Access to care in general, and wait times in particular, continue to be a major concern for Canadians, their health care providers, hospitals and agencies, and governments. Most people can relate a story of how they or a member of their family has had to wait excessively for a health care encounter. Waiting for care is not the exception. It is the norm.
Patients wait to see family physicians. They wait for diagnostic tests. They wait in emergency rooms. They wait to see consultant specialists. They wait for surgeries and procedures, like hip replacements, cataracts, and colonoscopies. They wait to get into hospitals, and, as the ALC (alternate level of care) crisis has shown us, they sometimes wait to get out of hospitals, too.
In 2004, Canada’s first ministers acknowledged this pressing concern when they signed the 2004 Health Accord, an agreement that, among other things, committed a considerable amount of federal money to the wait time reduction effort. The ten-year agreement would “fix health care for a generation”, said then-Prime Minister Paul Martin.
The initial focus for wait time reduction coalesced around five areas: cardiac (bypass surgery in particular), sight restoration (cataract surgery), diagnostic imaging (CT and MRI), cancer care and joint replacement.
Canada’s doctors responded to this exciting challenge by forming the Wait Time Alliance (WTA). Seven national specialty societies, together with the Canadian Medical Association (CMA), banded together and immediately set to work to determine what the medically-acceptable maximum wait times should be for these treatments, procedures and surgeries.
It’s important to understand that the WTA did not use this opportunity to set unreasonable or impossible-to-achieve benchmarks. We know, and accept – as do the vast majority of Canadians – that patients need to wait for some scheduled (non-urgent and non-emergent) treatments. Canadians accept some degree of wait for scheduled medical consultations, tests and procedures as long as they know that their wait will be safe, that it will not be unreasonably long and that their care team will monitor their status throughout the duration of the wait for any change in urgency status. So the WTA did not play politics with this opportunity; rather, WTA member societies defined, after evaluating published evidence and by expert consensus, what the safe and reasonable maximum wait periods should be for a whole host of health care experiences. The intent in developing these wait time benchmarks was threefold: to provide a national standard to which all provinces should aspire as they worked to improve access; to provide a way to compare performance between jurisdictions (provinces/territories or regions), and to allow Canadians to be confident that medical experts, rather than governments, were determining what constituted the maximum medically -acceptable wait. The end result was an array of very sensible documents that laid out state-of-the-art, contemporary wait time benchmarks.
Within a couple of years, the WTA began publishing annual report cards, using provincial governments’ own publicly-reported data. We’ve graded the provinces with letter scores – A to F – based on the percentage of patients treated within the benchmark timeframe. 80% earns the province an A; less than 50% earns them an F. Over the years, as the WTA has grown to 13 specialty society members, 3 specialty society partners, and the CMA, the report card has expanded it’s scope to include many additional consultations, tests, and procedures. In addition, we have featured examples of best practices in wait time management, shed light on the total patient experience (rather than focusing on just one aspect of their wait in what is really more of a journey), and have directed sustained attention to both the ALC issue and on the wait time for referral from family physician to consultant specialists.
The impact of these annual report cards has been astounding. In the months leading up to the release of the reports, officials from provincial Ministries of Health proactively call the WTA office to ensure that we have their most up-to-date information, and to point out areas where they feel they have improved over the prior year. Our annual grading of the provinces’ wait time websites on their user-friendliness and comprehensiveness has led to marked improvement in the quality of these websites over a very short period of time (we have patient panels grade the sites and we report their findings). Excerpts from our reports have been read and the findings debated on the floor of the House of Commons and in nearly every provincial and territorial legislature in the country. The coverage by the press has increased every year; last year’s report card (http://www.waittimealliance.ca/media/2012reportcard/WTA2012-reportcard_e.pdf) had a press reach over over 30 million Canadians. Stories ran for weeks after the report card’s release. As I did interview after interview with reporters from every region in the country, the first question was, inevitably, “So, how did our area do?”
We’ve taken a very deliberately respectful approach to the issue of wait times. We do not want to embarrass governments. We want to inspire them. There is no “blame and shame” – only facts and a fundamental presumption that all the stakeholders want to see improvement. We want to help governments to help improve access to care. One of the most telling moments for me, reassuring me that this approach is the correct one, was an incredible moment of candor from Manitoba Health Minister Theresa Oswald. Upon receiving a not-so-flattering report card for her province last year, including a few F grades, she was quoted in the press as saying, “I’ve been an A-student my whole life, I don’t like getting anything other than A’s.” (http://metronews.ca/news/winnipeg/269301/manitoba-wait-times-getting-nearly-failing-grades/). This refreshing departure from the usual “deflect and dodge” strategy employed by most elected officials demonstrated to us that she respected what we said, she recognized the legitimacy of what we were saying, and she trusted us. We, in turn, felt that we were motivating her to turn those F’s into A’s, and we all want to do whatever we can to help her do just that.
This is what Canadians expect of their elected officials and of their doctors – simply, to lead honestly and to work together. When stakeholders are made into villains, conversations shut down and progress stops. We should evaluate our progress critically, but respectfully.
Last year, I was privileged, as Chair of the WTA, to present before the Senate of Canada’s Committee on Social Affairs, Science and Technology – the committee charged with examining progress made in Canada since the 2004 Health Accord. (The transcript of the testimony is here: http://www.parl.gc.ca/Content/SEN/Committee/411/soci/49055-e.htm?Language=E&Parl=41&Ses=1&comm_id=47). We advanced the argument that access had not improved as much as it should have because of inadequate accountability for the federal dollars spent, and because the money that was spent did not buy real change. These sentiments were reflected in the committee’s final report (http://www.parl.gc.ca/Content/SEN/Committee/411/soci/rep/rep07mar12-e.pdf).
The WTA (www.waittimealliance.com) is stronger than ever. Our membership continues to grow, and our members are energized by the conviction that we are playing a noble and productive role in the national discussion on access to health care. We will continue to shed light, provide expertise, and lend our hand to all partners and stakeholders. Canadians deserve nothing less than our very best effort.
Again, great work!
Could you explain “… patients need to wait for some…”? Why? Are we adding value for patients by making them wait?
I realise you need to stay positive and keep our politicians engaged, but shouldn’t we advocate that all patients receive the same service our most privileged patients receive?
Keep up the great work!
Thanks, Shawn! I appreciate your comments, as well as the significant work you do advocating for patients!
I heard a great quote on CBC today, “Care delayed is care denied”. In many ways, this is true.
Some would argue that some degree of wait is necessary in order for the system to run efficiently. It also allows for preparation to be done carefully and safely. In the grand scheme of things, most patients wouldn’t mind waiting for a little bit of time as long as they know that their wait is safe and that it has a purpose. But we see ridiculous waits in Canada for some things. Months and years. This is never acceptable. Waiting for your hip replacement for a few weeks seems reasonable, even if it isn’t ideal. But waiting years? That’s just not on.
The WTA has established a slate of maximum medically acceptable wait time benchmarks for a wide variety of consultations, tests and procedures. These are thoughtfully assembled and offered to system planners as tools to help measure system improvement and performance. To your point, though, these are the maximum acceptable times. When we can’t even achieve this, it is clear that we have a lot of work to do.
I think that what we need to do is to establish a culture of continuous improvement. We want to see governments adopt our benchmarks, and then work to achieve them. Importantly, these data and the progress must be publicly reported. Only with this information in the public domain will political pressure truly come to bear. As of this writing, though, there are many more blank spots than data across the country in our tables reporting wait times. For example, how long do people wait for colonoscopies in Canada, procedures that lead to early detection and cure of colon cancer? Aside from some survey data done by the Canadian Association of Gastroenterology (Great work, CAG!) we have no idea. No one reports wait times for colonoscopies.
Canadians deserve to know. And the WTA will continue to shed light. To those governments who are working diligently to improve, we salute you. But Shawn, you’re right. Our work isn’t done until every Canadian has equitable and timely access to care.