INNOVATIONS IN REDUCING WAIT TIMES: A VIDEO SERIES

Today, the Health Council of Canada  launches the first two videos in our feature series, “Innovations in Reducing Wait Times,” on the Health Innovation Portal and website. Pan-Canadian in scope, the series highlights the innovative practices and solutions working to reduce wait times in specific health care settings. 
Ari Grief is the Project Lead on the series.
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Video #1 took the production team to Thompson, MB to visit the Burntwood Community Health Resource Centre (BCHRC) to learn more about their success story in Advanced Access for the primary health setting. 

An old mining town originally built “not to last,” Thompson is now a city of 15,000 residents. As a “Hub of the North,” its location poses specific challenges to residents needing timely access to primary health care. 

Since opening in 2000, the BCHRC was plagued with long waits for appointments and received many complaints from community members trying to make appointments. In 2008, with the help of Manitoba Health, the BCHRC implemented the Advanced Access project with the aim of decreasing appointment waits and providing same-day access while ensuring quality improvement. In order to realize this goal, office efficiency needed to be increased while decreasing the time for arriving patients waiting for their appointments. 

So far, the program has been a great success: complaints are reported as down to zero; delays for appointments have dropped so that most providers have either same day or next day availability; and the continuity of care (in this case, seeing the same primary care provider) has improved. “There was a paradigm shift in how we manage our patient flow,” says Dr. Harold Nyhof, Medical Director, Primary Care Clinics for Manitoba’s Northern Health Region. “We used to push work to tomorrow in order to protect today. Now we look to do more work today, in order to protect tomorrow. It’s a completely different attitude.”
 
Other jurisdictions across Manitoba and throughout the country are taking notice from what the BCHRC itself has learned. However, Jo-Anne Lutz,  Director and Project Lead of the Advanced Access Program, is quick to point out that Advanced Access is much more than a scheduling system: “It’s a comprehensive approach. By respecting the patient’s time and matching them with the right provider, we are more able to handle today’s work today so we can optimize the care team to provide the best care in the best possible way.”
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Dr. Harold Nyhof (right) collaborates with the BCHRC team. Clinic Director Jo-Anne Lutz is to his right.

Video #2 in the series shines a light on Eastern Health’s Orthopedic Central Intake (OCI) based in St. John’s, Newfoundland. OCI was instituted in 2011 with the purpose of reducing wait times by creating a system change to redesign the orthopedic service along the entire continuum of care. 

The Bone and Joint Canada “Hip and Knee Replacement Toolkit” suggests that a central intake model is ideal, but Eastern Health’s OCI took it one step further: OCI is the first in Canada to expand central intake for all orthopedic referrals, and not just hip and knee joint replacement. 

Elaine Warren, the former Director of Regional Surgical Services who was part of the team that helped secure start-up funding from Health Canada and the Province of Newfoundland and Labrador to get OCI underway, believes that the model “… helps streamline care. We had a very broad vision and to see this through, it’s been great.” 

The previous model of referral and assessment was individual physician-based, with no formal process for tracking wait times from family physician to initial surgeon visit, also known as Wait 1. Prior to OCI’s implementation, the median time of Wait 1 exceeded 300 days. “[Now,] it’s the way the system should work,” adds Warren. 

Today, the average for Wait 1 is 92 days for high priority referrals.
“Our wait times have gone down. We’ve seen a fairly significant improvement, about a 71% improvement,” says Michelle Alexander, Project Lead. 

Michelle Alexander with patients in a pre-surgery information session.

Ms. Alexander acknowledges that the early engagement of stakeholders was key to achieving goals and implementing change. System change can be difficult but with all levels on board, the Regional Health Authority (RHA) is now able to better evaluate referral practices and measure referral services. Access has improved, including better clinic capacity through the redesign of templates to reflect referral volumes and surgeon practice. 

Make sure to bookmark healthcouncilcanada.ca/waittimes to view these as well as new videos in the series, set for launch in the summer and fall of 2013.
For more information about the video series please contact Ari Grief, Project Lead at agrief@healthcouncilcanada.ca .