WHY BUSINESS TOOLS ARE ESSENTIAL FOR MANAGING A SPINE PROGRAMME

Spine care delivery in Canada is in a state of crisis and clinician advocacy to hospital leadership and government is essential to successfully implement positive change. While clinical research and quality improvement work are both well-established domains familiar to surgeons, business techniques such as granular financial quantification and operational modeling are not commonly used but can play a crucial role in advocacy efforts. This study describes 2 instances that business tools were used from October 2023 to October 2024 to successfully advocate for major progress in increasing the capacity of a provincial spine program. The first example of the use of a business technique was granular financial quantification to compare costs of an existing program to export spine surgeries to the USA against the costs of building capacity within the province instead - via capital investment to expand the spine program within the province. The second use case was quantification of the existing waitlist via an operational model in order to accurately ascertain the exact OR resources required to address a surgical backlog. The initiative led to the successful cancellation of surgeries being sent to the United States, yielding net savings of $30 949 per case and $4.1M per annum. The capital procurement for the secondary site expansion ($2.2M) along with an operating budget ($959 000) was approved due to the demonstration of a return on investment (ROI) of 27%. (2) The precise quantification of the waitlist demonstrated a 4.3 year waitlist for spine surgery, on track to reach 5.7 years by 2027. This data provided a strong case for additional OR time, which is being incrementally added, after a fifteen year status quo. Advocacy for additional resources was unsuccessful until the introduction of business tools resulting in accurate quantification (in this case, net profit/ROI values and precise wait times). We hope these techniques become more widely implemented nationally as our experience highlights the potential benefits of strategic data-driven decision-making.