Table 3.

Organisation problems and inefficiencies.

Care pathway
Poor communication on the implementation of changes in the outpatient THA care pathway.	√
Lack of information-sharing and transparency between caregivers causing problems in the provision of care.	√
The ward doctor alternates monthly between specialists in training, which requires time to adjust and settle in the role of preparing, examining and prescribing the right medications to the patient.
The different actors of the care pathway do not feel responsible for the pathway’s development, as a result of which problems are neglected, making it difficult to improve the care pathway.	√
Model phase 1
The information provided to the patient (education) is outdated, repetitive, excessive and generic.
Inefficient consultations with the orthopaedic consultant, long and redundant.	√
Patient does not always prepare for the orthopaedic consultation by reading the information folder.
Many patients do not visit the group information session pre-operatively.	√
High number of pre-operative patient transactions and hospital visits, which is very time-consuming, especially for patients traveling from afar.	√
The anaesthetist has not always enlisted the medication in the patient’s file at the time the patient visits the ward doctor pre-operatively; this results in that the ward doctor is unable to provide a patient prescription, causing issues at a later time.	√
Model phase 4
The recovery time from spinal anaesthesia varies per patient, making it difficult to predict when mobilisation can take place.
Misunderstanding between caregivers on the patient treatment. The agreement is that only the first two patients may be discharged on the day of surgery. Even if the third patient meets the discharge criteria he or she cannot go home.
The ward doctor’s presence is needed at both the ward and outpatient clinic. However in the afternoon the ward doctor is at the outpatient clinic and rarely visits the ward, which means the patients only get to see a doctor at discharge.	√