Tuesday, March 25, 2008

What is Success in Wait Times?

They tell me its working but I don’t believe them. They’re prioritizing programs, increasing funding and diverting home care cases from the emergency rooms. Our surgical wait lists are dropping.

Then why do I have this sense of impending doom.

I’ve now carried a pager and worked as an intern, resident and staff surgeon for 14 years. I’ve covered emergency call all the way from the biggest hospitals in Toronto to the smallest in rural Ontario. It seems that our resources are getting stretched thinner and thinner. We do more cases in the OR’s with the same (or slightly fewer) anaesthetists. Our emergency room has fewer regular emerg docs. Our after hour CT’s are being read by someone 100 miles away. I have to ask, what the statistics are missing because we all know that something is amiss. Something is getting worse.

Using our own experience I look to the outliers; that 5% of patients that wait the longest. Because whether you’re in the service sector or industry you know that the real efficiencies come not from managing the mean but controlling the number of outliers. And there are more and more outliers. That ever growing number of marginalized patients that don’t have access, can’t find a family doctor and have long waits to discuss the smallest of problems. What I fail to find in all of the statistics is an analysis of the outliers. I think the problem occurs because our wait time statistics are generated from inside the system. In other words, you don’t start waiting until you’re on the wait list. As the patient, once I make it to the wait list I’m almost home.

Whether it’s the E.R., O.R. or clinic, it’s not that the average wait that I worry about it’s about being that person that can’t access health care and falls in the top 5%. Our system is making strides but we need to change our frame of reference to align it with that of the patient. Winston Churchill said, “Success is going from failure to failure without a loss of enthusiasm.” and because of it I applaud our governments enthusiasm. By the same logic, however, our success should not be judged by the average patient but by its own failures. That is, those patients that fall outside of the 95th percentile.

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