WAITING TIME

Waiting time for Surgery

Waiting time for Surgery

Problem Definition Summary

This paper focuses on issues surrounding the measurement of waiting times to access elective, or scheduled surgery. The first part covers, measuring and managing waiting times, describes several different methods of measuring waiting times, assesses their advantages and disadvantages, and describes the characteristics of an ideal data collection system.

Peter Checkland's Soft Systems Methodology (SSM) (1985a, 1985b, 1994, 1999) is a systematic process of inquiry with a view to take action and develop successful outcomes in complex human activity initiatives'; “It presents a way of thinking that guides problem owners towards purposeful action” (Travis & Venable, n.d., p. 1).

Implementation approach

At the general practitioner (GP) step, delays may arise in the time it takes to see the GP, and in the way that the GP manages the problem. Waits to see GPs have not generally been flagged as a big problem in either the literature or the popular press. In the Canadian Medical Association's National Report Card, 66% of respondents rated access to family physicians as good to excellent, but only 42% felt that way about access to specialists (Canadian Medical Association 2001). However, this may be an emerging issue. A call to the Manitoba College of Family Practitioners in October 2001 revealed that only ten family physicians in the city of Winnipeg were accepting new patients. On January 8, 2002, a news release from Manitoba Health and the Manitoba College of Family Physicians announced a new phone line established to “connect Winnipeggers with family physicians accepting new patients.” Shortages of family physicians may be related to lower medical school enrolments, an increase in the medicalization of care (Black et al. 1995) (Moynihan and Smith 2002), low fee schedules, and recruitment of general physicians by the United States.

General practitioners have differing referral thresholds (Earwicker and Whynes 1998). That is, different GPs faced with patients with the same complaints or symptoms will manage the patient differently. Some will try to investigate the complaint themselves more thoroughly to arrive at a diagnosis before referring a patient on; others will refer more quickly. Some will try to manage a patient medically, before opting for a surgical opinion. Some may be more easily influenced by the “squeaky-wheel” patient than others. In Manitoba, there is evidence of the different referral thresholds exhibited by doctors: the consult rate in 1995/96 ranged from 153 per 1000 population in Central Regional Health Authority to 242 in Winnipeg; residents of both of these regions have similar and relatively good health status (Roos et al. 1997).

Implementation plan

Once a referral is made to a surgical specialist, if the specialist deems the patient's problem to be non-surgical, he or she will refer the patient back to the referring doctor, who then has to run more tests, and/or perhaps refer to a different specialist A family physician, interviewed about waiting times, said:

Surgeons, basically, operate on the premise of... if the problem fits into something that they can operate on, and ...