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A patient during a right ankle arthroscopy procedure at St. Paul's hospital in Vancouver November 2, 2010.

JOHN LEHMANN/John Lehmann/The Globe and Mail)

There is a special observer from the public taking in Ken Zhu's right ankle arthroscopy on this particular morning at St. Paul's Hospital in downtown Vancouver. It's the patient, himself.



Pulling down his thin hospital bed sheet to get a better view, Mr. Zhu gazes intently at the video screen showing surgeon Alistair Younger skillfully working away inside his damaged ankle.



The two interact throughout the 40-minute procedure. "That piece of bone shouldn't be there?" wonders Mr. Zhu, aloud. "Yes, there's a piece down there near the end," Dr. Younger replies. He asks whether Mr. Zhu is in any discomfort. "No, okay," says the patient.

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As ordinary as their conversation seems, the fact that it's taking place at all is one of the keys to a remarkable pilot project at St. Paul's that has achieved a stunning reduction in the hospital's once-horrendous waiting list for such surgeries.



Three years ago, there were 3,919 patients, waiting, on average, 734 days just to see a foot and ankle surgeon for consultation, let alone surgery.



Today, that list has been cut by more than 65 per cent, the time required to see a surgeon has plummeted from two years to less than four weeks, while the wait for actual surgery is down from 97 to 41 days.



Although not quite as dramatic, significant reductions have been achieved at St. Paul's for hand and wrist injuries, which are also part of the project.



"We are now seeing patients in lickety-split time," says Cheryl Bishop, director of the surgical program at Providence Health Care that runs St. Paul's.



The project's success is a vivid illustration that innovation and common-sense solutions to de-clog the country's frequently stopped-up delivery of timely care are possible within the public health-care system.



St. Paul's achieved its results through a series of well-thought-out changes, funded by a provincial innovation grant, that included:

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  • Setting up screening and triage clinics staffed by six specially trained GPs to whittle down the number of patients who really require surgery
  • Building two adjacent operating rooms, known as "swing rooms," to allow a surgeon to go back and forth between patients and work on each almost simultaneously;
  • Greatly increasing the use of local anesthetic, as was employed on Mr. Zhu. This facilitates speedier operations, cuts down on post-op recovery time, and minimizes patient discomfort.


Above all, however, the project emphasized a philosophy, just beginning to be trotted out in Canada, that earmarks funds for specific procedures, rather than simply tossing money into a general pot.



The St. Paul's project is now under the formal umbrella of British Columbia's pioneering program to implement this system, known as patient-focused funding.



The hospital has already negotiated a price with the province to perform 140 additional foot and ankle procedures. These extra operations mean more funds going to St. Paul's.



"Before, as soon as you went over budget, you'd slow down at the hospital," says Ms. Bishop. "But very focused funding gives you motivation. It makes you accountable. It protects that money from other priorities."



Dr. Younger says he now operates on as many as 12 patients a week "instead of three. Everything's so much quicker now. Patients are still waiting but not nearly as long."



Back in the operating room, Dr. Younger concludes his time with Mr. Zhu. "That's going to feel better, eh?" The patient laughs with relief.

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"We're doing Mr. Wood next," says the surgeon to his team.

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