Priority setting for acute surgery procedures

Abstract

Accessibility as well as providing care on equal terms to all inhabitants are the main objectives stated in the Swedish law SFS 2017: 30. As Sweden is facing demographic imbalances with more patients in need of care, prioritization decisions have become more common. Health care professionals daily face various forms of prioritization decisions on how to use available resources to provide care on equal terms. However, a literature review scoping relevant existing research shows that guidelines on how to prioritize care in daily practices are few. Further, no studies give an in-depth process description on how priority decisions might be evaluated or improved in practice.

The study's extensive empirical material was obtained by observations and interviews from a four-month long improvement process at Skaraborgs Hospital Group (SkaS) that sought to improve local priority guidelines for acute surgery within as well as between specialties. The case description gives an overall narrative of a long volatile process with perspectives from both involved and non-involved staff capturing the work to improve prioritization routines at SkaS.

The research questions focus on how priorities for acute surgery are currently performed at SkaS and what factors affect priority setting? Further, is the current priority setting perceived to be fair and work towards the targeted statutory objectives in practice? Finally, has the priority process affected SkaS and what benefits and shortcomings can be identified to improve priority setting in daily practice? A thematic qualitative content analysis was used to identify key themes that were related to the research questions. The identified themes were also validated by participants in the improvement project.

The study´s result found homogeneous perceptions among co-workers regarding routines and justice in the case process concerning priorities, but certain scenarios imply that some priorities were not solely based on patient's needs assessment. However, patient safety and medical treatment quality were found to not be at risk despite delayed acute surgeries. Transparent dialogues with an understanding of each specialty department's patients were found to be a key factor to improve current routines. The main benefit was insights of learning in the process. In addition, routines for priorities between specialties were argued to be beneficial to continuously work with. The organization's process confirms that SkaS succeeded to decide on a value-creating change to prioritize elective surgeries according to eight principles stated in the Swedish law.

The study’s findings support previous research that there remain conflicts of priority setting in healthcare, especially regarding horizontal practical priorities. The study also provides an insight into processes from everyday care illuminating how priorities are complied with in practice. The findings could be relevant for other health care organizations working with improvements project in similar contexts.