By Sameena UddinContributors
In this second article of a six-part series examining how we can build back a better health system for a post-pandemic Canada, Sameena Uddin and Danielle Martin look at how co-operation across hospitals, providers and regions that occurred in the pandemic could be harnessed to address wait times once and for all.
The pandemic was a strange time for Canada’s health systems. Suddenly there were three streams of work to be done: There was the COVID-19 work. There was the work of continuing care for the most urgent non-COVID needs, like cancer care and emergency care. And there was routine daily work, like diabetes care and mammograms. Much of that continued to happen, but some of it was deferred.
As we move into recovery, it’s time to face the consequences of those necessary but tough choices that health organizations had to make during the pandemic. There are significant backlogs that need to be addressed, and that can’t be done just by running operating rooms or MRI departments 24/7 — the health-care workforce hasn’t doubled in size. Burnout and ongoing infection control guidelines suggest there is a very long road ahead, and it may be difficult to get back to pre-pandemic volumes anytime soon.
Instead, the key to addressing waits can be summarized in one word: co-operation.
Here’s an illustration. During the pandemic, Tim was scheduled for surgery for esophageal cancer at a GTA hospital. He had already received his diagnostic imaging, chemotherapy and radiation near his home in Oshawa, and surgery was the next critical step. But a COVID-19 outbreak at the hospital led to the cancellation of his surgery with no indication of when it would be rescheduled.
Under the traditional model where every hospital is an island and every surgeon oversees their own personal wait list, Tim would simply have had to wait. Instead, his surgeon reached out to a colleague at a different hospital who was able to perform the surgery. And once he returned home, he was able to follow up through virtual appointments.
Co-operation of this kind — treating every resource in the system as a shared one and when necessary, offering quality care with another team in the region — can and should continue.
In the case of highly specialized care, co-operation means centralizing care in specialized centres and standardizing it, so that no matter where a person is cared for, the care is the same. This has been done successfully in Canada for cancer care, and is one of the reasons why our outcomes for cancer are stronger than comparable countries.
Co-operation has a different meaning when it comes to more routine procedures and surgeries that can be performed in many, if not most, hospitals. From joint replacements to cataract surgery, most surgeons in Canada work independently. Wait times vary widely, with older surgeons tending to have longer waits because they are better known — which doesn’t necessarily correlate with their outcomes. Unconscious bias plays a role too: research has shown that women surgeons tend to receive fewer referrals, despite their surgical outcomes being as good or sometimes better.
As soon as any pressure is exerted on this siloed model that focuses on individual doctors rather than collaborative teams, the inefficiencies and inequities appear.
Team-based models of care, often linked to a “single front door” (or single-entry model), are effective at overcoming these constraints. These models create a single queue, directing patients to the next available provider in the region based on their acuity and priority. A patient might then be assessed by a physiotherapist rather than a doctor prior to their hip replacement; a different surgeon might perform the operation than the one who met the patient at the initial appointment; and post-surgical care might happen through video visits with a nurse.
This approach is different from what we are accustomed to in Canada. But it is the most ethical way to ensure that all surgeons and health-care professionals have an opportunity to use their skills and training. Such team-based models of care will also provide the most accessible and patient-centred approach to addressing the profound challenges of the post-COVID backlog in health care.
We need to learn from Tim’s experience — and quickly. In Ontario alone, there is a backlog of nearly 16 million health-care services. Addressing wait times will require us work together as a cohesive system — through single-entry models, regionalized centres and leveraging virtual care to keep health care working for everyone as efficiently as possible.
We know this type of co-operation can happen — it already has during the pandemic. There is no reason we can’t fix wait times once and for all.
Dr. Sameena Uddin is a thoracic surgeon, the program chief and program medical director of oncology at Trillium Health Partners. Dr. Danielle Martin is a family physician and executive vice president at Women’s College Hospital and author of “Better Now: Six big ideas to improve health care for all Canadians.“
This article was originally published in the Toronto Star, August 8th: https://www.thestar.com/opinion/contributors/2021/08/08/fixing-health-care-wait-times-once-and-for-all.html