Toward systematic reviews to understand the determinants of wait time management success to help decision-makers and managers better manage wait times.

BACKGROUND: Long waits for core specialized services have consistently been identified as a key barrier to access. Governments and organizations at all levels have responded with strategies for better wait list management. While these initiatives are promising, insufficient attention has been paid to factors influencing the implementation and sustainability of wait time management strategies (WTMS) implemented at the organizational level. METHODS: A systematic review was conducted using the main electronic databases, such as CINAHL, MEDLINE, and Cochrane Database of Systematic Reviews, to identify articles published between 1990 and 2011 on WTMS for scheduled care implemented at the organizational level or higher and on frameworks for analyzing factors influencing their success. Data was extracted on governance, culture, resources, and tools. We organized a workshop with Canadian healthcare policy-makers and managers to compare our initial findings with their experience. RESULTS: Our systematic review included 47 articles: 36 related to implementation and 11 to sustainability. From these, we identified a variety of WTMS initiated at the organizational level or higher, and within these, certain factors that were specific to either implementation or sustainability and others common to both. The main common factors influencing success at the contextual level were stakeholder engagement and strong funding, and at the organizational level, physician involvement, human resources capacity, and information management systems. Specific factors for successful implementation at the contextual level were consultation with front-line actors and common standards and guidelines, and at the organizational level, financial incentives and dedicated staffing. For sustainability, we found no new factors. The workshop participants identified the same major factors as found in the articles and added others, such as information sharing between physicians and managers. CONCLUSIONS: Factors related to implementation were studied more than those related to sustainability. However, this finding was useful in developing a tool to help managers at the local level monitor the implementation of WTMS and highlighted the need for more research on specific factors for sustainability and to assess the unintended consequences of introducing WTMS in healthcare organizations.

Wait time management strategies for scheduled care: what makes them succeed?

OBJECTIVES: To assess experts' perceptions of the contextual and local factors that promote or inhibit the implementation of waiting time management strategies (WTMS) in Canadian healthcare organizations. METHODS: We conducted 16 semi-structured interviews and one focus group with individuals involved in WTMS at the federal, provincial or organizational level. RESULTS: The most frequently cited local factor was physicians' participation. Physicians' leadership made the greatest difference in bringing resistant physicians on board. To be effective, however, local leadership had to be supported by senior management. Alignment of financial incentives between the contextual and local levels was also frequently cited, and interviewees stressed the importance of tools used to design, monitor, evaluate and prioritize WTMS. CONCLUSIONS: Finding the right balance between supportive resources and tools and an effective management system is a tough challenge. But achieving this balance will help reconcile contradictions between top-down and bottom-up WTMS.

[An accreditation process for public health. Is is possible? Is it desirable?]. / Un processus d'agrément pour la santé publique: est-ce possible? Est-ce souhaitable?

OBJECTIVES: The objective of this pan-Canadian study was to evaluate the feasibility of developing a set of accreditation standards supported by an accreditation process for public health in Canada. METHODS: Twenty-four telephone interviews were conducted, recorded, transcribed and analyzed. RESULTS: The scope of public health implied in respondents' answers included health protection, health promotion, disease prevention and surveillance. A large majority of the experts were in favour of implementing accreditation in public health. Of these, close to two thirds answered that public health needed its own standards to address some of the current gaps. People in health systems were faster to question the relevance of separate standards for public health to avoid creating artificial barriers within the continuum of care. Respondents who opposed an accreditation process for public health cited the lack of capacity currently in the system. Yet, proponents argued that accreditation could actually be used as a capacity-building tool and assist "to fight the tyranny of the urgent". Some identified the actual process of developing accreditation standards for public health as being a valuable exercise. CONCLUSION: It appears that public health in Canada would benefit from an accreditation process developed in consultation with the field, to enhance visibility, capacity building, and performance through pan-Canadian standards which would also have to be flexible enough to accommodate specific provincial and local contexts.