Project Details
About the Project
Often, tough times spur change, and Christmas 2024 was no exception. The already short-staffed group of Surgical Assistants was facing the usual challenges of scheduled time off and illness, leading to a holiday season of frustration for patients, physicians, and nurses alike. There was collective desire from surgeons and assists alike to find solutions so that the holiday crisis wouldn’t happen again. A group of surgical assists including Dr Tania Wall and Dr Jane Papp sought funding through the South Island MSA to support engagement work around this issue.
Not only do Surgical Assists support surgeons during elective cases, they also provide 24/7 in-house support for emergency care for vascular, general, orthopedic, and pediatric surgeries. Not having enough Surgical Assistants on the rota means that surgeons end up assisting each other, cancelling elective cases, or even diverting urgent cases to other facilities.
The first step undertaken by the project team (which included Dr. Ellen Forbes and Dr. Geoff Protheroe) was to understand the problem: They developed and sent out surveys to Surgical Assists to identify barriers to providing coverage, crunch points, and pebbles in shoes. They also polled the surgeons to learn what they value in Surgical Assists and what they see as the problem.
84.2% of surgeons reported difficulties scheduling Surgical Assists over a one-year period, with 10.5% having to cancel a slate, cancel a case, or divert due to their inability to secure a surgical assistant. Results were broken down into Schedule, Income, Culture, and Experience, and change ideas were developed in each category.
Some solutions felt simple: Surgical Assists are privileged by site, limiting their ability to cover at multiple sites as needed. Other solutions were well outside of the project scope, more systemic in nature: The pay for surgical assist services is inequitable, so physicians can pick and choose the cases they assist on. Notably, the data showed that, “if things don’t change, one third of Surgical Assists would cut down the amount they work.”
The project team shared their comprehensive results back with those who were surveyed, at SISPAC (Island Health Surgical Services Committee), and to the provincial Division of Surgical Assistants. Everyone agreed that this was an important topic, but there wasn’t traction to create change on any level. As shared by Dr. Wall, “there was no connection to next level people, or the ability to advocate.”
Some progress has been made, one involving a grassroots approach: Using a WhatsApp chat, surgeons are able to share shift availability more readily and quickly with Surgical Assistants. While the group of local Surgical Assists has grown, thanks to the successful recruitment of some hospitalists and retiring physicians, “if we don’t change the system, we will lose them again. We aren’t changing the trajectory, just delaying it.” Next steps include speaking with Island Health about revisiting the approach to privileging Surgical Assists within Island Health.
Sincere thanks to Drs. Wall, Papp, Forbes, and Protheroe for their passion, persistence, and quality improvement approach!