Gain Sharing in Hip and Knee Replacements

Christina Barr Archive

The 10,000 Albertans who will have a hip or knee replaced this year are going to be up and mobile sooner after surgery, have less pain and better physical outcomes, be home from hospital sooner, and express greater satisfaction with their care than those who had the same surgery five years ago. These improvements won’t cost taxpayers any additional money. In fact, costs are being reduced because of them.

In June 2010, the first Hip and Knee Learning Collaborative was held in Edmonton, with representatives from 12 of the 13 hip and knee replacement hospitals across Alberta. This Learning Collaborative introduced participants to balanced scorecards and enabled these hospitals to develop their first hip and knee replacement balanced scorecards. The balanced scorecard is a quarterly continuous improvement tool with measures in each of the Health Quality Council of Alberta’s six dimensions of quality.

In the past five years since the balanced scorecards began, sites continue to regularly use the balanced scorecards to inform and monitor their quality improvement work. Participants meet in their multidisciplinary site teams as well as site representatives attending provincial meetings. These provincial meetings enable sites to learn from one another. Successes to date include reduced length of stay, increased mobilization on day of surgery, reduced blood transfusions, and improved patient satisfaction. 

Alberta Health Services’ Bone and Joint Health Strategic Clinical Network has created an infographic on the results of the work to date. This shows how the improvements interplay and how the principles of gain sharing have been applied in the hip and knee replacement program. The estimated $37.7 million in savings from decreased length of stay in addition to the estimated $2.5 million in savings from decreased transfusions equates to over $40 million in savings from the program to date.

In January 2016, representatives from the 13 hip and knee replacement hospitals across Alberta once again came together at a Learning Collaborative. Participants attended interactive learning sessions on key topics, such as rapid discharge, and reviewed their balanced scorecards. While significant gains have been made, there are opportunities for improvement using the latest evidence for the management of patients seeking hip and knee replacements. The participating hospitals continue to share their successes and learnings to advance the quality of hip and knee replacement services in Alberta.