What to do with the Queue: Improving Wait Times Flashcards
What to do with the Queue?
“people with cancer may be treated with various combinations of surgery, radiation therapy, and chemotherapy. Radiotherapy cannot be administered in every hospital; it requires equipment and skilled technical staff. One such specialized hospital, the Princess Margaret Hospital (PMH) in Toronto, found itself faced with a growing waitlist problem in its radiotherapy department. What should it do?
Policy Issues Addressed
- queuing theory
- wait lists and how to manage them
- human resources planning
- payment mechanisms and incentives
- ethics of rationing
Summary of the Issue
- PMH had huge backlogs in both 1991 and 1999, so bad patients had to be referred elsewhere
- shortages of radiation therapists, oncologists and physicists (only 20% of patients were being treated within the 4-week period recommended by CARO
- almost half were waiting longer than 8 weeks
- cancer care Ontario, established at this time to coordinate wait times management for cancer treatment
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 CCO 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
- Queue discipline
- service mechanism
- ethics
Policy Theory and Ethics and Queuing
- consensus policy - costs/benefits, technical issues
- virtue ethics
- utilitarian (happy: unhappy)
- ethics of care as a goal, sometimes hard to achieve
- personality (access, common good, performance)
- principlism
Queue Theory
p = A / (s*u)
p: proportion of available resources
A: the rate at which patients arrive
s: the number of health care professionals in the system
u: rate at which patients are treated
- consider queue discipline (How do people line up)
- behaviour in the line up
- people leave queue (end up coming back needing more advanced care)
- baulking (take a long time)
- blocking (limits on how many ppl they’ll see)
5 Mechanisms to Reduce a Wait List
- Decrease patient arrival rate (A) - more population health prevention, disperse places to go, cap on # of procedures
- increase the treatment rate (u) - increase hours of operation
- Increase the number of health care providers in the system (s) - accept international doctors, increase # of med school students
- limit number of patients in the queue
- Modify the queue discipline
ECFAA (Excellent Care For All Act)
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 a 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 pediatric surgery hospitals
- the system tracks all surgical procedures in Ontario
- Hels us to 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 waitlists
- reports wait time information to the public
Goals and Strategic Objectives
- person-centred
- safe
- equitable
- efficient
- effective
- timely
Surgical Wait Time: 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
