Expert panels and ontario's wait time strategy: part 2

Expert panels have been widely used in healthcare as a way of bringing knowledgeable people together to examine issues and identify solutions in well-defined areas. Various terms have been used to describe these groups of experts such as "consensus panels," "blue ribbon panels" and "expert committees or panels." Regardless of the term used, panels of healthcare experts have a history of providing invaluable advice to policy- and decision-makers.     

Contract management of Ontario's cancer surgery wait times strategy

The province of Ontario, as a result of the First Ministers' Meeting, was committed to addressing surgery wait times in Ontario. The Ministry of Health and Long-Term Care's response to this commitment was the Wait Times Strategy (WTS) initiative, which addressed access issues with the aim of positively impacting wait times in cancer surgery. Cancer Care Ontario (CCO) was tasked with managing the cancer surgery WTS. CCO engaged in accountability agreements with Ontario hospitals to provide incremental cancer surgery volumes, in return for one-time funding. Through the use of accountability agreements, CCO was able to tie service volume delivery, quality care initiatives and reporting requirements to funding. Other elements of the cancer surgery WTS implementation included the development of wait times definitions, guidelines and targets; the use of a performance management system; facilitation by existing regional cancer leads and continued development of regional cancer programs. Eight key lessons were learned: (1) baseline volume guarantees are critical to ensuring that wait times are positively impacted; (2) there is a need to create a balance between accountability and systems management; (3) clinical quality initiatives can be tied to funding initiatives; (4) allocations of services should be informed by many factors; (5) regional leadership is key to ensuring that local needs are met; (6) data are invaluable in improving performance; (7) there is regional disparity in service delivery, capacity and resources across the province; and (8) program sustainability is an underlying goal of the WTS for cancer surgery. The implication is that accountability agreements can be leveraged to create sustainable health management systems.     

Bladder cancer in women: no time to wait

Bladder cancer is more common in men, but more often discovered at an advanced stage in women. Know the warning signs--and act on them quickly.     

Willing to wait?: The influence of patient wait time on satisfaction with primary care

Background  

This study examined the relationship between patient waiting time and willingness to return for care and patient satisfaction ratings with primary care physicians.     

Creating a surgical wait list management strategy for Saskatchewan

In the summer of 2001, Saskatchewan Health asked Dr. Peter Glynn, Health Care Consultant, Dr. Mark Taylor, the Deputy Head of General Surgery at St. Boniface General Hospital in Winnipeg and Dr. Alan Hudson, a Toronto-based neurosurgeon and former CEO of the University Health Network, to advise on the creation of a provincial surgical wait list management strategy to address growing concerns about waiting times for many non-emergent surgical procedures. Although the work was focused on Saskatchewan, this is a common issue across the country.     

Public views on a wait time management initiative: a matter of communication

Background  

Many countries have tried to reduce waiting times for health care through formal wait time reduction strategies. Our paper describes views of members of the public about a wait time management initiative - the Ontario Wait Time Strategy (OWTS) (Canada). Scholars and governmental reports have advocated for increased public involvement in wait time management. We provide empirically derived recommendations for public engagement in a wait time management initiative.     

The impact of Ontario's end-of-life care strategy on end-of-life care in the community

This article describes the impacts of the Ministry of Health and Long-Term Care's End-of-Life Care Strategy on the quality of end-of-life (EOL) care services delivered by home care providers across the province of Ontario. We compared key home care services one year before the strategy's implementation with those one year after. In addition, we conducted a qualitative survey of all community care access centres, the main providers of home care, and nearly all EOL Care Network directors to assess improvements to EOL care at the system and client level. Results showed that the number of clients of EOL care served increased by 3,537 over the baseline year. Moreover, the total number of nursing visits, shift nursing hours and personal support hours increased by 26%, 31% and 47%, respectively, compared with the baseline year. The qualitative analysis indicated that increased collaborations and communication have enhanced integration, coordination and consistency of EOL care. Anecdotally, clients and families feel more supported navigating the healthcare system, and more of their wishes are being met. The strategy appeared to improve EOL care on multiple levels. However, several barriers and challenges remain. Further investments and research are needed to achieve reliable quality EOL care for all Ontarians.     

Waiting time information services: an evaluation of how well clearance time statistics can forecast a patient's wait

Governments in some countries have created web-based information services so that patients requiring elective surgery can compare the waiting times of surgical units. This study investigated how accurately the waiting times of patients about to join a waiting list can be forecast by various clearance time statistics. It used 3 years of elective surgical activity data that covered 46 surgeons in 10 specialties within a public hospital. Six clearance time functions were tested, and the best function was compared with average waiting time statistics derived from census and throughput data. The forecast accuracy of the clearance time functions was found to be greatly affected by the characteristics and behaviour of a surgeon's waiting list. Although there was less difference in performance among the six functions, systematic differences between them were also found. The best of these performed better than the statistics derived from waiting time data, especially where waiting times exceeded 6 months. Yet, its accuracy was still poor. For each surgeon with an average waiting time of more than 6 months, at least 20% of patients waited more than 90 days beyond the clearance time forecast. Consequently, while waiting time information services should consider adopting the clearance time approach, they need to be explicit about its statistical limitations.     

Watching your wait: evidence-informed strategies for reducing health care wait times

Nobody wants the health care system to be characterized by long, involuntary waits for treatment. Both a strong theoretical rationale and a growing number of case studies support approaches that address the root cause of long waits-usually a poorly designed system, rather than an absolute lack of capacity. This structured review of both peer-reviewed and "gray" literature on waitlist management identifies the 7 common problems that underlie long waitlists and describes remedies that have been successfully applied, using Canadian and British examples with international relevance. Understanding these issues can help administrators and providers develop effective wait-reduction strategies in diverse health care settings.     

Transitional funding: changing Ontario's global budgeting system

In 1988, Ontario introduced transitional funding, a collaborative process between the Ministry of Health and the hospitals to modify Ontario's global budgeting system. The goals are to achieve greater equity; encourage hospital efficiency, and promote a shift from inpatient to outpatient services. To implement these goals, inpatient care is being measured in terms of case-mix groups, i.e., a classification system comparable to the diagnosis-related groups. However, since there is no patient level cost data, cost weights are being derived from patient-level data from New York State. Transitional funding draws attention to both positive and negative aspects of global budgeting.     

The impact of unacceptable wait time on health care patients' attitudes and actions

A great deal of time is spent by patients waiting for health care services in doctors' offices. The literature points to a negative impact of wait time on patients' perceptions of health care services, and on patients' subsequent behavior. A survey of 200 patients suggests wait time affects perceptions of quality, satisfaction and likeability, as well as likelihood of recommendations and repeat visits. In addition, response to unacceptable wait time was found to be significantly related to income. These findings indicate a cultural shift in patients' perceptions of wait time, and underline the need for providers to retain patients' loyalty through more timely service.     

A research of service outcomes in Taiwan: the role of patients' quality perceptions and wait time

Wait time is a continuing issue in healthcare services. U.S. studies reveal wait time is inversely related to healthcare service outcome as well as patient behavior and attitudes. However, Taiwan, despite being an important center for global healthcare services, has not been the subject of much research attention regarding wait time and its impact on patient perceptions and behavior. In the authors' exploratory study, patients in Taiwan completed a self-report questionnaire on how wait time and service quality characteristics relate to service outcome. Results indicate the influence of healthcare service quality and wait time on service outcome. Contributions, limitations, and research and managerial implications are discussed.     

Ontario's underserviced area program revisited: an indirect analysis

Financial incentive programs are used in various developed and developing countries to effect change in the geographic distribution of physicians. The Underserviced Area Program of Ontario is the longest running financial incentive program in Canada. It is described in detail and analyzed for its effectiveness in solving the problems of the maldistribution of physicians in northern Ontario. Using location quotients as an indirect measure shows that the maldistribution of physicians continues despite the implementation of the program. It is argued that the unidimensional solution of financial incentives cannot be used to solve the multidimensional issue of accessibility to health care in rural and remote areas.     

Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

Background  

As no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement.