Briefing Note - HSCI305 PDF

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Juan Carlos Rodríguez Nolasco 301337107 Timothy Xu 301314711 Briefing Note Audience: Mary Ackenhusen (President and CEO of Vancouver Coastal Health). Title: Alternative Approach To Improve Wait Times Discrepancies in The Canadian Health Care System. Purpose: Creation of a centralized provincial organism to improve wait times management in BC. In order to systematically reduce waiting times, it is required to know how many people are waiting for treatment, how long have they been waiting for, and which procedures require the most attention. Summary of the facts: The Canadian health care system is a highly complex, diverse, and decentralized group of providers and institutions that respond to the health needs of Canadian residents. The fact that many institutions and individual providers, as well as a huge complex of federal and provincial branches deal with different issues and work under their own jurisdictions, creates many structural challenges that significantly affect the health service delivery for anyone seeking healthcare attention. Additionally, provinces tend to implement different strategies, organizational structures, and policies according to the specific demographics of their populations, as a way to improve the efficiency of their healthcare delivery. This complex system translates directly into severe issues to keep track of everything happening across the country. Particularly, access to care and wait times for different interventions has been one of the most prevalent and controversial issues in this system. According to international health standards and benchmarks, Canada´s wait time performance is poor compared to other countries. Wait time issues flow throughout a continuum of care in which patients face challenges even at the most basic levels (ie. routine care). According to the Canadian Institute for Health Information report 2012, 41% of the interviewed patients reported waits of 2 or 3 months for specialist appointments; Canada has the largest proportion of adults waiting in the ED, with times rounding +4 hrs before being treated (19% larger than international average); 33% reported waits of +6 days for doctor/nurse care when sick; 25% reported +4 month waits for elective surgery (ie. bypass surgery within 2 to 26 weeks). In other surveys, specialist physicians have reported a median waiting time of 20.9 weeks between referral from a general practitioner (GP) and receiving treatment. These numbers have continued increasing every year despite huge monetary investments from the federal government. Such long wait times have significant implications for the patients´ economies (ie. loss of productivity or workdays while waiting for treatment), as well as their physical and mental health (ie. constant fear they won't receive the treatment needed on time). POLICY OPTIONS

Juan Carlos Rodríguez Nolasco 301337107 Timothy Xu 301314711 Complex challenges faced by patients in the wait time issues flow throughout a continuum of care. Particularly access to care and wait times for different interventions has been one of the most prevalent and controversial issues in this health care system. There are many structural factors preventing the efficient management of waiting times and the reduction of physical and emotional pain of individuals. This complex phenomenon has nothing to do with economic or resource inputs, but it flows across the country and influences policies, providers, and institutions. Therefore, we need to address the problem through three policy options. Option 1) Implement a wait time priority system Advantages · The wait time is effectively managed · Applies to all stages of diagnosis Disadvantages · Patients still require the process to be faster before surgery Option 2) Introduce artificial intelligence Advantages · Provide screening results sustainably in the case of a labour shortage · Reduce the incidence rates for some diseases · Improve the accuracy and efficiency of cancer screening Disadvantages · It is hard for patients to reach physicians Option 3) Ask government agencies to work together on health services Advantages · Make significant changes in health services Disadvantages · It is not easy to improve the Canadian health service system, shorten the wait time and make patients satisfied · Affected by policy frameworks, economic situations, social conditions, and many other aspects. RECOMMENDATION Option 1: Implement a wait time priority system This option allows for good communication, coordination, reasonable arrangement and better use of medical resources. Using priority systems, based on the patient's condition, has contributed to significantly improve service delivery and reduce wait times. Once the decision is made to treat cancer with surgery, the cases are assigned priority.

Juan Carlos Rodríguez Nolasco 301337107 Timothy Xu 301314711

Why did we choose that policymaker? As mentioned above, to significantly improve healthcare wait times in Canada, it is required to develop a systematic intervention where not just one but many organisms coordinate and work together. Recognizing the difficulty and challenges associated with the creation of a centralized national organism dedicated specifically to wait times management, we do believe that the creation of a regional/provincial organism would be a more feasible and attainable goal. Nonetheless, the magnitude of this intervention is still quite significant. Hence, we considered that directing this report to the president and CEO of Vancouver Coastal Health would be a very useful first point of contact with the States health authorities, as we would have a better idea about how feasible our proposal is. The second reason why we chose this policymaker is that for our intervention to happen, the 5 regional health authorities in BC (Fraser Health, Interior Health, Northern Health, Vancouver Coastal Health, and Vancouver Island Health Authority) would need to be the main actors in this proposal. Therefore, President Mary Ackenhusen could facilitate contact with them.

Juan Carlos Rodríguez Nolasco 301337107 Timothy Xu 301314711 Works Consulted: 1. Canadian Health Services Research Foundation. (2005). A parallel private system would reduce waiting times in the public system? Retrieved from https://www.cfhi-fcass.ca/Migrated/PDF/myth17_e.pdf 2. Cancer Care Ontario. (2018) Women with breast cancer are being appropriately assigned surgical wait times. Retrieved from https://www.cancercareontario.ca/en/cancer-facts/women-breast-cancer-are-being-app ropriately-assigned-surgical-wait-times 3. Fraser Institute. (2019). Waiting Your Turn: Wait Times for Health Care in Canada, 2019 Report. Retrieved from https://www.fraserinstitute.org/studies/waiting-your-turn-wait-times-for-health-care-i n-canada-2019 4. Gov. BC. (2020). Regional Health Authorities. Retrieved from https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/partners/he alth-authorities/regional-health-authorities 5. Government of Canada. (2020). Canada's Health Care System. Retrieved from https://www.canada.ca/en/health-canada/services/canada-health-care-system.html 6. Health Care in Canada, 2012: A Focus on Wait Times. (2012). Canadian Institute for Health Information. 7. MacKinnon, J. (2017). Wait times in Canada. Retrieved from https://journals-sagepub-com.proxy.lib.sfu.ca/doi/pdf/10.1177/0840470417700162 8. McKinney, S. M., Sieniek, M., Godbole, V., Godwin, J., Antropova, N., Ashrafian, H., … Shetty, S. (2020). International evaluation of an AI system for breast cancer screening. Nature, 577(7788), 89–94. https://doi.org/10.1038/s41586-019-1799-6 9. Statistics Canada. (2020). Median waiting times for specialized services. Retrieved from https://www150.statcan.gc.ca/t1/tbl1/en/tv.action?pid=1310069501&pickMembers%5 B0%5D=4.5...