How queueing theory can improve wait times

In this video blog, Dr. David Stanford of the University of Western Ontario demonstrates how queueing theory can influence wait times and how simple changes can have a big impact on reducing them.

In addition, the University of Western Ontario has announced a new mathematical finding by an international research team led by Dr. Stanford. It provides the health care system with a more balanced approach to how patients are selected for treatment, which will consequently decrease wait times.

CLICK HERE to see the other videos in the series, Innovations in Wait Times 
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The Home First philsophy - creating safe transitions for patients from acute care to home

Caroline Brereton, RN, MBA is a registered nurse and holds an MBA from Queens University. She is a graduate of the Rotman School of Management Advanced Health Leadership Program.
A senior healthcare executive with 15 years of leadership experience, Caroline became Chief Executive Officer of the Mississauga Halton CCAC in May 2010. Caroline has a vision for a system that is fully aligned to support the needs of patients.

The growing population of seniors across the province will continue to increase pressure on the health sector to provide health care at home, including community services to help seniors move from  hospital to home following acute treatment and programs to help residents remain safely at home for longer. We feel it acutely in our Mississauga Halton communities of South Etobicoke, Mississauga, Oakville, Milton and Halton Hills.  We experienced one of Ontario’s highest growth rates in population, a 12 per cent increase in population from 2006 to 2011.  The Mississauga Halton region is the second fastest growing population of seniors in Canada (projected 32.3 per cent increase in 75 to 84 year-olds and 71.1 per cent increase in seniors 85 and older, by 2013).

 In 2009, anticipating population growth, the Mississauga Halton CCAC, was the first to launch the Home First Philosophy. In collaboration with our region’s hospitals, Trillium Health Partners and Halton Healthcare Services, funding was provided by the Mississauga Halton LHIN.

The philosophy embodied our objective: to slow the growth of alternate level of care (ALC) rates in hospital, while at the same time supporting the province’s goal to increase access aging at home. It was ambitious; the number of ALC days nearly doubled from 9.3 per cent in 2007 to 17.5 per cent in 2008.
The Home First Philosophy was the foundation for a new suite of Wait at Home services and that was our approach to tackling the growing ALC rate. It is a team-based philosophy that promotes safe and timely care, services and supports, which helps to meet the health care needs of patients and families in the most appropriate setting. The Home First philosophy recognizes that the home environment is the best place for recovery and supports people in returning to their homes from hospital wherever possible. It also provides the necessary services to help older adults maintain their continued independence in the community.

Challenges and Hurdles
This new philosophy necessitated changes in workflow, culture and communication. When we introduced it to our patients, staff and partners, it was a huge culture shift in health care thinking for families and physicians.  Traditionally, patients applied to long-term care homes from the hospital.

Physicians were concerned about safety and risk to patients leaving hospital and returning home. We helped physicians understand the quality of care provided in the community through the Mississauga Halton CCAC. We explained our approach and introduced new services that would ensure patients, even those with complex care needs, would be safe at home while they applied for long-term care or recovered and realized they could stay at home safely with services from our CCAC.

Better Outcomes
Together, with our partners, we drove better results and we continue to bring proactive change to the health care system. With innovative efforts and focused teamwork, the consistently low ALC rates in Mississauga Halton is evidence of system integration as a key mechanism for delivering the right care, in the right place, at the right time.  In fiscal 2012/13 our ALC rate was seven per cent and 6.3 per cent in the previous year. This means that 93 per cent of hospital beds in our region were available to patients needing hospital care.

Staying in hospital after surgery or treatment is not in a patient’s best interest. There is an increased risk of infection; and patients become less independent the longer they stay in hospital.The Home First philosophy is an enormous cost savings to our health system. Every ten per cent  shift of ALC patients from acute care to home care results in a $35-million saving.  And most importantly, it provides better outcomes for patients where they are happier and more comfortable in a familiar setting and they tend to recover more quickly.
Recently, a patient’s son, who is caring for his 83-year-old father at home, told us:  “The Mississauga Halton CCAC made it so simple and smooth. You take care of everything – personal support workers, nurses, occupational and physical therapists, medical equipment and supplies.  They brought the hospital to our home.  Now my father is safe and secure, and getting the quality of life he deserves.  My father belongs here.  Without you, we could not do it.  It would have been impossible. It is a blessing to have my dad here.”
However, if a patient and family decide that long-term care is the right place to be, we help them through the process from beginning to end. We start by directing them to our long-term care website – http://mhccac-ltc.com/ –which provides information about wait lists and costs, as well as a virtual tour of our region’s 27 long-term care homes.

At the Mississauga Halton CCAC, we look at health care differently. We recognize health care at home is not the future; it is the reality of health care today.

*Watch the video on the Home First program, part of the Health Council's Wait Times video series.

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Something more must be done to address the health challenges of Aboriginal seniors

Dr. Catherine Cook, councillor with the Health Council of Canada, is also a family physician, researcher, health care manager, and Métis. She currently has a joint role with the University of Manitoba and the Winnipeg Regional Health Authority. At the University of Manitoba, Dr. Cook is the Associate Dean for First Nations, Métis and Inuit Health in the Faculty of Medicine and is currently a leader of the newly established Section of First Nations, Métis and Inuit Health in the Department of Community Health Sciences, Faculty of Medicine. 

 First Nations, Inuit and Métis seniors are indeed Canada’s most vulnerable population. We know that they do not receive the same level of health care as non-Aboriginal seniors. Interviews with key stakeholders, literature searches and consultations across Canada, undertaken by the Health Council of Canada during the winter and spring of 2013, confirmed some glaring facts:

• Access to care is an issue. Most need to travel to urban areas for anything beyond the most basic care, with significant disruption to their lives.
• They often fall victim to the vagaries of government policies at the federal and provincial levels as to what costs are covered by whom and who is eligible for what services.
• There is little or no communication and coordination between services supported by governments, regional health authorities, and communities.
• Many Aboriginal seniors don’t have the same level of care in their communities as non-Aboriginal Canadians, so their health conditions can become more severe, increasing the amount of care they need. 

The situation is exacerbated by the impact of colonization, residential school experiences and by determinants of health such as poverty, poor housing, racism, language barriers, and cultural differences. Geographic isolation also comes into play: Aboriginal seniors are also more likely than younger generations to live in rural and remote communities where the majority of the population is Aboriginal, and where they can be connected to their culture. The result is that they have more complex health needs and are often living in regions where it is more challenging and expensive to provide care.

The Health Council report provides context on these challenges and why it is important to provide additional support and seamless care to First Nations, Inuit, and Metis seniors.  Without this, an already vulnerable population is at even greater risk. This issue that requires immediate attention by Canadians and governments alike.
However, there are some promising examples from across Canada where governments, health regions, and Aboriginal communities have formed partnerships to improve health care for Aboriginal seniors. I invite you visit www.healthcouncilcanada.ca/innovation to read about these practices. 

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