs are subject to financial penalties if they do not meet the targets.
Waikato DHB was second only to Northland in the fourth quarter of the 2016/17 financial year target results, sitting on 114 per cent with 2374 discharges.
Acting chief executive Neville Hablous said there was "an absolute commitment" to clawing back the $25m worth of elective surgeries outsourced each year and instead using resources already available in the public sector.
"It's basically unconstipating the organisation."
The six-month project is being undertaken by Australian business improvement consultancy Keezz with the DHB paying $1.4m for eight consultants to develop the new operating model.
The consultants, who began four weeks ago, were mapping out the surgical process with the help of doctors, nurses and other clinical staff.
They will then help staff implement the new system once a better process is worked out.
When asked about a similar project begun in the orthopaedics department last year by a business manager at no extra cost to the DHB, Stephenson and Hablous said that workshop only covered one specialty.
The surgical services project covered all specialities including the Emergency Department, orthopaedics, medicine and obstetrics and gynaecology.
The earlier project, which was never completed, was one of the catalysts for the surgical services project, Stephenson said.
Another factor was the increased number of theatres, added four years ago, that had not dented the number of surgeries being outsourced.
Keezz was chosen because they came highly recommended, they had glowing references, and were approved by clinical leaders.
A former staff member, who didn't want to be named, said the project would fail if managers were not adequately trained to continue the new processes once the consultants left.
Stephenson said there was complete buy-in by healthcare staff to the project and their ownership of the project would continue after implementation.