Wait Times in Canada:

The Wait Time Alliance

(WTA) Perspective

Presentation to

Taming of the Queue 2012

Dr. Chris Simpson, WTA Chair

March 29, 2012

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Patients should not wait excessively

for important medical care Tumour Doubling

Time (weeks) by

Primary Cancer Site

128 studies of 8071 cases

77%

93%

100%

95%

85%80%

46%0%

100%

Cancer Surgery

Bypass Surgery

Cataract Surgery

Hip ReplacementKnee Replacement

MRI

CT

Target Actual

5

Note: Priority 4 targets used in absence of priority-level data. Angiography and

Angioplasty Cardiac Data are currently unavailable.

Source: Wait Times Information Office

Expected

Current State (October 2007) - % of cases

completed within target

Wait time guarantees

6 Provinces chose cancer (radiation therapy) as their target

of choice and received share of $500m

Province RT guarantee

PEI 8 weeks

NS 8 weeks from referral

NB 8 weeks

Man 8 weeks

Alta 8 weeks

BC 8 weeks

* CIHI report: Wait Times Tables—A Comparison by Province, 2007

Wait time guarantees – Radiation

therapy 6 Provinces chose cancer and received share of $500m

Province RT guarantee Current wait time *

PEI 8 weeks 2 wk

NS 8 weeks from referral

< 4.1 wk

NB 8 weeks

Man 8 weeks 1 wk

Alta 8 weeks 2-3.5 wk

BC 8 weeks 0.9 wk

* CIHI report: Wait Times Tables—A Comparison by Province, 2007

Canadians want PM to place priority on

health care

Survey asked more than 1,200 Canadians to rate on a scale of 1 to 5 how highly they viewed nine

possible priorities for this government. Here are the average scores each priority earned:

• Working with the provinces on health care - 4.32

• Creating jobs through training - 4.01

• Eliminating the deficit - 3.98

• Cutting taxes - 3.69

• Investing in research and development - 3.63

• Getting tough on crime - 3.58

• Focusing on new trade opportunities around the world - 3.48

• Strengthening Canada's armed forces - 3.05

• Reforming the Senate of Canada - 2.99

Source: Nanos Research, Institute of Research on

Public Policy poll June 2, 2011

The Genesis of the WTA

Who makes up the WTA?

• Canadian Anesthesiologists’ Society

• Canadian Association of Emergency Physicians

• Canadian Association of Gastroenterology

• Canadian Association of Nuclear Medicine

• Canadian Association of Radiation Oncology

• Canadian Association of Radiologists

• Canadian Cardiovascular Society

• Canadian Ophthalmological Society

• Canadian Orthopaedic Association

• Canadian Psychiatric Association

• Canadian Society of Plastic Surgeons

• Society of Obstetricians and Gynaecologists

of Canada

• Canadian Association of Paediatric Surgeons

• Canadian Medical Association (secretariat)

WTA History

– Established following First Ministers’ 2004 Accord

with commitment to reduce wait times

– Purpose: Ensure that physicians play leadership role

in patient access (e.g., setting wait-time benchmarks)

– Hold governments accountable on their commitments

to reduce wait times: “Meaningful reductions” in waits

for priority areas (cancer, heart, DI, joint replacement,

sight restoration)

Wait Times From the Patient’s

Perspective

Decision by

patient to

see family

physician

Family

physician/GP

consultation:

Differential

diagnosis &

referral

as needed

Specialist

consultation

Decision to treat or

refer back to family

doctor

Treatment

received

Adapted from prototype shared by The College of Family Physicians of

Canada and from ICES, Access to Health Services in Ontario, Fig. 1.1

Rehabilitation (if necessary) and follow

up with family physician and specialist

Testing

WTA wait time definition

WTA Mission

• The WTA is concerned over delayed

access to care for Canadians. We work

collaboratively with our stakeholders to

inform, advocate, and provide solutions

to achieve timely, appropriate and

equitable access to high quality health

care.

WTA Directions

1. Approach wait times from the patient’s

perspective

2. Add the Patient’s Voice

3. Build Partnerships

4. Provide Solutions

5. Celebrate Success

WTA 2011 Report Card

• “Time Out!”

• WTA’s 6th annual report assigning grades

• Graded: – 5 priority areas against government benchmarks

– Additional procedures/diagnoses graded against WTA

benchmarks

– ALC

– Provincial wait time websites

– Links to WTA member leading practices

2011 WTA Report Card

Provincial breakdowns for 5 priority areas

WTA’s 5 Year Assessment

2007-2011

National Grades Procedures

Diagnostic

Imaging Joint Replacement Radiation Cataract

CT MRI Hip Knee Oncology Surgery CABG

4

weeks

4

weeks 26 weeks 26 weeks 4 weeks 16 weeks 26 weeks

2007 nb nb B B C B A

2008 nb nb B B B B A

2009 nb nb B C A A A

2010 nb nb B C A A A

2011 nb nb B C A B A

5 Year trend nb nb B C B B A

5 Year national

grade: B

Treatment/service/procedure WTA

Benchmark NL PE NS NB QC ON MB SK AB BC

Anesthesiology (chronic pain)

Acute neuropathic pain 30 days ? ? ? ? ? ? ? ? ? ?

Cancer pain 2 weeks ? ? ? ? ? ? ? ? ? ?

Cardiac Care (scheduled cases) $ $ $ $ $ $ $

Electrophysiology catheter ablation 90 days ? ? ? ? $ ? ? ? ? ?

Echocardiography 30 days ? ? ? ? ? ? ? ? ? ?

Gastroenterology

Cancer 2 weeks ? ? ? ? ? ? ? ? ? ?

Inflammatory bowel disease (IBD) 2 weeks ? ? ? ? ? ? ? ? ? ?

Emergency Department 4hrs/8hrs ? ? ? ? ? A/F ? ? A/D ?

Nuclear Medicine $ $

Bone scan -whole body 30 days ? ? ? ? ? ? ? ? ? ?

FDG-PET 30 days ? ? ? ? ? ? ? ? ? ?

Obstetrics and Gynaecology $ $ $ $ $

Abnormal premenopausal uterine bleeding 12 weeks ? ? ? ? ? ? ? ? ? ?

Urinary incontinence 12 weeks ? ? ? ? ? ? ? F ? ?

Plastic Surgery $ $

Carpal tunnel release 2 months ? ? $ $ ? ? ? F D ?

Skin cancer treatment 4 months ? ? ? ? ? ? ? B ? A

Pediatric Surgery* $

Advanced Dental Caries: carious lesions/

pain 90 days ? ? ? ? ? $ ? ? ? ?

Cleft Lip/Palate 21 days ? ? ? ? ? $ ? ? ? ?

Psychiatry (scheduled)

Early psychosis 2 weeks ? ? ? ? ? ? ? ? ? ?

Postpartum severe mood disorders 4 weeks ? ? ? ? ? ? ? ? ? ?

Table 3: Provincially Reported Wait Times Compared to Select WTA Benchmarks

WTA assessment of wait-time

commitments • Slight improvement in reported wait times

for 5 priority areas since 2007

• Inconsistent reporting for other specialty

areas; wait times frequently fall outside of

acceptable wait-time benchmarks/targets

• Provincial reporting has improved but

need more consistent and standardized

reporting to properly assess progress

• Need to address regional variations

Next Steps: Improving wait time

measures

The WTA will continue to shed light on:

(1) the wait that patients experience for a wider

range of specialty care services (beyond the

initial 5 identified by government); and

(2) the total wait times that patients face in trying to

access specialty care – including access to

primary care, chronic disease management and

end of life care.

21

Canadian Health Care System

Toward a new professionalism

• Cost and Benefit together with Care and Trust

– Anchored in accountability

• Civic-oriented professionalism

• Seize the leadership of this issue

– A moral imperative

– A professional responsibility

– A “professional social ideal”

WTA website To access WTA reports, benchmarks,

news releases etc…

http://www.waittimealliance.ca/