Time for Progress: New Direction from the Wait Time Alliance

Introduction
It is my pleasure to be here today to participate in this important gathering. I am also pleased to be able to offer my support for the important and ongoing work of the Wait Time Alliance.

Just last spring the Wait Time Alliance released an important assessment of the progress to date on the part of governments in addressing wait times.

At that time, I said - as did Dr. Bellan and other members of the WTA - that progress was being made and that Canadians had some cause to be cautiously optimistic that governments were "finally getting it."

We were cautiously optimistic that progress was being made.

Today, I would like to talk a bit about what has been accomplished and that progress.

Second, I will share important new benchmarks being released today by the WTA. Benchmarks in clinical areas needed by thousands of Canadians every day.

Finally, I would like to send a clear message from here on the shores of Lake Ontario, up the Rideau River to Ottawa - indeed to all legislatures in Canada: It's time for progress.

How far we've come
Just over three years ago Canada's first ministers signed the 10-Year Plan to Strengthen Health Care.

The Plan's accompanying 41-billion dollar figure - and the subsequent argument over "new" money versus "old" money - captured much of the attention.

You, my colleagues here today, will recognize that agreement was also unprecedented because for the first time ever governments - not just one, but all - agreed on commitments to reduce lengthy wait times in Canada.

These commitments included developing wait-time benchmarks for the 5 priority areas by December 2005, and showing meaningful reductions in wait times by March 31, 2007.

Last April, in its report, the Wait Time Alliance (WTA) stated that some progress had been made in reducing wait times in recent years and, where reductions had not yet occurred (e.g., diagnostic imaging), steps were being taken to increase output and improve patient flow.

As I said at the outset, however, "some progress" does not mean the job is finished.

Rather, reducing wait times must be seen as a starting point for improving access to the full continuum of health care and strengthening health system accountability.

Reducing lengthy wait times is a unifying goal and an excellent target at which to aim for funders, providers and patients alike.

The wait-times agenda also increases focus on the processes involved in managing wait times and how different parts of the system need to interconnect.

Despite progress, there has been criticism over the focus on wait times.

Concerns centre on addressing wait times for only 5 conditions, and often only a narrow range of procedures within them.

Critics also point out that health care goes beyond the 5 priority areas and that focusing on these 5 will mean resources will not be directed to other areas or may even be redirected away from them.

These concerns were a prominent theme at the 2007 Taming of the Queue IV conference last April.

However, work on wait times does not have to be limited to the initial 5 priority areas. Indeed, the Ontario Wait Time Strategy stated - (ASIDE -- Dr. Hudson will hopefully back me up on this) - "the five areas were just the beginning of an ongoing process to improve access to, and reduce wait times for, a broad range of health care services."

From the outset, the members of the WTA considered the initial 5 clinical areas to be just that: a starting point.

Last April the WTA announced its next step by expanding to include 5 more medical specialties ready for development of wait-time benchmarks: emergency care, psychiatric care, plastic surgery, gastroenterology and anesthesiology.

Developing wait-time benchmarks for these specialties, as for the initial 5, has helped foster important discussions among specialists regarding what ought to be acceptable wait times for their patients and how they may be reduced.

Today we are pleased to be able to talk about new wait-time benchmarks for what the WTA is calling "the next 5." I encourage you all to examine them in the report: "Time for Progress" (copies here and at www.waittimealliance.ca).

This is the next step in the WTA's ongoing effort to ensure timely access to a broad range of medical care for patients.

As we look at the progress to date a critical concern is how to take the guarantees formed last summer for one procedure and apply them in the remaining clinical areas.

Similarly, we need to move now to standardize these guarantees across provincial lines so that we achieve uniform progress for all Canadians.

This is critical to ensure that we do not end up with "have" and "have-not" provinces when it comes to providing patients with timely access to quality health care.

Where we need to go
A critical component of my "cautious optimism" last April was the expansion of the WTA to include five new medical specialty areas.

The wide range of wait-time benchmarks or performance goals being released today were developed by the Canadian Psychiatric Association, the Canadian Association of Emergency Physicians, the Canadian Society of Plastic Surgeons and the Canadian Association of Gastroenterology.

The Canadian Anesthesiologists' Society provides a double contribution to the WTA. Not only has the CAS created wait-time benchmarks in the area of pain management, but it also provides an important link in the development of wait-time benchmarks by other WTA specialties given the anesthesiologist's role as a member of the surgical team.

Each of the participating specialties followed the methods used to generate the initial set of WTA benchmarks.

This involved reviewing available clinical evaluations or epidemiologic evidence on wait-time thresholds, reviewing existing standards of access, where available, and holding consultations and other exchanges among specialty members to review and consider wait-time targets.

The WTA also again followed an "evidence-based" rather than an "evidence-bound" approach.

As everyone here knows, building benchmarks means building consensus and insufficient or inconclusive research evidence should not stop the process of identifying wait-time targets. Decisions must be made based on the best evidence available.

Yet these wait-time benchmarks should not be construed as standards.

They should be viewed as health system performance goals that reflect a broad consensus on medically reasonable wait times.

Every patient is has different care needs. But, for the most part, these benchmarks should be viewed as "maximum acceptable" wait-times, not "ideal" wait times.

Now, we must keep pressure on governments to act and ensure they are met.

How we can get there
So, as I said at the outset, progress has been made - and everyone here today has played a part in that - but we now need to consolidate that progress and take it forward.

There are 2 key milestones on the horizon regarding wait time benchmarks and the commitments pertaining to the first ministers' 2004 health accord or 10-year plan.

First, the plan calls for provinces and territories to announce multiyear targets for meeting the wait-time benchmarks by Dec. 31, 2007. Although some jurisdictions are operating on the basis that the benchmarks are now in effect, for most it is not clear how and when they will take effect.

Therefore, the WTA expects to see announcements from provinces and territories on this matter between now and the end of the year.

The second milestone is a review of the 10-year plan itself.

The federal legislation passed to implement the plan's funding commitments provides for Parliamentary reviews to assess progress in 2008 and 2011.

The WTA will be an active participant in the upcoming spring 2008 review. An important part of that participation will be the next WTA report card, which will grade progress by governments toward improving access to timely care for Canadians.

In addition to these critical - and looming - deadlines, the WTA is also sending a clear warning today that, although meeting the wait-time benchmarks requires a number of steps, we must begin with addressing Canada's dire health workforce shortage.

This shortage is not limited to the specialties covered by the benchmarks released today, but cuts across all other medical professional groups, including family physicians, nurses and health care technicians.

That is why the WTA has consistently called for a pan-Canadian HHR strategy based on the principle of self-sufficiency for Canada.

Even in this - still dire - area, the Framework for Collaborative Pan-Canadian Health Human Resources Planning is a step toward achieving a pan-Canadian strategy.

The framework prepared by the federal-provincial-territorial Advisory Committee on Health Delivery and Human Resources must lead to further action.

Although health workforce shortages remain the biggest challenge to improving timely access to care, the WTA has also identified critical infrastructure gaps that need to be addressed.

These gaps include hospital acute care beds, alternative level of care beds, operating theatres, diagnostic suites and community services.

Finally, in addition to workforce shortages and insufficient infrastructure, WTA work over the past year highlights an alarming lack of standardized data suitable for monitoring progress in reducing wait times.

Wait-time data are captured and reported differently across the country. Also, jurisdictions use different starting points when measuring wait times, which often leads to distortions in the actual time the patient waits.

You can't manage what you can't measure and the lack of comparable data makes monitoring and cross-jurisdiction comparisons extremely difficult. Also, patients and governments remain largely in the dark as to what progress is being made.

Conclusion
The benchmarks released today by the WTA are just another installment in the ongoing commitment to reduce lengthy wait times faced by patients across the country.

Considerable progress has been made in developing benchmarks and taking action to meet them and everyone here today should be commended for playing their part in securing that progress and building on it.

Clearly, however, the challenge to measure and monitor new wait-time benchmarks must be tackled while remaining vigilant that governments fulfill their previously agreed-upon commitments.

That way forward has been charted with the work of the WTA and others.

Challenges such as addressing the health workforce shortage and critical infrastructure gaps will require even greater effort and focus from health care professionals, governments and other stakeholders.

Also, greater effort is required by all parties to capture wait-times data to determine with greater certainty whether any progress is being made, given the sizeable funding allocations provided by governments.

The challenges may indeed be many, but looking around this room I see the commitment required to overcome them.

Now more than ever we must come together to do just that so that no patient is forced to wait too long for the care they need.

Thank you.