Waiting for care

• Health Minister Kelvin Goertzen recently suggested he was willing to consider copying a Saskatchewan initiative that allows people to buy MRIs from private clinics. Read the full article by Dan Lett of the Winnipeg Free Press here.
• Donald Trump and Hillary Clinton are merely the latest in a long line of American politicians who have cast aspersions on the Canadian health care system. Here’s what they don’t get…Read the full article by Trudy Lieberman in the Centre for Health Journalism.
• The Health Council of Canada has completed a six-part pan-Canadian video series, “Innovations in Reducing Wait Times”, featuring innovative practices that are tackling waits for patients in various health care settings. To view these videos in English or French visit healthcouncilcanada.ca/waittimes.
• The Health Council of Canada features a video blog, “How queueing theory can influence wait time”, by Dr. David Stanford of Western University. In this video blog, Dr. Stanford demonstrates how queueing theory applies to wait times and how simple changes can have a big impact on reducing them. To view this video in English or French visit healthcouncilcanada.ca/waittimes.
• See our infographic on 2011 wait times in Canada: Still waiting, by Lindsay Jolivet.
• 47% of physicians say most or almost all of their patients get same-day or next-day appointments. Also, 46% of physicians have made arrangements for their patients to see a physician or nurse (other than at the ER) when their practice is closed. The Health Council of Canada presents How do Canadian primary care physicians rate the health system?, a report that examines physicians’ perspectives on the performance of the health care system based on their experiences with access to care, coordination of care, use of information technology, and practice improvement and incentives. (See infographic).
• Wait time performance has slipped in the past year, the Wait Time Alliance, a consortium of 14 medical groups, says in its 2012 annual report. Although some provinces have shown improvement, the overall trend is downward, the WTA adds. The WTA has been measuring wait times for six years, and the five procedures First Ministers identified as priorities in the 2004 health accord. These are cancer (radiation therapy); heart (bypass surgery); joint replacement (hip and knee); sight restoration (cataract) and diagnostic imaging (CT and MRI scans). Benchmark wait times were subsequently set by health ministers.

Why do we wait?

• If Canadian physicians say that only 47% of their patients can get a same-day or next-day appointment when requested, health care leaders need to better understand the implications on patients around wait times and apply known solutions to these recurring problems. The Health Council of Canada has launched the first two videos in a multi-part series that will continue through the summer and Fall 2013, pointing to where exactly we’re seeing progress on wait times in our health care system and how examples like these can be adapted in new locations for the benefit of more Canadians.
• Visit http://healthcouncilcanada.ca/waittimes, to learn about wait time success stories in Thompson, Manitoba (Advanced Access for the Primary Health Setting) and St. John’s, Newfoundland and Labrador (Centralized Intake for Orthopedic Surgery). To access the Health Council’s Health Innovation Portal, where you can search further solutions to reducing wait times, please visit: www.healthcouncilcanada.ca/innovation.

Is Physician Shortage a Driver of Wait Times?

• Increases in physician supply slowed in the 1990’s and several provinces, particularly Ontario, experienced a decline. However, in most provinces, the declines have been reversed and the number of physicians has climbed steeply to the highest levels ever in the past several years. View a province by province graph on physician supply.

• Wait times in Canada are improving with 75 per cent or more of provinces meeting benchmarks for some procedures.

Needed: Better Data

• Creating a single, common framework for reporting wait times is an effective first step, ie moving from individual wait lists for each physician to a ‘single list.’  This reduces inefficiencies which may arise if one provider is swamped, but another happens to have openings in his/her schedule, while still allowing patients to wait for the provider of their choice if the situation is not urgent.

Needed:  Better Management

• Appropriate management tools combined with getting the surgeons, primary care physicians and the health authorities working together, can have a significant impact on access to care. For example, a hip and knee pilot project in 3 Albertan cities reduced wait times for surgery from 290 to 37 days by altering the management model and at the same time brought hospital costs down by 15 per cent.  Many projects have found the using tools from industrial engineering/operations research can greatly improve the efficiency of care delivery.

• Cape Breton has taken a new approach to patient scheduling which seems to work. Traditional patient scheduling approaches can cause long wait times. “Advanced access” is an innovative, patient-centered approach to scheduling that leaves a physician’s appointment calendar relatively open and allows doctors to see more patients in a timely way.

• The evidence suggests that Emergency room overcrowding is a complex problem to solve. Simply reducing the number of people coming through the ER door and introducing more primary care physicians will not resolve the backlog. ER overcrowding  also requires better management of hospital beds.  The solutions to ER wait times often are found elsewhere (e.g., by ensuring that primary care practices offer after-hours care).

• Would a  parallel private system help reduce waiting times in the public system? Research evidence suggests parallel private systems appear to lengthen waits for healthcare in the public system.

Needed:  Agreement On – Is the Care Appropriate?  What Is A Reasonable Wait Time?

• In the management of waiting times for diagnostic tests and surgery it is necessary to develop standards for when treatment is appropriate and necessary and when it is not. Tools are available to help deal with this issue and with the prioritization of patients when a decision for testing or surgery has been reached, but they are not yet widely used in practice.

Needed:  More Resources (At Least Sometimes)

• While we have reviewed several aspects of improving wait times which don’t necessarily require more resources, sometimes more resources are indeed what is necessary.

International Efforts To Improve Wait Times

• Wait times in the United Kingdom fell dramatically in recent years. Why? There was an aggressive public policy push and unprecedented increases in public funding under the Blair government.

• Over this period (1998-2008) the privately-funded share of elective surgery in the UK shrank from just under 15% to just under 11% according to Laing and Buisson, a firm which monitors these trends.

• The Brits also introduced operational efficiencies through a ‘choose and book’ system

Wait Times In Canada

• Ontario Stroke Evaluation Report 2012: Prescribing system solutions to improve stroke outcomes.
• From CIHI: The Canadian Hospital Reporting Project (CHRP): is a national quality improvement initiative from the Canadian Institute for Health Information (CIHI). CHRP’s web-based, interactive tool gives hospital decision-makers, policy-makers and Canadians access to indicator results for more than 600 facilities from every province and territory in Canada.
• Wait Times in Canada – A Summary, 2012
  
• Note: CIHI data are updated on a regular basis. For the latest available information please visit their website (www.cihi.ca) or contact their media team at [email protected]

• Recommended Reading On Wait Times From The Health Council of Canada