Week 10 Lecture 1 Flashcards
Framing (Problem Identification)
Distribution: Send patients to other centres where demand
is not so great
* HHR Issues:
* Address shortages
* Improve pay
* Extend length of time imaging machines were running
* Management and Oversight: Establish oversight body to
address wait times
Key ideas in the cancer care Ontario Approach to Wait Times Management
- Queue: A line or sequence of patients waiting to be treated
- Identifying Appropriate Wait Times
- Measuring Wait times appropriately – e.g. two intervals established
Key ideas in Queue Theory
- Customers
- Input Source (where are they from)
- Queue Discipline
- Service Mechanism (how many servers do we have?)
- Ethics
Policy Theory and Ethics in Queuing
- Consensus policy – costs/benefits, technical issues
- Virtue ethics
- Utilitarian (happy: unhappy)
- Ethics of Care as a goal, sometimes hard to achieve
- Personalism (access, common good, performance)
- Principilism
Queue Theory
p : Proportion of available
resources
lambda (𝞴) : Rate at which patients
arrive
s : The number of health
care professionals in the
system
(𝞵) : Rate at which patients are
treated
p must be <1 and
As p approaches 1 the entrance rate = the exit rate
5 Mechanisms to Reduce a Wait List
- Decrease patient arrival rate (𝞴)
- Increase the treatment rate (𝞵)
- Increase the number of health care providers in the
system - Limit the number of patients in the queue
- Modify the queue discipline
p = (𝞴) / (s*𝞵)
Queue Theory
ECFAA
- The legislation applies to hospitals as identified in the Public
Hospitals Act - Hospitals must:
- establish quality committees
- put annual quality improvement plans in place and make these available to
the public - link executive compensation to the achievement of targets set out in the
quality improvement plan - put patient / care provider satisfaction surveys in place
- conduct staff surveys
- develop a declaration of values following public consultation, if such a
document is not currently in place - establish a patient relations process to address and improve the patient
experience.
Why an Understanding of Wait Times is
Important for Consumers:
- Control. Estimating when the service you need will happen
means you don’t have to put your life on hold. - Awareness. Seeing how the wait time at your hospital
compares to other Ontario hospitals means you can have a
better-informed conversation with your family doctor about
your options. - Peace of mind. Understanding why you may need to wait can
help put you at ease because your wait time will be
appropriate for your condition.
What is Wait Time?
- Wait time is the amount of time you have to wait for
surgery/exam - Wait is measured from the time your surgery/ exam is
booked until the time it is received - If several surgeries or exams are required, each one may
have its own wait time.
Wait Times Information System:
- A key part of the Ontario Wait Time Strategy.
- Collects wait time data in 94 adult surgery and DI
hospitals and in 78 paediatric surgery hospitals. - The system tracks all surgical procedures in Ontario.
- Helps to ass assess patient urgency using a defined
wait times standard - Measures and reports wait times and data on the
utilization of procedures - Assists by providing near-real time data for
monitoring and managing wait lists - Reports wait time information to the public
Wait 1
Date referral for new consultation is received to the date the patient
had their first surgical consultation minus any Dates Affecting
Readiness to Consult (DARCs) which are patient related delay reasons
Retrospectively collected
Wait 2
Number of Days from Decision to Treat to OR Date, minus any Dates
Affecting Readiness to Treat (DARTs)
Dates Affecting Readiness to Consult (DARC)
Developmentally Appropriate Wait
Inability to Contact Patient
Change in Medical Status
Missed Consultation
Patient – Chooses to Defer
Pre-Defined Follow-Up Interval
