SPEECHES

Dr. Ron Zernicke, Executive Director
Alberta Bone and Joint Health Institute

Release of Results of the Alberta Hip and Knee Replacement Pilot Project
Monday, June 18, 2007

Calgary, Alberta

This is truly an exciting moment – one that we have been anticipating eagerly.  You’ve no doubt heard the horror stories about long, painful waits for hip and knee replacements.  Many of those who wait in pain are the most vulnerable in our society – the elderly. 
Our new made-in-Alberta model has shown that these waits can be slashed, service quality can be enhanced, and service delivery can be made more efficient. 
The comprehensive 3-month results of the pilot – a test of this new approach on 1,125 patients that we are releasing today – show that for those patients in the pilot:

1. Wait time to see a specialist fell to just 21 days on average – from 145 days.
2. Wait time for surgery dropped to just 37 days on average – from 290 days.

It gets even better – especially for people who can think of better places to stay than in the hospital.  This new approach took hospital stay down by almost a day and a half – to 4.7 days, from an average stay of 6 days.
Not surprisingly, patients – and their care providers – were more satisfied.
Patient outcomes improved – the ultimate objective of any endeavour in health care.  For example, patients were better able to function physically and there was less pain following their hip or knee replacement.  Eighty-five per cent of patients were up and mobile the day of their surgery.
These improvements were accomplished with greater efficiency, with improved utilization of resources, especially operating room resources.
Best of all, we think we can do even better as practices and procedures improve with experience.  We have built into the new hip and knee replacement model the necessary mechanisms for continuous improvement, and we expect to set the standard higher over time.
Making these improvements was not easy.  There are many different parties involved in health care, each with a distinctive perspective and unique needs and circumstances.  But we accomplished change by engaging in one of the most comprehensive and collaborative efforts in health care service delivery ever seen in Canada. 

It involved researchers, medical practitioners, service leaders, policymakers and administrators working together:

1. Alberta Health and Wellness provided infrastructure funding and a supportive policy environment. 
2. Regional health authorities contributed administrative expertise, surgical facilities and teams, hospital data and personnel, and served as agents of systems and process change. 
3. The Alberta Orthopaedic Society provided clinical expertise and essential clinical data and facilitated surgeon consensus on new systems and processes. 
4. Physicians brought a frontline view of service and essential clinical guidance and feedback.
5. The Alberta Bone and Joint Health Institute provided health system research, design and development and evaluation expertise, as well as financial support.

Together, these partners took a novel approach – one that is based on the best evidence, benchmarked against world leaders, and standardized to ensure consistent and equitable service for all patients.  Services are team-based, integrated, and delivered with a shared-care approach that puts patients at the centre of their care and keeps them there.  Patients are empowered and accountable.
These are the main results of a pilot project that ranks as one of the most extensive health care services delivery evaluations – particularly in the area of bone and joint – ever undertaken in North America. 
But I want to point out that these improvements only demonstrate what can be achieved if they can be implemented for all patients.  The partners in this effort have built the structure and engineered the processes that can make this level of access and service the standard for all Albertans.  The good news is that – with the support and encouragement of Alberta Health and Wellness – we are now working together to make this happen as quickly as possible for the other Albertans who need this surgery.
There is no time to waste.  Hip and knee replacements are most common in people 65 and older.  This age group is increasing in both number and proportion in Alberta.  There will be almost three seniors for every 10 working-age Albertans in the next 25 years.  That’s almost double the proportion today.  Obesity rates are rising dramatically, increasing the population risk for osteoarthritis, the leading cause of hip and knee joint replacement.
These demographic projections mean bone and joint health care is rising to the top of concern.  The Institute, the health regions, the doctors and other health care professionals, and government are responding by expanding the hip and knee model throughout the province and to other areas of bone and joint care – such as back and spine – where a team approach to health care services is needed.

We are particularly grateful to Minister Hancock and Alberta Health and Wellness for providing the funding to continue this important work for Albertans.  And thanks to all of the partners – especially physicians, surgeons and health regions – we have the collaborative environment needed to continue to move forward.
Thank you.