Over the past two weeks, the B.C. government has announced a series of new initiatives to address wait times for surgeries and diagnostic tests and improve overall access to care in the public health-care system. These initiatives represent the types of system-wide, long-term vision that health-care advocates have been recommending for years.
Health professionals and policy experts have long pointed to innovations at local and regional levels that can reduce wait times and improve access. These are often led by local groups of surgeons, administrators or even colleagues across disciplines who can see a better way forward. But we rarely see a government scale up such systems to a provincial level with co-ordinated regional efforts. And B.C. is doing just that.
First, Premier John Horgan rolled out the province’s new surgical strategy — with hip and knee projects to be launched in each regional health authority. The new hip-and-knee strategy is modelled on the Richmond Hospital’s hip-and-knee project and includes elements such as dedicated operating room time, pre- and post-surgical support, centralized intake and wait lists, and access to the first available surgeon. B.C. will also increase the number of procedures completed year over year (starting with an additional 9,400 surgeries this year).
In addition to the Richmond project, the Alberta Bone and Joint Health Institute and Shared Care “Rocc and Roll” Orthopedics program in North Vancouver, among others, have also shown that collaborative and multi-disciplinary approaches to care (for instance, having physicians, surgeons, nurses and physiotherapists working together on a team) are efficient and highly effective. Early intervention and effective pre-surgical care can reduce suffering and even help avoid unnecessary imaging and surgery. The current announcements will ensure these benefits are equitably shared on the basis of need and not ability to pay.
Our public system is full of innovative ideas, yet without system-level support, these initiatives often fail to scale and spread beyond the pilot stage. In this case, B.C. is focusing squarely on an area we badly need to reform, spreading best practices and changing the way we deliver health-care services.
While the bulk of the announcement focuses on the new hip-and-knee surgery projects, Horgan emphasized his government’s commitment to reducing wait times for a number of surgeries. Similar models of interdisciplinary teams and centralized waiting lists can be replicated across the board.
For many patients, however, there can be a long wait just to get the correct diagnosis. Before their doctors and specialists can recommend a specific surgical procedure, they often need to undergo some form of diagnostic imaging. Wait times for MRIs vary across the province, but in 2016-2017, roughly one in 10 patients waited more than 200 days.
Under the B.C. Surgical and Diagnostic Strategy, B.C. will provide 37,000 more MRIs by March 2019 (up to 225,000 from 188,000) with further increases planned for 2019-2020. Echoing the new surgical wait-times strategy, MRIs will also have central waiting lists, the hours in which MRI machines are used will be expanded and capacity within the public system will be increased through the installation of new machines.
It is clear to health practitioners and patients awaiting treatment that there is an acute need for increased capacity, but it is also clear that this can be achieved within the public health-care system. By looking at the evidence available and expanding it provincewide, the government can provide smart solutions that improve care for everyone, not just those who can afford to pay.
Politicians will often look for a short-term project that will give them the best bang for their buck. Too often, we see pilot projects or a one-time infusion of funds to improve an acute problem within the health-care system. Such stop-gap measures fail to use the best evidence to improve care in the long term. In addition to a system- and provincewide approach, the long-term funding allocated to these initiatives ensures continued growth of B.C.’s public health-care system’s capacity.
The very lack of this type of systems-wide approach is how B.C. has ended up with the wait lists we currently face and the spread of both private surgical facilities and diagnostic imaging clinics. However, with strong provincial leadership and projects such as those recently announced, we can change this trajectory and provide better care for all British Columbians.
Dr. Richard Klasa is a retired medical oncologist, in the division of medical oncology and department of experimental therapeutics at B.C. Cancer. Dr. Rupinder Brar is a primary care and addictions medicine physician in the Downtown Eastside. They are both board members of Canadian Doctors for Medicare.
