ARCHIVED - Synthesis of the Results by Theme

Projects funded under the NWTI were diverse in both scope and topic.  The activities resulted in a range of outputs which included: 

• policy research;
• options and advice;
• new approaches;
• models and best practices;
• networks/collaborative initiatives;
• new data collection methods; and
• guidelines and standards.

The findings, challenges and lessons learned identified through the projects, when taken together, can be organized under ten cross-cutting themes:

1. Data Collection and Reporting:  Data collection and reporting were addressed by numerous projects, with both the availability and the comparability of data often emerging as key issues.  While standardized and valid data was found to be key to measuring and monitoring the extent of the problem around wait times, challenges regarding the cost and maintenance of Information Technology (IT) systems were identified.  Lessons learned highlighted the need to invest in IT, make use of existing systems and processes if possible, and benefit from cross-jurisdictional approaches (such as provincial/territorial agreement on common data definitions for measuring waits).
2. Engagement/Leadership:  Reducing wait times requires change in the behaviours, practices and cultures of health care professionals, program managers, government officials and Canadians at large.  A number of projects addressed the need for leadership, commitment and support in driving change, the importance of physician buy-in, in particular, and the difficulty in changing medical practice in general, but noted that medical schools and improved communications and stakeholder engagement may help create change.  The need for collaboration between institutions and jurisdictions was also highlighted.  Lessons learned included the role of leadership, commitment and support, effective change management, and professional education and training, as well as the need for public engagement to empower patients to advocate for the transformation required to make durable progress on wait times.
3. Managing Waits:  Various models and approaches for managing waits were explored or discussed (such as central intake systems, patient pathways, the use of patient navigators, and modelling), including assessments of how international experiences could be of use in the Canadian context.  Challenges to improving management of waits identified included patient reluctance to change to another physician, lack of effective patient navigation, emergency room overcrowding, and the dynamic nature of wait lists.  Lessons learned included the importance of understanding patient perspectives, keeping wait lists up to date, improving integration across the continuum of care and clinical areas, and exploring the potential for patient navigation supports.  The potential to achieve low-cost solutions to reducing waits through wait list management was also identified. 
4. Appropriateness of Care:  Several projects were involved in the development or implementation of standards or guidelines to ensure appropriateness of care, especially in the area of diagnostic imaging.  It was noted that while awareness of appropriateness can help control demand, there are no common definitions in this area, and different perspectives impact how appropriateness is or should be assessed.  Factors that should be considered include net clinical benefit, cost-effectiveness, ethical issues, impact of culture, and patient perspective and choice.  Project findings indicated that physician uptake and/or lack of compliance with guidelines, and implementation of IT tools to support appropriateness were key challenges, and emphasized the utility of national guidelines, patient-centred care and a focus on prevention, as lessons learned in this area.
5. Wait Times Targets/Benchmarks/Guarantees:  Benchmarks and targets were considered to be key tools in improving timely access under the 2004 Accord and several projects directly contributed to this and subsequent work on Patient Wait Times Guarantees.  Other projects suggested moving beyond the five priority areas of the Accord in establishing benchmarks, incorporating the entire continuum of care (including primary care) in these measures and, noting inconsistent data as a concern, suggested new areas of research which could lead to more or improved benchmarks.  Projects also explored potential legal ramifications and expectations set by guarantees, the role of patient choice and diverse needs in achieving targets and offering guarantees, and highlighted the need for appropriate tools and caution in developing guarantees in order to understand associated impacts.
6. Capacity:  Capacity and its link to waits was mostly explored in terms of health human resources and information technology.  Projects noted increasing demand for services, variable demand for services across regions, the time and effort required to implement IT systems, and costs as barriers to improving waits.  Some lessons learned were that addressing health human resources and IT capacity issues can be key to reducing wait times, but that efficient use of existing capacity is crucial and that there are often less costly alternatives to new investments in capacity.  Other lessons included the importance of developing surge capacity and anticipating IT implementation challenges.
7. Population Disparities:  Several projects explored wait times issues that were specific to particular population groups, including Aboriginal peoples, northern Canadians, children, women, Canadians with mental health care needs, and marginalized populations such as those with poor literacy or language issues.  Projects highlighted the benefits from looking at gender-based analysis of wait times, prioritizing access to services and wait times specific to children, addressing challenges facing Aboriginal and northern populations, implementing standards for mental health assessment, and providing support such as patient navigators for certain populations.  Challenges identified included data collection, lack of research, limited access to primary care for vulnerable populations, and inequities in services to First Nations.
8. Collaboration:   Projects noted that Canada would benefit from improving the sharing of best practices among provinces/territories, and some initiatives in particular under the NWTI succeeded in bringing together researchers, decision makers, provinces and communities. Key challenges to knowledge exchange included lack of resources, the need for culture change and buy-in for data sharing, and resistance to interdisciplinary teams and collaboration. In addition, resistance to change, the decentralized nature of health care, stakeholders' ownership of innovative practices, lack of awareness about existing research and best practices, and inconsistent timeframes between research generation and decision-making were identified as areas of concern.
9. System-Wide Reform:  System-wide reforms that have been critical to successful strategies for wait time reduction in the United Kingdom and other European countries were explored and new approaches were tested in the Canadian context.  Projects looked at an expansion of focus beyond the five priority areas of the 2004 Accord, and at the role of heath professionals, primary care reform, bridging of general and specialist care and adopting more modern management approaches in reducing waits.  Physician buy-in was highlighted as a challenge which requires attention to creating change in culture.  Lessons learned pointed to the benefits of adopting multi-faceted reforms across the continuum of care, addressing system fragmentation, and focusing on putting the patient at the centre of the system.
10. Reducing Demand:   Addressing issues of demand was seen as particularly important in the context of an aging population, which may put pressure on health services.  In projects, the reduction of long-term demand was often linked to emphasizing health promotion and disease and injury prevention, improved management of chronic diseases and ensuring the appropriate use of health resources.  Lessons learned highlighted a role for guidelines and standards for care, a renewed emphasis on primary care and self-management, and health human resource strategies to help control demand.