1. Wait Times and Access MHRC Applied Health Services Research Workshop March 4 2014

2. Wait Times & Access Strategies in Manitoba 2004 - 2013 Increased funding for specific procedures / services ($250M) Access targets & benchmarks for priority procedures set nationally Wait times reporting publicly for select group of services Wait list validations Deployment of Patient Access Registry Tool for collection of wait times information for consultation and surgery Establishment of Patient Access Data Submission Policy Deployment of eReferral to improve appropriateness of referrals / consultations Volume based funding for specific procedures Deployment of Lean Six Sigma capacity buildi ng

3. Results Standardized wait time measurements Development of tools for managing waits – lack of uptake or expectation for use, lack of expectation setting for management of waits Improvements in wait times achieved through volume increases not sustained Continued focus on “investing more” & “building bigger” versus “managing differently” Continued belief that we can’t do any better Misaligned incentives and disincentives between “cultural” groups Lack of collaborative action Absence of a “system” approach – continued independent, unaligned actions

4. “If we keep doing what we’re doing, we’re going to keep getting what we’re getting.” -Stephen Covey ….so let’s do something different

5. 2014 forward Clinical practice guidelines / Choosing Wisely Identify and stop non value added activities and services Culture shift to “system thinking” which is patient centred Reorganization of services to environments which maximize efficiencies and throughput (Christiansen) Improved system management of patient access Enhance collaborative action between all parties that impact / influence patient access

6. 2014 forward Improve patient and public engagement in decision making - increase understanding of risks, benefits, alternatives Identify and deploy alternatives to specialist and or surgical care Improve patient flow (by keeping people out of facilities in the first place, improving processes for discharge and community based support, making hospital based care the last resort) Improve accountability, performance management, value for money, customer service

7. Think differently, approach systemically, work collaboratively, demonstrate accountability, engage and serve patients and public