Better Now by Danielle Martin

Author:Danielle Martin [Martin, Danielle]
Language: eng
Format: epub
Publisher: Penguin Canada
Published: 2017-01-10T00:00:00+00:00

What Better Looks Like

The challenge we face is complex: an aging population that wants greater convenience, autonomy, and engagement, and better health at a lower cost. This challenge won’t be met by putting more money, whether public or private, into the system. We need to develop new ways of doing things that aren’t just about spending more. Here are just a few examples of what that can look like.

1. Cue the Queue

One of the biggest challenges we face in Canadian health care is wait times for elective procedures and appointments. In almost every case, we can reduce waits without spending more if we use a centralized intake process for specialty services.

When I first started my practice a decade ago, if I had a patient who needed a knee replacement, I’d refer him or her to the orthopaedic surgeon whose name I knew. That surgeon kept his wait list in the top drawer of his secretary’s desk. If he went on vacation for the month of August, the wait list just grew.

Now, as a result of the concerted effort to reduce wait times in many parts of the country, when I refer a patient with late-stage osteoarthritis of the knee, that person is seen within a few weeks by a nurse and a physiotherapist. These highly trained professionals educate patients about the nature of osteoarthritis, teach them exercises to improve their pre-operative strength, counsel them on the importance of weight loss, and use a checklist to determine whether they’re good surgical candidates. If they are, they can either wait for the surgeon of their choosing or see the next one available.

Let me illustrate this important point about the next available surgeon. At six p.m., when I’m rushing home to my hungry six-year-old, I sometimes stop at the grocery store. I grab whatever I need and head for the checkout line. And then I play the guessing game. Which line shall I choose? If I get it right, I’m home in twelve minutes. If I get it wrong, and I’m in the training line, or behind the teen counting coins from his pocket, it’s twenty minutes. Now, if I make the same stop at the bank, I get in a single line—just one line—and am served quickly by the next available teller. The banks have figured out the beauty of applied queuing theory. Grocery stores have not.

By adopting the bank-line method and instituting a single common queue, we’ve reduced wait times and increased the appropriateness for surgery of those patients who are awaiting surgical consultation. And because groups like the Wait Time Alliance insisted on actually monitoring wait times, we’ve been able to measure our progress and identify when things start to go off track.

There is no reason why this model can’t be applied to the majority of specialty care. If you have two specialists in a geographic region who offer the same services, you can do centralized intake. What’s required is a willingness on the part of specialists to give up

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