Federal Wait Times Advisor Releases Final Report

Doug Thomson
CEO, Canadian Orthopaedic Association

You may have missed seeing any detailed reporting on the Final Report of the Federal Advisor on Wait Times, authored by Dr. Brian Postl. That was likely by design. In what has become a time honoured tradition in Ottawa, when the government wishes to avoid highlighting a report, that report is released on a Friday before a long weekend. Such was the case for this useful report as it was released just before the Canada Day weekend. There are some strong indications that the Harper government is quietly backing away from its only stated health care priority, the so-called ‘wait time guarantees’.

Dr. Postl’s report is, nonetheless, an important one that highlights that the issue of wait times is a systemic problem that requires a systemic solution involving all stakeholders. The COA, as a member of the Wait Time Alliance (WTA)*, supports the report’s call to adopt best practices for wait times, including the development of regional centres of excellence that could handle surge capacity, and to accelerate the adoption of information technologies. The report also makes the sensible recommendation that there is an important role to be played by a public education strategy on wait times.

Perhaps Dr. Postl’s most important point that he makes in his report is that however important the subject of wait times might be, if they are dealt with in isolation, there will be little progress. The report recognizes that wait times are part of a much larger problem. Dr. Postl argues that in order to create a more efficient and productive health care system, Canadians need to support a transformation that puts patients at the centre of the system. This transformation will not take place, according to the author, unless immediate action takes place in the following areas:

• Ongoing research to support benchmarking and operational improvements;
• Adoption of modern management practices in health systems;
• Accelerated implementation of information technology solutions;
• Cultural change amongst health professions;
• Development of regional surge capacity; and
• Public education to support system transformation.

In fact, the medical community has already taken great steps toward engaging effectively in system transformations that support improved patient access to care. The report notes “evidence-based benchmarks are critical to the development of wait time guarantees”, and the COA, through the National Standards Committee, has worked diligently over the past two years toward developing national wait time benchmarks that are based on the best available evidence. The COA also, through the WTA’s final report, It’s About Time: Achieving benchmarks and best practices in wait time management released August 2005, provided some recommendations on how to effectively improve wait time management at all levels. The WTA remains committed and is actively working with other organizations and governments to improve access to care.

The overriding weakness of the 2004 First Minister’s accord was that the government focussed only on the five so-called priority areas: cancer, cardiac, diagnostic imaging, joint replacement and sight restoration. The wait time benchmarks developed for these five areas are sound and progress has been made in these areas, however the focus on the five has led to neglect of other areas where, as our members know all too well, the waits are bad and getting worse. Dr. Postl highlights this gap in his report by noting that there are no waiting time benchmarks for children, for example, nor for, what he terms “Cinderella diseases”. “Cinderella diseases” are the ones that did not get invited to the ball. Unlike the “big five” priority areas, these conditions, though important, have not made it into the first “cut”. The fear is, and the danger is, Dr. Postl argues, that the five conditions that figured prominently in the First Minister’s Meeting agreements will starve out all the others for attention, resources and technology, leaving Cinderella diseases behind, in the shadows, at least temporarily if not permanently. A situation that many COA members who do other than hip and knee replacements, unhappily experience every day.

Dr. Postl’s report deserves a better destiny than the dreaded pre-long weekend release fate. We encourage all members to review this report.