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Dr. Joshua Tepper

Wait Times: A Metric to Watch

Earlier this summer, Health Quality Ontario revamped its public reporting on wait times to make it more user-friendly. We also added reporting on the wait time between a specialist receiving the referral from the patient's family doctor, to the patient's first surgical or specialist appointment, to gain a fuller picture of the patient experience.

Since then, the data has been used on numerous occasions to document how well or badly one hospital is doing compared to the rest of the province. There have also been almost 100,000 page views of the wait times pages on the Health Quality Ontario website since their launch. Interest in the information remains strong and there were more than 13,000 page views of the nine wait times measures pages between mid-November and mid-December.

Health Quality Ontario has now added wait times information for diagnostic imaging and time to see a physician in the emergency department, the latter being added to information already being reported on the total time spent in the emergency department (length of stay) for both admitted and non-admitted patients. Both of these are important measures and have long been identified by the Ontario government as key wait time areas to monitor and address. The initiative is a partnership with Cancer Care Ontario who collects, tracks and analyses the data.

Wait times for healthcare are a common focus in Canada and around the world. Globe and Mail health reporter Andre Picard recently generated a huge response when he asked people to start documenting their wait times experiences on Twitter through the #CanadaWAITS hashtag. It’s easy to make a government or health system look bad with one well-chosen patient narrative about an excessive wait time with a horrific outcome: Witness, for example, news stories about the recently published Fraser Institute report on wait times stating they are “the longest ever reported” – despite significant concerns some have about the methodology used by the Institute.

In Measuring Up, Health Quality Ontario’s yearly report card on the Ontario health care system and the health of Canadians, the good (cancer surgery times reduced) and the bad news (hip and knee replacement time surgery increased) about wait times received prominent attention. Our report on emergency departments in 2017 spoke to these wait times, and just a few weeks ago the Canadian Institute for Health Information released its latest report on emergency department wait times.

The provincial framework for health care quality (Quality Matters) considers timeliness one of the six key dimensions of quality. And over 15 years, federal and provincial/territorial government as well as numerous policy and research bodies across the country have identified wait times as a key measure to be addressed.

Public reporting of wait times supports a commitment to transparency and provides necessary information to the public, health care providers and policy-makers alike. It helps us understand where we are performing well and where there are gaps in care and outcomes. Publication of wait times for a number of health care indicators by Health Quality Ontario puts the province in a leadership position for transparency compared to other provinces in Canada, many of whom also maintain robust wait times websites.

The new format used by Health Quality Ontario for publically reporting wait times, making the pages more user friendly and easier to navigate, has gone a long way to address issues raised by the Wait Time Alliance – a group of physician organizations who, until 2016, provided a critique of public wait times sites – about Ontario’s wait time reporting.

Wait times are only one aspect of the health care system upon which Health Quality Ontario reports. Online and in our reports, such as the recent Measuring Up, we also report broadly on uptake of preventive screening procedures, health outcomes, and performance of the primary care, long-term care, home care and hospital sectors.

It is of course important to be cautious about the limits of measuring and reporting. At our recent Health Quality Transformation (HQT) conference, Quality Improvement (QI) legend Don Berwick cautioned that those involved in health care can be excessive in what they measure. We need to put “measurement on a diet” he said. Health Quality Ontario agrees, which is why it has steadily reduced the number of overall measures. With the input of experts, providers and patients, Health Quality Ontario regularly reviews and refines its metrics.

And of course measurement is not enough. As Don Berwick said “We can’t measure ourselves to better”. That is why Health Quality Ontario partners with many others to turn data from reporting into better care, through programs such as the Ontario Surgical Quality Improvement Network to improve patient safety, the MyPractice reporting service for primary care physicians which allows them to compare themselves with their peers, and the Adopting Research to Improve Care (ARTIC) program which is dedicated to accelerating the spread of proven health care throughout the province.

When it comes to measuring the quality of a health care system there are dozens of metrics that can be used, and wait times are often near the top of the list. While wait times can be an indicator of how well-resourced or responsive a system is, they may also reflect how resources in a community are organized.

Wait times tell us about the timeliness and to some extent patient-centredness and geographic equity and efficiency of the system, but not about its effectiveness or safety.

Public reporting of wait times ensures transparency and provides important information, which is why Health Quality Ontario has recently expanded this initiative to diagnostic imaging and emergency departments. Data on wait times can be exaggerated and misrepresented and used for political purposes, but ultimately the goal must be to use this objective data to drive accountability and improvement.

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