Why do we wait for healthcare?

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Ticket_takeAnumber_v5Our health care system may be set up to make us wait, but innovative practices and solutions are making a difference in reducing wait times and improving patient safety and care

Wait times create a heavy burden on Canadian patients, caregivers, employers and the economy through worsening of medical conditions, lost productivity and revenues, and other effects. In fact, Canadian physicians say that only 47 per cent of their patients can get a same-day or next-day appointment when requested.1

However, in recent years positive steps have been taken in different parts of our country to reduce wait times, some of which are excellent examples of innovative practices that the Health Council features on our Health Innovation Portal to promote adoption as similar challenges exist across the country.

With the pan-Canadian video series “Innovations in Reducing Wait Times” our goal is to make a positive impact in reducing wait times for patients, by promoting the spread and adoption of these and additional innovative practices in other health care settings.

We launched the first two videos in the series in June. Our first video showcases the Burntwood Community Health Resource Centre (BCHRC) in Thompson, Manitoba and looks at their success story in Advanced Access for the primary health setting. Serving a regional population of approximately 45,000 in the Northern Health Region of Manitoba, the Burntwood Community Health Resource Centre opened in 2000 but was immediately plagued by an overwhelming number of complaints from community members due to extremely long waits for appointments.

More than just a scheduling system, Advanced Access is a continuous quality improvement initiative which resulted in a paradigm shift for Burntwood. Physicians and practitioners no longer push work off to tomorrow but rather, they accomplish today’s work today. Advanced Access strengthened the concept of the health care team to support them working at their highest level; and as a result, patient complaints have essentially gone down to zero, primary care appointment wait times have decreased, and 93 per cent of Burntwood’s patients are now able to get an appointment with their primary care provider when they want.

Our second video shines a light on Eastern Health’s Orthopedic Central Intake (OCI) based in St. John’s, Newfoundland and Labrador. Before 2011, the residents of Newfoundland and Labrador had difficulties accessing orthopedic surgical consultations, due to a referral system that created extremely long waits. At that time, the median time for a patient referral from doctor to specialist was more than 300 days. The new system refers orthopedic patients to the next available surgeon while keeping track of the referral status and involving all health care providers throughout the process. OCI reduced orthopedic surgery wait times through a system change which redesigned the orthopedic service along the entire continuum of care. Patients are now provided with pre- and post-op services to better prepare them for not only their surgeries, but also their recuperation, which also improves the efficiency of hospital services.

The third video in our series launching on September 9th, highlights the Pay-for-Performance emergency department model in Vancouver, British Columbia. Emergency department congestion has been a long-standing issue for quite some time. With an ever-increasing demand, emergency departments, like the one at Vancouver General Hospital, struggle to provide patients with more timely care and access to diagnostics, while also creating capacity for admitted patients – something referred to as “access block.”

But the name Pay-for-Performance can be misleading. The model does not pay nurses or doctors to work faster and harder. Rather, the Pay-for-Performance model rewards the hospital with additional funding, if it meets predetermined targets for moving patients through the emergency department, either to a hospital bed or back to the community. This additional funding provides hospitals like Vancouver General with more options in regards to staffing, patient flow tools and other access initiatives. This relieves congestion in the emergency department and ensures patients receive the care they need in a timely manner.

“What the financial incentive does is it gives you a little bit of comfort in taking risks that you might not otherwise have taken,” says Michelle de Moor, Operations Director, Emergency Access and Flow at Vancouver General Hospital. “So if you’re working within a system that has a fixed funding envelope, you tend to stick with what you know you can safely fund and safely do to deliver service. If you have a little bit of an incentive to try different things, in order to create more access, financially you’ll take risks and try different things.” Early in the fall, we will release the fourth and fifth videos in our series which will look at the Saskatchewan Surgical Initiative and the Champlain Building Access to Specialists through E-consultation (BASE) in Ottawa, ON. The sixth and final video in the series will focus on an innovative practice in the long-term care setting.

With this video series, our goal is to promote some of the solutions that are available to help solve the problem of wait times in the Canadian health care system.

To view the first two installments and learn about innovative approaches to reducing wait times, visit our website at healthcouncilcanada.ca/waittimes

Also, please consult our Health Innovation Portal: healthcouncilcanada.ca/innovation which houses hundreds of innovative health care practices, policies, programs and services from across Canada.

For more information about the video series please contact agrief@healthcouncilcanada.ca