Let's think of urgency, excluding the emergent case. Let us focus for a moment on something that we might be able to agree on, whether we represent a provincial medical association, a government, a research organization or a regional health authority. But it certainly seems, at least from a clinical and management perspective, that something related to urgency would be much more reasonable than first-come, first-served, a lottery, or special criteria or merit. As for merit, might we consider putting children first, for instance, at the start of each operating room list? We can use urgency and we would perhaps have some difficulty in agreeing to exactly what we might mean by that. So might be a lottery that gives everybody equal opportunity.
If the first-come first-served method were used, you might not like it but it is intrinsically fair at one level. With respect to the issue of fairness to the patients whom we serve, there are all sorts of ways of attempting to achieve fairness: first-come, first-served a lottery or special criteria or merit or, we could use urgency criteria. Even if we did, there remains the question of when the intervention can actually be done. Generally, we don't know what the right answer is. “Oh, 18 months maybe, if we are really lucky.” We do not do a good job of answering that question, and it is not necessarily the clinician's fault. What is it we are trying to manage anyway? How about starting with, Who should come next - in short, how do we order the queue? A second and frequent question encountered every day in many clinical situations at which scheduled services are being considered is “How long ought I to wait for that, doctor?” How many times a day are you asked that when you are doing clinical work? Think sometimes of the answers you may give and imagine if you were the recipient of them…. It is not because managers are necessarily uninformed or of poor quality, but because we do not have the necessary tools. We do not manage very well when it comes to waiting lists and waiting times, for a lot of different reasons.
Yet, simply adding more resources does not appear to offer consistent or sustained improvements. We all believe there is a resource issue here, whether it is operating room time or whether it is people or money. There are a host of factors that drive long waiting times. It is simplistic to believe that long waiting times are easy to fix and are simple problems with simple solutions. The issues vary with place, sometimes even within a single geographical confine such as a city. Virtually every country that has a publicly funded health care system has some issue with access to services and waiting.
What do we know about long waiting times? First, they are common to all publicly funded services, worldwide. To take the first of the 3 aspects dealing with waiting lists in this symposium, namely the management of waiting lists, let us start with what we think we know and what we are trying to manage, and then add a few comments about the mission and strategies of the WCWL Project.
0 kommentar(er)
