The use of coaching to improve peri-operative efficiencies: the Ontario experience.

Coaching has traditionally been associated with sports, where coaches help teams and individuals focus on improving their athletic performance and achieving top results. Coaches do not play the game; rather, they stand on the side and provide advice and guidance to those who are playing. Increasingly, organizations are recognizing the value of coaching to develop and train leaders, managers and employees to become top performers. Ontario's Wait Times Strategy--which was launched in November 2004--adopted the concept of coaching to help hospitals improve access to services and reduce wait times.

Contributing to the value-for-money challenge.

McGrail, Zierler and Ip do an excellent job of analyzing the complex issues surrounding the value-for-money challenge in healthcare. In response to their call for a new perspective, the following observations are made. Many questions can be asked to help articulate values. More will be accomplished in the short and medium term by focusing on the simpler questions. Some questions about value will never have an absolute answer with complete agreement. Furthermore, what is valued in healthcare tends to be clouded by what is rewarded in healthcare. Although the authors call for reviving the notion of building a pan-Canadian health information strategy, there are excellent examples of provincial success stories on which to build (e.g., Ontario's Wait Times Information System). Research and evaluation will not add value unless they are closely linked to the knowledge needs of decision- and policy makers. In reply to the authors' call to stop treating information technology as optional and demand that anyone paid with public funds report on the use of those funds, it should be recognized that information technology is the enabler that everyone should use. What we need to stop treating as optional is accountability and appropriateness for the use of funds.

Chronic disease prevention and management: some uncomfortable questions.

Morgan, Zamora and Hindmarsh make a compelling case for a national strategy on chronic disease prevention and management. The truths raised in the lead paper are not particularly inconvenient, but they do raise a number of uncomfortable questions: (1) Why are physicians not taking a more responsible and active role to prevent and manage chronic diseases on behalf of their patients? (Physicians must recognize that it is their professional responsibility and their job to provide their patients with the appropriate level of care for chronic conditions.) (2) Why are non-physician healthcare providers not playing a larger role to prevent and manage chronic diseases? (3) Why is there a greater focus on managing chronic diseases than on preventing or delaying them from happening? (4) Have we forgotten the profound impact of the social determinants of health on illness, life expectancy and death?

Evaluating outcomes in Ontario's Wait Time Strategy: Part 4.

It is widely recognized that Ontario's Wait Time Strategy is a significant change management initiative. But has the province achieved the goal that it set out for itself in November 2004? This article answers this question, beginning with a brief overview of the major inputs or foundational building blocks of the strategy, followed by a detailed analysis of the major outputs or outcomes of the strategy to date.

The pivotal role of critical care and surgical efficiencies in supporting Ontario's Wait Time Strategy: Part 3.

As part of its Wait Time Strategy, the Ontario Ministry of Health and Long-Term Care provided significant amounts of money to perform more cases with the understanding that improving access by reducing wait times is not just a matter of increasing funding. Rather, fundamental system and practice change is required to sustain improvements in the long term.

Has Ontario's Stroke System really made a difference?

The progress that has been made in preventing and treating stroke since 2000, when the Joint Stroke Strategy Working Group tabled its blueprint report, Towards an Integrated Stroke Strategy, is very encouraging. The evaluation results demonstrate that the Ontario Stroke System has had positive measurable impacts on access to stroke-related services, the integration and coordination of stroke care, treatment for stroke, and client and provider satisfaction.

Developing a culture to sustain Ontario's Wait Time Strategy.

Ontario's Wait Time Strategy--a significant change management initiative--is designed to improve access to healthcare services in the public system by reducing the time that adult Ontarians wait for services in five areas by December 2006 (cancer surgery, cardiac revascularization procedures, cataract surgery, hip and knee total joint replacements, and MRI and CT scans). These five are just the beginning of an ongoing process to improve access to, and reduce wait times for, a broad range of healthcare services beyond 2006. Change management initiatives are initially successful because of the significant time, attention and resources that are dedicated to the start-up effort. Many initiatives lose their momentum and impact and ultimately fail in the long run since it is difficult to sustain this level of intensity. The probability of success increases if a culture is developed to sustain the initiative into the future. A pivotal element for this sustained culture is accountability for achieving results. If Ontario is to reduce waits for quality healthcare services over the long term, it must shift from a paradigm where no one--or only a few--are accountable for achieving a particular set of results to one where a wide range of players is accountable for achieving a broad range of results. This includes explicit accountabilities of the public, healthcare providers (including physicians, other healthcare providers, professional associations and regulatory bodies), government and Local Health Integration Networks. Tools required to support these accountabilities include developing leaders, aligning incentives to reinforce what needs to be achieved, and developing information systems to provide the data needed to make decisions, and manage and improve performance.

Expert panels and ontario's wait time strategy: part 2.

Expert panels have been widely used in healthcare as a way of bringing knowledgeable people together to examine issues and identify solutions in well-defined areas. Various terms have been used to describe these groups of experts such as "consensus panels," "blue ribbon panels" and "expert committees or panels." Regardless of the term used, panels of healthcare experts have a history of providing invaluable advice to policy- and decision-makers.

Ontario's wait time strategy: part 1.

Ontario's Wait Time Strategy was designed to improve access to healthcare services in the public system by reducing the time that adult Ontarians wait for services in five areas-cancer surgery, cardiac revascularization procedures (cardiac surgery, percutaneous coronary intervention, diagnostic catheterization), cataract surgery, hip and knee total joint replacements and MRI and CT scans. These five are just the beginning of an ongoing process to improve access to, and reduce wait times for, a broad range of healthcare services.

System change in healthcare: the Ontario Stroke Strategy.

The development of the Ontario Stroke Strategy was due to a combination of strategic decisions, hard work, good timing and luck. This article reviews the development of the strategy from its early days to the present, outlines the approaches used in working with government to influence its policy and investment decisions and reflects on the future.

Connecting for change: networks as a vehicle for regional health reform the early experiences of the Child Health Network for the Greater Toronto Area.

The Child Health Network (CHN) for the Greater Toronto Area (GTA) is a partnership of hospital, rehabilitation and community providers committed to developing a regional system to deliver high quality, accessible, family-centred care for mothers, newborns, children and youth. This article reviews the history and model of the CHN, assesses its achievements, and provides insights into the challenges and lessons learned by the network. Stemming from the CHN's commitment to quality, accessibility and efficiency, regionalization of maternal, newborn and children's services is emerging as a success story.