Has Canada’s approach to identifying priority areas and setting wait-time targets helped or hindered Canadians’ access to care? 2012 Taming of the Queue ConferenceMarch 29th, 2012Dr. Vasanthi SrinivasanAssistant Deputy Minister, Health System Strategy &Policy DivisionOntario Ministry of Health and Long-Term Care
Introduction MOHLTC is an evidence and analytical resource to the system: social policy ministries, Government of Ontario, Local Health Integration Networks, etc. At the macro level Ontario has not always had a strategic approach: sector-by- sector, initiative-by-initiative, issue-by-issue focus. A suite of products has been created within a strategic framework • has utility and facilitates movement in the system • provides evidence for policy • influences day-to-day decision-making and future strategic planning Focus on two themes: • Role of evidence in a system that uses benchmarks and targets. • Ontarios Wait Times Experience
Enhanced quality of care results when research knowledge istranslated to health care providers The Ministry works closely with health sector research partners, including research institutes, universities and agencies to generate the needed evidence that serves as the basis for Ontario’s clinical standards of care. Knowledge exchange activities bring research evidence into Ministry policy development, strategy development and planning. Knowledge Generation Policy Development, Implementation Decision-Making and of evidence- Dissemination based research Institute for Clinical Evaluative Sciences (ICES) Ministry of Health LHINs and Ontario Health Quality and Long-Term Health Care Council (OHQC) Care Providers Medical Advisory Secretariat (MAS)
Ontario’s Wait Time Strategy Since the 2004 Health Accord, reducing wait times for key services has been an integral element of the Ontario governments strategy to transform its health system and improve timely access to appropriate care for all. Wait Times Strategy: • increasing access by focussing on outputs with incentives. • funding based on measurement and aligned everything else to it • was/ is a success (monitored and tracked), compares favourably on a national level Since 2003/04, Ontario has invested approximately $1.7 billion for 2.9 million procedures in the following priority areas: • cancer surgery • hip and knee replacements • selected cardiac procedures • cataract surgery • magnetic resonance imaging (MRI)/computed tomography (CT) scans -4-
Results in Ontario The Ontario Wait Time Strategy includes reporting of reliable data on wait times, pay- for-performance incentives to encourage efficient and effective practices, and expert advice and public forums to obtain wait time information. Data from the MOHLTC Wait Times website for September 2011 demonstrates Ontario’s continuing success in meeting its wait time targets in the priority areas: • Cancer surgery: 96 per cent of all patients received care within Priority Level 4 (PL4)* access target. • Hip replacement: 89 per cent of all patients received care within PL4 access targets. • Knee replacement: 85 per cent of all patients received care within PL4 access targets. • Cataract surgery: 97 per cent of all patients received care within PL4 access targets. • Bypass surgery: 100 per cent of all patients received care within PL4 access targets. • MRI/CT scans: 43 per cent and 88 per cent, respectively of all patients received care within PL4 access targets.*Priority level is the outcome of an assessment performed by clinicians on each non-emergency patient to determine their urgency of care rating usingpriority assessment tools recommended by clinical expert panels. A description of each priority level by service area is available on the Wait TimesTargets website. -5-
Results in Ontario, cont’dSuccesses in the priority areas have also driven improvements in surgery morebroadly. For example: • Over 90 per cent of Ontarians requiring treatment for other procedures such as neurosurgery, general, gynaecologic, and plastic and reconstructive surgery are within provincial benchmarks. • The 2011 Wait Times Alliance Report Card also gave the province an “A” grade (i.e., 80- 100 per cent of population treated within government benchmark) for all five priorities.An Expanded Wait Times Strategy: • In May 2007, Ontario became the first province in Canada to post paediatric wait times for all 10 paediatric surgical sub-specialties (75% of patients received procedures within provincial benchmarks, September 2011) • Ontario has also set two provincial targets for the length of time a patient should spend in the emergency room. • ER/ALC Strategy is focused on: targeting investments to reduce emergency room demand, improving emergency room capacity and performance, and improving bed utilization. • Programs in the areas of stroke and cancer care have proven to improve wait times and the continuum of care. -6-
Role of public reporting for accountability The Wait Time Information System was created to support the strategy and is a province-wide system that tracks, measures, and reports on surgical and diagnostic wait times. This system is the technological backbone behind the province’s public reporting website. Over 3,300 clinicians in 94 wait time-funded hospitals submit information on 2.3 million adult and paediatric surgeries and magnetic resonance imaging and computed tomography scans each year. The website provides current wait times for hospitals across the province for the five priority areas and includes information on wait time issues, including questions to ask your doctor. -7-
Final Thoughts• Setting and achieving targets is an accomplishment to be proud of . . .• . . . but it is important to remember that those areas outside of the “spotlight” of a target may not progress as much those “in the light”.• Target setting is never “done”.• There is a danger of confusing descriptions of activities (e.g. an Operational Plan) with a framework for measuring activities to know what is and is not working.• Public policy making requires that performance against targets is analysed thoroughly, and that new targets (in some cases in new areas) are established as appropriate. -8-
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