Suggestions for strategies to manage wait times
| Strategy | Suggestion (theme and exemplar quote) |
|---|---|
| Patients and family | |
| Prevent illness | Health promotion “Can we get more funding for physical activity in the general public so that people have access to gyms and training programs or whatever, and for health experts outside of the system who are not covered by OHIP [Ontario Health Insurance Plan] like massage therapists, physiotherapists, kinesiologists so that it doesn’t cost as much to individuals.” — Patient 8, PT Focus Group 2 |
| Shift services out of the hospital | Provide support to patients while waiting “I wondered if there were ways to support people. Social work support, psychological support for people while they’re waiting. Because the anxiety of waiting is horrible. And maybe that can be a possible way to help.” — Patient 2, PT Focus Group 1 “If there’s some arrangement that can be made that would satisfy them. And it wouldn’t be dangerous. Such as providing payment for physiotherapy or transportation or home care or all these things to say, you know, if we can delay you 2 months, we could provide some support for you.” — Patient 2, PT Focus Group 1 Provide treatment in community or at home “Looking at what needs to be done on-site versus what can be done in the community. And trying to think outside of the building and finding those solutions so that we’re not always relying on the hospitals for that kind of care.” — Patient 8, PT Focus Group 2 Provide support at home after early discharge “If you’re looking at a surgical procedure that normally would keep someone after the procedure for 2 days, what are the resources in that person’s area that can help them feel safe to go home after 1 day, and they have the phone number, name and email of the care provider that is going to check in on them.” — Patient 8, PT Focus Group 2 Use private services “Use public–private partnerships or private hospitals coverage to expand capacity. We need different models to perform different types of surgeries.” — Patient 2, PT Focus Group 1 |
| Send patients elsewhere | Send patients out of province or country “Could we do a big push, just to catch up, of out-of-province care for all the people who have waited for more than, let’s say, 10 months for something that really affects your life. And you’re going to be flown out to another province or another country to get the care so that we can catch up to prepandemic levels.” — Patient 8, PT Focus Group 2 |
| Increase pool of health care professionals | Incentivize people to enter health professions “There’s a shortage right now in the market, so I’m not sure if there is a way to maybe fund education for the health sciences to get more of these people into the funnel.” — Patient 8, PT Focus Group 2 Redistribute Canadian health care professionals “COVID is not gonna last forever, hopefully, and ideas like reallocating doctors, redistributing within the country … might be viable.” — Patient 7, PT Focus Group 1 Modify professional scope of practice “Train up staff that may not be as in demand as others for one reason or another, and have them redeployed into areas where they can cut through the backlog and other procedures.” — Patient 7, PT Focus Group 1 Expedite licensing of foreign-trained clinicians “Streamlining the process for already-qualified physicians and surgeons from other countries, who are here to become certified to be practising medicine here.” — Patient 10, PT Focus Group 2 |
| Improve and expand services | Optimize efficiency and coordination “Schedule a surgery before scan comes back instead of waiting for the scans come back, you know that might save some time for sort of a placeholder appointment.” — Patient 7, PT Focus Group 1 “Is there a way for us to optimize surgeons’ time? I don’t know what exactly happens at the day of life of a surgeon, but so that surgeons time is used in surgery as opposed to in administrative tasks.” — Patient 10, PT Focus Group 2 Extend and expand services “All the areas like CT [computed tomography] scans and MRIs [magnetic resonance images] have to be open 24 hours a day.” — Patient 3, PT Focus Group 1 “There’s a huge need in the eye care side of things. My mother-in-law got her cataracts done at a private clinic a few years ago and she didn’t wait. So, can we expand that to reduce the backlog in hospitals and put more people through?” — Patient 8, PT Focus Group 2 |
| Manage the wait-list | Use data to assess waits and bottlenecks “They may want to track and find the bottlenecks, start to finish, in the process of getting a surgery. It also would determine times … this typically takes 6 weeks, this takes 6 months.” — Patient 1, PT Focus Group 1 “Predictive analytics. Leveraging that to model and manage the ORs [operating rooms] and the access and expected wait times.” — Patient 8, PT Focus Group 2 Reassess how procedures are prioritized “Patients and families like ourselves get confused with the words unnecessary, elective, scheduled. A heart surgery may not be considered necessary, but might be more urgent and may not be elective. So defining unnecessary based on patient family perspective will be very important.” — Patient 6, PT Focus Group 1 Centralized referral If we say that person has 20 people on the wait-list and you only have 7, is there any way that we divvy it up so that it can be a little bit more even to reduce the overall wait time?” — Patient 5, PT Focus Group 1 |
| Funding | Physician fee for service “Pay per cut, if you will. The ones who are paid on salary, they’ll do what they can within the time that they’re there. Whereas the ones that are per surgery … incentivize them somehow to do more.” — Patient 8, PT Focus Group 2 Solicit private funding or donors “We need to be innovative by working with private sectors to improve clinical workflow, because the money is there. One organization got $25 million to build a new building.” — Patient 6, PT Focus Group 1 |
| Learn from other countries and past pandemics | “For some reason, they threw out anything they learned from SARS [severe acute respiratory syndrome] or H1N1 [influenza A virus subtype], all those mini pandemics, and went with some new model that really didn’t help anybody.” — Patient 1, PT Focus Group 1 “Different countries have faced similar problems or continue to face similar problems. Are we hooked in to these global initiatives, seeking out best practices?” — Patient 9, PT Focus Group 2 |
| Health care leaders | |
| Prevent illness | Health promotion “The pandemic brought us back 10 years with all of the prevention campaigns that we had with regards to colonoscopy, colposcopy, a lot of those pieces. If the Ministry, government, whoever, somebody could help us get this word out and start to do some of that advertising on media, social media on TV. That sort of stuff would definitely help because prevention is going to definitely be the key to managing and predicting what our volumes are going to be like.” — Health care leader 16, HCL Focus Group 4 |
| Shift services out of the hospital | Provide treatment in ambulatory and community settings “There are surgeries that absolutely need to be done in acute centres, 100 percent, and there are other procedures that don’t. The alternate health facility model allows for those procedures that don’t need to be done in hospitals and take up valuable OR capacity, and have them done in the community, things like colonoscopies and cataracts.” — Health care leader 8, HCL Focus Group 2 Provide support at home after early discharge “We have a virtual ward of nurses that call and follow up. So there’s a possibility there’s other pathways of patients that we could theoretically move through the hospital experience faster if we have the proper supports, which would require community support, but also this remote care monitoring piece as well.” — Health care leader 15, HCL Focus Group 4 Move COVID-19 screening to primary care or community “I had the COVID assessment centre under me and I just transitioned it to an external provider so we could recapture our staff.” — Health care leader 20, HCL Focus Group 5 Use private services “There’s already lots of private facilities that are probably being underutilized with staffing and rooms, etc. And we have done that in our province before, where we’ve used private facilities, but they’re funded by the government to do certain cases.” — Health care leader 11, HCL Focus Group 3 |
| Send patients elsewhere | Send patients out of country “Funding them to go out of country.” — Health care leader 11, HCL Focus Group 3 |
| Increase pool of health care professionals | Need more staff of all specialties and staffing prediction models “We often talk about OR nurses, they’re critical for sure, but you can’t do anything without recovery room, you can’t do anything without day surgery nurses. You can do some things without increasing inpatient beds like your same-day optimization of joints and gyne patients and things like that. You need more diagnostic imaging techs. It’s not just 1 particular professional that you need. And I think there’s a lack of understanding of that.” — Health care leader 20, HCL Focus Group 5 Employ alternative roles and expand scope of practice “Whether it’s physician assistants, whether it’s nurse practitioners with the anesthesia training, RNs [registered nurses] that can administer anesthesia with the supervision of anesthesia, and really looking at new models of care that don’t rely on 1 particular health profession but a coordinated team to increase the throughput through the ORs.” — Health care leader 8, HCL Focus Group 2 “Scrub techs was what I was used to working with, and they’re incredibly good. We did address this briefly, sort of midpandemic, and it’s a land mine. I didn’t realize it was going to be, I just thought it was a normal thing to discuss. It’s unions and this and that. It has to come from top down because when we try to address it from within, all it did was create more conflict and low morale, and it actually took an unstable system and made it a little bit worse briefly, so we kind of abandoned it.” — Health care leader 6, HCL Focus Group 2 Provide on-the-job training programs “We’ve put an in-house training program where their tuition costs are covered, they don’t take an income hit and it’s expedited so they’re ready to work in less than 6 months.” — Health care leader 9, HCL Focus Group 2 Increase rate or volume of health professions training “We’re going to need to train more nurses, we’re going to have to gear up the schools that are training them.” — Health care leader 3, HCL Focus Group 1 Incentives and support to retain nurses “How can we retain nurses? We’ve done stuff here that we never wanted to do before. If you look at the new research literature of leadership in crises, you need to increase your flexibility. We have no flexibility in health care because do more for less has always been one of our things: be efficient, pick up another unit, what’s the big deal. And I think nurses are tired.” — Health care leader 18, HCL Focus Group 5 Expedite licensing of foreign-trained clinicians “Try to get internationally graduated nurses, try to adapt them to the Canadian system with some timely consideration to eventually help the system.” — Health care leader 1, HCL Focus Group 1 |
| Improve and expand services | Extend and expand services “We’re talking about surgery, but we should also take into consideration all the diagnostics and support services that go along with the surgical backlog which is imaging, the CT scans, the MRI, labs. And so if we really want to increase the surgical flow, we also have to look at those support services that enable those procedures to get done.” — Health care leader 8, HCL Focus Group 2 Increase bed capacity “We have areas in the hospital that could be used that were patient care areas. So focus on being able to expand hospital beds because there are patients who just can’t get home. Expanding that even temporarily until we get through the backlog so that we can get through the patient cases.” — Health care leader 6, HCL Focus Group 2 “Patients who need to go home, they go home, or they get charged every day. Because we spend half our day arguing with patients and their families about why they don’t want to go home. Now I know it sounds a little out there, but that’s where we’re at right now.” — Health care leader 18, HCL Focus Group 5 “People don’t know where to go, there’s nowhere in the system to go to. So a navigator coordinates all this and it has decreased the ED admissions. But if every big diagnosis like CHF [congestive heart failure] or renal had a navigator to work with the physicians and the patients and the community services, the system would function better.” — Health care leader 18, HCL Focus Group 5 Find alternate sources for equipment and supplies “One of the things that concerns me about the push to just increase volumes is a huge supply chain issue that we are actually starting to experience now. There’s a huge backlog of casting, materials, crutches, surgical gloves. So unless there’s alternatives for sourcing strategies, we will probably not be able to operate.” — Health care leader 16, HCL Focus Group 4 Optimize efficiency and coordination “Improve the efficiency in the OR. They [surgeons] spend almost as much time waiting for the OR to be turned over and ready for the next patient as doing the procedure. And that’s a very inefficient use of resources.” — Health care leader 2, HCL Focus Group 1 “The right case with the right surgeon in the right location. Not all cases need to be the tertiary care centre and yet people are travelling. There should be better systems to establish what the needs and demands are in certain regions and what’s available there and prevent all that traveling to tertiary care centres.” — Health care leader 11, HCL Focus Group 3 Monitor surgeon upskilling and compliance with standards “Hysterectomy has been a procedure that’s basically routinely done laparoscopically now, that change happened in the last 10 years, 15 years, but there’s still some surgeons that just didn’t bother to train to do it and are still doing it abdominally requiring more resources, more postoperative time.” — Health care leader 11, HCL Focus Group 3 |
| Manage the wait-list | Reassess how procedures are prioritized and funded “And the other issue that we see is that the government is for the last at least 10 years has grasped onto knees, hips and cataracts as the only surgeries that need to be prioritized, and all of us recognize that those are not the only surgeries that are performed in [province].” — Health care leader 2, HCL Focus Group 1 Verify who is really on the wait-list “We’ve actually embarked on a process to verify the actual number of patients on the wait-list. We’re more than halfway through that systematic process and it turns out we may have somewhere between 30% and 40% of names on our wait-list who are listed as backlogged patients who actually are no longer in that pipeline.” — Health care leader 9, HCL Focus Group 2 Analyze wait-time data accurately “When we’re looking at data, really look at apples-to-apples comparison of data. Wait times look very short, it almost doesn’t seem like there’s a concern, but we’re not looking at all indicators and all pieces of the puzzle. So really having a comprehensive scorecard per hospital that takes into account the wait times but also other procedures.” — Health care leader 16, HCL Focus Group 4 Provide surgeons with data on their wait times “We used to have dashboards that went out to individual surgeons about their activity. I think that has diminished since then. They were very effective because they told individual surgeons what was in their queue and what their wait times are. That information to individual surgeons, plus to the surgical leads, the surgeons-in-chiefs would be very valuable to help individual hospitals deal with their issues.” — Health care leader 5, HCL Focus Group 2 Triage those on wait-list to other services for management “Interventional radiology can offer some procedures that avoid surgery. I think in the chronic pain world that’s also, you know, there are some procedures that interventional radiologists or anesthesiologists can offer, but often the connections aren’t there, so patients will be in a surgical wait-list but they can’t access those other people. So if there was a more streamlined pathway and kind of guidelines about, you know, what you do first and what you can access, that would certainly relieve surgical lists.” — Health care leader 11, HCL Focus Group 3 Restart wait-list counting “Stop counting, start from scratch. I remember sitting in a radiology presentation, they were talking about the backlog of mammography, and they were showing a slide that said by 2035, we will have caught up to less than 10 000 mammograms and I thought to myself how incompletely clinically significant that was.” — Health care leader 13, HCL Focus Group 3 Centralized referral “I know that there was a centralized list for cardiac surgery that worked well. What we do, for example, is to say, ‘you can wait 6 months with Dr. X or you can have Dr. Y in a month. Your choice.” — Health care leader 18, HCL Focus Group 5 |
| Funding | More funding for hospitals “Hospitals have been running on a 25th percentile year after year after year after year. So what is available to most departments these days is a fraction of what was available 25 years ago. This pandemic has just brought this to the rest of the public. They weren’t affected previously, now they are. The answer is to start looking at better funding for hospital facilities.” — Health care leader 2, HCL Focus Group 1 “Government needs to strategically fund a package program tailored to individual organizations for surgical recovery and that might look different site to site.” — Health care leader 14, HCL Focus Group 4 Bundled care model “Bundled care works for certain procedures and specialties and it doesn’t for others. So, pre-op, the procedure, post-op, which includes home care, and include primary care because I know primary care is not included in the current bundles. So that there is a price set for the entire journey of care and all the partners involved in that care. So the partners are jointly incentivized to get that patient with the best health outcomes, close to home.” — Health care leader 8, HCL Focus Group 2 Physician funding models “We have excellent people, but they all work in their own silos; we are not integrated as a system. It becomes a turf war and a matter of losing business and revenue because we work fee per service. If we could take this step forward so that physicians work on an alternate payment plan and get rid of these petty concerns, maybe we can work towards really programmatic work rather than having our individual turfs.” — Health care leader 9, HCL Focus Group 2 “Salaried. I believe in that for a whole number of reasons, being a female in surgery. So salaried for all surgeons would be great from my point of view, you can leave the female part out.” — Health care leader 13, HCL Focus Group 3 |
| Learn from past pandemics | “After SARS, I sat down just like we did now with people with the [organization] that the government asked with the same issues, ‘what can we do, what can you learn from it.’ And I think we learned a lot, but it all got forgotten after 17 years.” — Health care leader 18, HCL Focus Group 5 |
Note: HCL = health care leader, PT = patient.