Shifting Focus to Performance Improvement

Last week, health care leaders met in Ottawa for the annual wait time conference known as Taming of the Queue.  Now in its ninth year, this event has been an important forum for sharing what works in wait time management. Canada’s strategy to reduce long waits for surgical, radiation and diagnostic services has yielded results. It’s time to apply this same formula – set targets, measure results, report progress – to the performance of our health care system as a whole. Wait times are only one aspect of quality in health care. We also need to ensure that the care we’re waiting for is safe and effective. And the care must be tailored to each patient’s needs and preferences.

As the Health Council of Canada has reported, provinces and territories have made progress toward meeting the national wait time benchmarks that came out of the First Ministers’ 2004 Ten Year Plan. Working with hospital managers and clinicians, governments have taken practical steps to manage wait times. They continue to report publicly on their progress.

Despite our efforts and investments, wait times in Canada for some services are still longer than in other OECD countries. For example, in a survey of sicker adults conducted last year, 50% of Canadian patients reported that they waited four or more weeks for an appointment with a specialist. Canada ranked 10^th out of 11 countries surveyed. Moreover, about 14% of hospital beds in Canada are occupied by patients who are waiting to be discharged to another facility, such as long-term care, or are waiting for home care.  

Long waits for care in the community are symptoms of wider system issues. To address these waits, we need to improve the performance of our health care systems overall. We can start by setting measurable goals and targets. In the case of hospital wait times, the pan-Canadian benchmarks were a catalyst for change. Patient satisfaction, coordination of care, or waits for home support services are just a few examples of indicators that are being tracked today, at least in some regions.

Where targets are set, clinicians and managers can come together to develop an action plan that meets local needs. Measurable targets also enable us to monitor performance continuously, providing crucial feedback to know where health care services are improving outcomes for patients, and where they are not.

Clearly, monitoring performance system-wide requires a data infrastructure that reaches and connects every point of care, including physicians’ offices, long-term care facilities and home care providers. Interoperable health records are essential to providing streamlined care and to making each patient’s information available where and when it is needed.

Many patients today have chronic conditions. They need a wide range of services and they use them over many years. A high-performing system requires that each sector, from acute care to primary health care to continuing care, be safe and effective in its own right. We also need seamless linkages among them. Far from being wishful thinking, this type of care is already a reality for some Canadian patients. Examples of effective patient-centred care were showcased at the Canadian Health Services Research Foundation’s CEO Forum held in February.

Some observers warn that surgical wait times may rise again once we shift our attention to system performance. I don’t believe this will happen. Hospitals have implemented a suite of information technologies for managing wait times. These tools are becoming ingrained in the way hospitals do business and are here to stay. There is also more transparency with all provinces now publishing their wait times online.

Canada has been unique in its narrow focus on wait times for selected health care procedures. It’s time to shift our attention to the bigger picture and articulate a vision for the health care system we want. To do this, we need to tap into a vital source of knowledge on what constitutes good health care:  patients. At our national symposium on patient engagement, we heard how health care managers are engaging patients in the design of the health care system. In the process, they see the unique perspective that patients bring. As one participant put it, “patients have the 360 view.”

The Health Council works with patients, providers, governments and stakeholders at all levels to promote innovative practices. Through this work, we see pockets of excellent patient engagement and health care performance across the country. We know what works.  Now, spread what works and hold providers, managers and governments accountable to implement effective practices.

John G. Abbott, CEO, Health Council of Canada