Apr 26, 2016

Time to rethink BC’s surgical waitlist strategy

By cat-healthcare

By Andrew Longhurst, Marcy Cohen and Dr. Margaret McGregor

Have you had to wait months for surgical consultation, let alone the surgery itself? If so, you’re not alone.

British Columbians are waiting an unacceptable amount of time to receive the care they need. Since 2010, surgical wait times have increased significantly for key procedures, including hip and knee replacements and cataract surgery. BC has some of the longest waits in the country.

Why are wait times getting longer?

Over the last 10 years, BC has seen a number of successful initiatives intended to reduce surgical wait times in the public system—led by local groups of surgeons, health authority administrators and practitioners. But these have not been scaled up province-wide.

Instead, the BC government has focused almost entirely on short-term funding measures and incentives to complete more surgeries—strategies that, on their own, have a poor record of reducing wait times over the long term.

Last year, the government for the first time released a comprehensive report outlining its plan for tackling wait times. While the plan includes many good ideas, it proposes going in two contradictory policy directions at once.

One the one hand, the government’s report acknowledges the need for more provincial leadership to reduce waits, but on the other, it recommends extending the length of stay in private surgical facilities for up to three days.

Currently, private surgical facilities can only perform day surgeries, meaning all other surgeries must be performed in public hospitals. Allowing up to three-day stays would be a massive step towards health care privatization—a move the College of Physicians and Surgeons of BC recognizes would lead to a private hospital sector.

The Vancouver Island Health Authority is already experimenting with new strategies to contract out day surgeries. Last year it announced plans to send 55,000 day procedures to the for-profit surgical sector over the next five years.

We are at an important crossroads for health care in BC. Attempting to move in these two directions at once takes us farther down the road of health care privatization, and makes it even harder to implement surgical wait time solutions in the public system.

A large body of international research shows that private, for-profit delivery actually costs more, is lower quality and less safe, and destabilizes the public system.

Meanwhile, the government itself acknowledges that 18 per cent of operating rooms in the public system are not regularly staffed, primarily due to a lack of funding. Some sit completely unused during summer months, and none have extended hours. And yet the government has no concrete strategy for better utilizing this existing capacity.

Our research report offers many innovative public policy solutions, drawing on successful surgical improvement strategies from BC and beyond.

Here’s just one example: Richmond Hospital reduced wait times for hip and knee replacements from 20 months to five months by using two operating rooms: surgeons moved between rooms and teams completed eight joint replacements per day instead of six. Yet this successful, innovative program was terminated two years ago. All hospitals in BC could be using this more efficient model, but provincial leadership and coordination is required.

Canada’s Wait Time Alliance—made up of 18 national medical organizations—encourages us to learn from Scotland’s impressive work. This is a country—comparable in population to BC—where 90 per cent of trauma and orthopedic surgery patients are treated within 12 weeks. In BC less than half of knee replacement patients receive surgery within 26 weeks.

Like Scotland, BC should adopt a central “first available surgeon” referral system so patients have the option to receive consultation and surgery faster. The current approach creates unnecessary bottlenecks and long waits. Scotland’s outstanding record comes from sustained leadership and a commitment to improving the quality and efficiency of care delivered in the public system.

The Wait Time Alliance also points to inadequate residential and home care for seniors as a barrier to reducing wait times. An investment in this important social infrastructure will reduce hospital overcrowding, cancellations of elective surgeries and, ultimately, wait times for all patients.

Solutions to long surgical wait times are abundant. If the BC government chooses public innovation over privatization, it can improve timely access to high quality surgical and specialist care. With provincial leadership, long waits can be a thing of the past.

Andrew Longhurst is a health and social policy researcher. Dr Margaret McGregor is a family physician and clinical associate professor at the UBC Department of Family Practice. Marcy Cohen is a research associate with the CCPA and an adjunct faculty member in Health Sciences at SFU. They are the authors of a new report, Reducing Surgical Wait Times in BC: The Case for Public Innovation and Provincial Leadership, published by the CCPA-BC.

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