Health System Strategy & Policy Division Ontario Ministry of Health and Long-Term Care

1. Has Canada’s approach to identifying priority areas
and setting wait-time targets helped or hindered
Canadians’ access to care?
2012 Taming of the Queue Conference
March 29th, 2012
Dr. Vasanthi Srinivasan
Assistant Deputy Minister, Health System Strategy &
Policy Division
Ontario Ministry of Health and Long-Term Care

2. Introduction
MOHLTC is an evidence and analytical resource to the system: social policy
ministries, Government of Ontario, Local Health Integration Networks, etc.
At the macro level Ontario has not always had a strategic approach: sector-by-
sector, initiative-by-initiative, issue-by-issue focus.
A suite of products has been created within a strategic framework
• has utility and facilitates movement in the system
• provides evidence for policy
• influences day-to-day decision-making and future strategic planning
Focus on two themes:
• Role of evidence in a system that uses benchmarks and targets.
• Ontario's Wait Times Experience

3. Enhanced quality of care results when research knowledge is
translated to health care providers
The Ministry works closely with health sector research partners, including
research institutes, universities and agencies to generate the needed evidence
that serves as the basis for Ontario’s clinical standards of care.
Knowledge exchange activities bring research evidence into Ministry policy
development, strategy development and planning.
Knowledge Generation Policy Development, Implementation
Decision-Making and of evidence-
Dissemination based research
Institute for Clinical
Evaluative Sciences (ICES)
Ministry of Health LHINs and
Ontario Health Quality
and Long-Term Health Care
Council (OHQC)
Care Providers
Medical Advisory
Secretariat (MAS)

4. Ontario’s Wait Time Strategy
Since the 2004 Health Accord, reducing wait times for key services has been an
integral element of the Ontario government's strategy to transform its health system
and improve timely access to appropriate care for all.
Wait Times Strategy:
• increasing access by focussing on outputs with incentives.
• funding based on measurement and aligned everything else to it
• was/ is a success (monitored and tracked), compares favourably on a
national level
Since 2003/04, Ontario has invested approximately $1.7 billion for 2.9 million
procedures in the following priority areas:
• cancer surgery
• hip and knee replacements
• selected cardiac procedures
• cataract surgery
• magnetic resonance imaging (MRI)/computed tomography (CT) scans
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5. Results in Ontario
The Ontario Wait Time Strategy includes reporting of reliable data on wait times, pay-
for-performance incentives to encourage efficient and effective practices, and expert
advice and public forums to obtain wait time information.
Data from the MOHLTC Wait Times website for September 2011 demonstrates
Ontario’s continuing success in meeting its wait time targets in the priority areas:
• Cancer surgery: 96 per cent of all patients received care within Priority Level
4 (PL4)* access target.
• Hip replacement: 89 per cent of all patients received care within PL4 access
targets.
• Knee replacement: 85 per cent of all patients received care within PL4
access targets.
• Cataract surgery: 97 per cent of all patients received care within PL4 access
targets.
• Bypass surgery: 100 per cent of all patients received care within PL4
access targets.
• MRI/CT scans: 43 per cent and 88 per cent, respectively of all patients
received care within PL4 access targets.
*Priority level is the outcome of an assessment performed by clinicians on each non-emergency patient to determine their urgency of care rating using
priority assessment tools recommended by clinical expert panels. A description of each priority level by service area is available on the Wait Times
Targets website.
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6. Results in Ontario, cont’d
Successes in the priority areas have also driven improvements in surgery more
broadly. For example:
• Over 90 per cent of Ontarians requiring treatment for other procedures such as
neurosurgery, general, gynaecologic, and plastic and reconstructive surgery are within
provincial benchmarks.
• The 2011 Wait Times Alliance Report Card also gave the province an “A” grade (i.e., 80-
100 per cent of population treated within government benchmark) for all five priorities.
An Expanded Wait Times Strategy:
• In May 2007, Ontario became the first province in Canada to post paediatric wait times
for all 10 paediatric surgical sub-specialties (75% of patients received procedures within
provincial benchmarks, September 2011)
• Ontario has also set two provincial targets for the length of time a patient should spend
in the emergency room.
• ER/ALC Strategy is focused on: targeting investments to reduce emergency room
demand, improving emergency room capacity and performance, and improving bed
utilization.
• Programs in the areas of stroke and cancer care have proven to improve wait times and
the continuum of care.
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7. Role of public reporting for accountability
The Wait Time Information System was created to support the strategy and is a
province-wide system that tracks, measures, and reports on surgical and
diagnostic wait times. This system is the technological backbone behind the
province’s public reporting website.
Over 3,300 clinicians in 94 wait time-funded hospitals submit information on 2.3
million adult and paediatric surgeries and magnetic resonance imaging and
computed tomography scans each year.
The website provides current wait times for hospitals across the province for the
five priority areas and includes information on wait time issues, including
questions to ask your doctor.
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8. Final Thoughts
• Setting and achieving targets is an accomplishment to be proud of . . .
• . . . but it is important to remember that those areas outside of the “spotlight”
of a target may not progress as much those “in the light”.
• Target setting is never “done”.
• There is a danger of confusing descriptions of activities (e.g. an Operational
Plan) with a framework for measuring activities to know what is and is not
working.
• Public policy making requires that performance against targets is analysed
thoroughly, and that new targets (in some cases in new areas) are
established as appropriate.
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