Since the early 2000s improving access to surgical and other hospital based care has been a national, provincial and regional priority across the country. Federal and provincial governments have allocated hundreds of millions of dollars to improve Canada’s weak performance in this area relative to other developed countries. Despite this investment, Canada continues to lag most other OECD countries in providing timely access to care.
Understanding that you can’t manage what you can’t track, many provincial government ministries of health have established provincial wait list registries. Each patient’s wait is tracked by these registries. Many of these provincial registries require the physician offices to submit paper forms or to log into a provincial web site in a parallel process outside the process of care. The timeliness and accuracy of capturing information by this approach has resulted in unnecessary costs and raised data integrity questions.
Furthermore, in Canada modern computerized wait list management systems to help those responsible for managing wait lists are only now being deployed. No single solution exists for reducing wait times, rather as the OECD has observed, countries that have made progress in this area have taken a multifaceted approach.
Two dispirit regions in Canada have taken a leadership role in their approach to improving access to care and improving patient safety.
The Central East Local Health Integration Network
The Central East LHIN on the eastern edges of Toronto Ontario, with eleven surgical sites, was the first health authority in Canada to deploy a web based eBooking and wait times reporting system across an entire region. Today, the LHIN’s almost 400 surgeons eBook their cases and are provided with a colour coded dashboard of their individual wait lists. All mandatory provincial reporting to Ontario’s wait list registry (WTIS) is done automatically and accurately in real time. At the request of the LHIN, the tool was recently modified to facilitate improved performance management and accountability by enabling provincial, regional and hospital specific wait time targets. This granular level of performance management promises to directly impact the CE LHIN’s ability to make progress on improving wait times for its 1.4 million residents.
Originally developed inside a large Canadian hospital by physicians, administrative leadership and information technology specialists, the Novari Access to Care™ system is in use in three Canadian provinces. In brief, the tool uses modern web technology to integrate the physician offices with the hospital surgical scheduling systems. The Novari system does not replace OR scheduling systems at individual hospitals but rather enhances them by acting as a wait times “front-end” to these systems in a very complementary approach.
The five pillars of the technology include:
- Wait list management
- Automated wait times reporting
- Pre-Op standardization
- Real time business intelligence, performance & accountability system
The success of the Novari system has rested on the designers’ founding principle that once deployed, every user to include the medical secretaries, physicians, booking clerks, wait time coordinators, surgical leadership, hospital administrators, provincial wait list managers and regional leadership should derive a benefit and not have an additional burden placed on them. Adhering to this principle has resulted in one hundred percent adoption wherever the Novari Access to Care has been deployed.