CAHI FELLOW - PANAMA
OPTIMIZATION OF SURGICAL PROCEDURES
FOR PANAMA’S SOCIAL SECURITY
Edgardo Saavedra is a physician, surgeon, gastroenterology specialist, and the Deputy Director of specialized care for Panama’s Social Security. He has been working at Social Security for the last 15 years. He is a member of the 5th generation of CAHI Fellows.
ABOUT HIS PROJECT
Dr. Saavedra’s project focused on the optimization of surgical procedures to reduce patients’ waiting time for procedures and treatments. His goal is to standardize processes and protocols of the Social Security services, to improve the provision of elective surgeries needed by patients.
In Dr. Saavedra’s experience, a patient who does not undergo surgery within a proper timeframe, may suffer complications which negatively affect the quality of life for both the patient and their family. Unnecessary delays can also increase costs for the patient and governmental institutions.
Some surgical procedures, although elective, provide great value for the people affected, such as gallstones, cataracts, and some gynecological and urological procedures. All of these are simple interventions with typically short recovery periods, improving the patients’ quality of life and health.
“A surgery that is not done within three months of the diagnosis is delayed. In Panama, we have patients that must wait years to receive an intervention, and this is not sustainable. Between 8,000-10,000 patients are not able to have their needed surgery every year.”
The most requested specialty procedures are clearly identified, explained Dr. Saavedra. He listed hernias, tumors, and hysterectomies as some of the most needed procedures in the Social Security system. In the specialty of ophthalmology, cataract surgeries are most needed. In orthopedics, knee and hip replacement are in highest demand. Finally, neurosurgical procedures and cardiovascular surgeries round out the waiting list.
The situation is complicated by multiple intervening factors, especially the human element. Part of the process to reduce the waiting times is raising awareness with the medical teams, promoting better performance of the specialists, encouraging everyone to respect the timetables and working hours for the surgeries in every shift. As it stands, quite often only one procedure is completed in a day when three were scheduled. Another challenge is the availability of the materials. The purchase of medicines and other medical supplies for surgeries is often delayed. Dr. Saavedra shared, “we need to be more prepared in advance, understanding what we need for every intervention.”
The third aspect of this challenging situation is the lack of availability of operating rooms and recovery beds for patients who require surgery. Like other countries in Latin America, hospitals do not have enough rooms and beds for the number of patients.
“We are working to create a system to meet the need for surgery within three months or less of the diagnosis. We need to attend the waiting list that currently exists in the system. In Panama, we operate on between 60,000 - 70,000 patients in the 18 surgical units in the country. Of that number, 30% are emergencies, and the other 70% are electives. We need to complete 10,000 additional surgeries every year to resolve the three-year delay.”
The effort and commitment of all the medical teams and nurses is required to coordinate the availability of operating rooms and medicines. That is all part of the new protocols and Dr. Saavedra is optimistic that the change is possible.
“In the last four years, the Social Security Services has authorized extraordinary days of overtime work, achieving improvements in operational efficiency and reducing the delay, but we need do more. We must create a new sustainable model. In 2017, we ran a pilot program, with the coordination of the executive office of Social Security in which we choose 14 of the most necessary surgeries and assigned them to hospitals outside of Panama City, so called peripheral hospitals. In 6 months, using the installations of 12 hospitals, we completed 12,700 additional procedures. We demonstrated that this process could work.”
Dr. Saavedra insists that by following the protocol and improving the procedures, the Social Security will avoid extra costs related to complications because patients receive needed attention in a timely manner, which is more efficient for all. His vision is to replicate this model throughout the public health system in Panama.
CAHI FELLOWS PROGRAM
“Through CAHI, we have learned to organize our projects and to identify the idea that mobilizes us. The initiative that I am leading is very complex, it has a national implication, and through the CAHI program I learned that the implementation must be progressive, beginning with four hospitals and then expanding the protocols to another health center.”
In the CAHI Fellows Program, participants receive tools for strategic planning and the design and development of projects that are efficienct. In the case of Dr. Saavedra’s initiative, the objectives are related to implementing a dynamic process to reduce the number of patients on waiting lists for surgery.
“I have expanded my knowledge in project management, learned how to measure results, identify problems, define objectives, use statistics, and implement a process step-by-step. All of that has been valuable, and, in the process of applying this new knowledge while implementing my project, I am gaining confidence about the impact I can generate.”
Dr. Saavedra expressed that now he feels like part of a network of support which allows him to expand the impact of his work. He knows that there is this group of colleagues and peers in Honduras, El Salvador, Guatemala, Nicaragua, Costa Rica, and he can ask for help at any moment of the process.
The CAHI Fellows Program has been a challenging process, with demanding expectations for the completion of homework and achievement of the learning objectives.
“I am grateful to CAHI and INCAE for this high-level program. I think that now the following-up is the key. We must work hard to stay connected with one another and continue with our initiatives to see good results and impact in two or three years. I know we can achieve significant changes in our countries and the region, and that is the vision of CAHI Fellows.”