We collected operating theatre data from the 23 health services that report to ESIS, and collated it into a dataset. Figure F1 outlines the 23 health services' results against common performance indicators. Health services use their own efficiency measures with different underlying assumptions. Our data, therefore, may differ from the health services' internal reports, as we have applied our own definitions.

Figure F1
Health services' theatre performance against key utilisation measures

DHHS mandates a common chart of accounts for health services to drive standardisation in recording financial information. However, we found significant inconsistency in how health services use the accounts.

We identified that the length of an operation falls as the surgeon performs more of that particular operation.

To demonstrate this, we examined six common surgeries that are performed by consultants in Victoria. In five of the surgeries we examined, the duration of the operation was shorter when it was performed by the top 10 highest-volume surgeons compared to surgeons who had performed the procedure 10 or fewer times, as shown in Figure D1. In three cases the difference was over 20 per cent.

In this audit, we analysed efficiency in various ways, as described in Part 1. The health services currently use some of the measures in their internal reporting. We developed some measures to test issues identified by our engagement with health services, DHHS, stakeholders and subject-matter experts. This appendix outlines the assumptions and qualifications that apply to each measure.

Universal assumptions

We used a range of assumptions and measures, which apply throughout the report unless specified:

DHHS does not collate health services' operating theatre data into a statewide dataset, and therefore does not centrally govern, audit and assure health services' theatre data. The weaknesses in the data outlined in this appendix result from the lack of central governance.

There is significant variation in health services' data quality due to a lack of central governance. Introducing a statewide framework for governance of the theatre data, combined with consistent definitions and measures, would enable performance evaluation across the health system.

We have consulted with DHHS, Alfred Health, Austin Health, Melbourne Health and SVHM, and we considered their views when reaching our audit conclusions. As required by section 16(3) of the Audit Act 1994, we gave a draft copy of this report, or relevant extracts, to those agencies and asked for their submissions and comments. We also provided a copy of the report to the Department of Premier and Cabinet.

Responsibility for the accuracy, fairness and balance of those comments rests solely with the agency head.

Responses were received as follows:

Under Victoria's devolved governance model, DHHS does not control the operating models health services choose or how they meet their targets.

In this part of the report, we examine how DHHS and health services design systems to allocate theatre resources and drive the productivity of Victoria's public operating theatres.

Efficient and effective management of resources requires clear objectives, evidence-based resourcing models, relevant and reliable data to evaluate performance, and sound governance structures to control resource allocation.

In this part of the report, we assess how health services' management practices affect the efficient use of their operating theatre resources.

In this part of the report, we analyse the productive efficiency of operating theatres in Victoria's public hospitals. For this purpose, we have identified various measures of productive efficiency, as shown in Figure 2A.

Figure 2A
Measures of productive efficiency for operating theatres

The Health Services Act 1988 (HSA) establishes Victoria's public health services as independent legal entities that operate at 'arm's length' from DHHS.

In this system of devolved governance, boards appointed by the Minister for Health are responsible for the efficient and effective management of health services. DHHS's role is to fund, monitor and evaluate healthcare delivery. DHHS also retains responsibility for the sector's ongoing capital investment, including building new operating theatres.