Still waiting after all these years

Yesterday afternoon, in my capacity as Cardiac Program Medical Director at my hospital, I met with Mr. B, a 72 year old man whose wife died in hospital.

I was expecting that he would want to talk about her hospital care; perhaps he wanted to explore why she died and if anything could have been done differently. I reviewed her chart thoroughly in advance so I could be sure I had all the facts I would need to discuss her case with him in a meaningful and productive way.

As it turned out, he didn’t want to talk about that at all. Instead, he wanted to talk to me about his wife’s experience leading up to her surgery. He told me her story chronologically. She’d had a series of encounters, each characterized by a wait. She had waited in the ER. She waited for diagnostic tests. She waited for consultations, she waited for decisions and she waited for her surgery.

“All of the doctors and staff were great”, he repeatedly told me, almost as if he were trying to protect those of us who work on the front line from critique, “but the system let her down.”

He went on to explain how all of these constituent waits in her health care journey left this very thoughtful, seemingly-empowered and articulate man and his wife feeling afraid, vulnerable, disconnected, anxious, demoralized and uncertain.

Canadians understand that when they require non-urgent health care, they will usually have to wait. When waits are appropriately brief and when patients feel connected and in control, they feel confident and satisfied. When waits are too long, however, and when people are left “in limbo” between encounters, patients and their families experience anxiety, economic hardship, needless pain and suffering, and perhaps even more serious adverse events, including death. Also important is the societal cost of excess waiting. The Canadian Medical Association has estimated that waits exceeding medically acceptable benchmarks for just four key procedures cost the Canadian economy $14.8 billion dollars in a single year.

As I reflect on the nearly ten years that have passed since the 2004 health accord was signed by the federal government and the provinces and territories, I find little reason to cheer. Despite all the goodwill, hard work and cooperation; despite the money committed to reducing wait times and the intense pressure from the public to improve, we have seen only modest progress. Over the past year or two, most discouragingly, we are now seeing the reversal of that modest progress. CIHI, the Health Council of Canada, and the Wait Time Alliance all agree that wait times have worsened again. Essentially, we’re regressing right back to where we started.

How is it that all this work and all these resources have not led to sustained improvements in wait times?

The reasons are many but they essentially boil down to one indisputable truth: the money that was invested didn’t buy change. All we did was to make the numbers look a little better for a short time. Our “success” was fleeting. The Senate Committee on Social Affairs, Science and Technology, in its review of the progress made since the 2004 Accord echoed this sentiment, recommending that investments must be used to buy change, not to maintain the status quo.

What would real, transformational change look like?

Well, it would start with the assembly of clear and timely information on outcomes and performance, the tools to measure these, and the establishment of a national body that is resourced and empowered to collect, analyze and present these data. We can’t change what we don’t measure.

Transformational change would also see more accountability to deliver the change that is purchased by the investment. We won’t change if the payers don’t hold us all accountable to deliver the change that the resources provided are intended to buy.

Transformational change means far less “siloism” in the system. It’s often said that we are a nation of health care pilot projects. Our jurisdictional and cultural silos impede the sharing of successes and best practices. We are forever “re-inventing the wheel” because we have diminishing national focus, standards, and goals.

And finally, transformational change means that all stakeholders in the system have to step up to do their part. Physician groups and other health care professional organizations must continue to advocate for individual patients but we also must embrace our civic professionalism – to help our system find better value for money and to help lead our collective responsibility to find a path to sustainability.

Putting my doctor hat back on, though, I see this as being about how to fundamentally change our approach to the provision of care from one that is provider-centric to one that is patient-centred. Mr. and Mrs. B wanted us to accompany them on their journey. Instead, we invited them to join us on ours.

Mr. and Mrs. B recognized the excellence embedded in the silos, but felt abandoned at the transition points in her care pathway. The transition points between each component are the wait times; it is at these bottlenecks where negative perceptions, inequities, and suboptimal outcomes are born. It is also where inefficiency and waste are generated.

They deserved better. All Canadians deserve better. And we can do better. Together, we can build a health care system that is truly worthy of Canadians’ confidence and trust.

This blog is republished with the permission of the Health Council of Canada.

The comments section is closed.

  • Farah says:

    I hope Dr. Brian Day wins his case because then I can purchase private insurance in Ontario and take care of my health quickly, instead of living my life on a waitlist. I want increased efficiency and competition in our health care system.

    The court case is starting up again soon and I’m excited to see how it turns out.

    Anyone interested in health insurance matters should listen to Sirius XM, Doctor Radio channel and the show is called Healthcare Connect. I find the show fascinating and would recommend it to others interested in health insurance.

  • Kira says:

    As a person with a long ongoing saga of managing orthopaedic, arthritic & hypermobility problems I have first hand experience with every aspect of healthcare & nothing means more to me as a patient then being spoken to, not at. Most patients haven’t gone to medical school but no one will ever know a patients body better then they do.
    So what has my 20 years of experience taught me?
    – A patient can talk but can’t make a doctor listen.
    – When a patient or their family are treated poorly, there is often a ripple effect creating the very attitude, environment & tone that makes healthcare professionals jobs more difficult
    – Trust isn’t automatic, a doctor has to earn it (just like everyone else in life)
    – When patients are excluded from the process, intentional or not it leads to distrust & because patients are already suffering & vulnerable once the trust is lost it’s not easily restored
    So if things are going to get better, patients have to, not just be invited to the table- the table has to be a round table with no hierarchy.

    • Sharon Wilton, Project Share says:


      your comment:

      ‘- the table has to be a round table with no hierarchy.’

      A truer word was never spoken.

    • F. M. says:

      As cynical as this sounds, doctors aren’t paid to talk to patients. They’re paid to “do”.

      The reimbursement system is set up to reward “doers” rather than communicators and thinkers, which I find backwards since doctors are supposed to be the communicators and thinkers, and nurses the doers. I mean, any procedure, even interventional cardiology, could be done by a monkey if it had enough exposure. But to diagnose, think, prevent, that takes skill.

  • Merrilee Fullerton says:

    Measuring and Monitoring, Accountability and Patient-Centred care, and Value for Money are noble objectives. Sadly, they aren’t enough. Dr. Simpson accurately identifies the reality that the transformation to date and the bundles of federal funding have not created substantial improvements.

    The triple threat of Diabetes, Dementia, and Cancer will bring the public health care system to its knees by 2025.

    People need to prepare and need to be given an accurate portrayal of what we are up against.

    Never before in the history of public health care will we be faced with the prospect of shrinking tax base with fewer and fewer relative number of taxpayers to fund the growing needs in public health care in addition to funding improvements to an aging infrastructure and increasing expectation of government support.

    • Sharon Wilton, Project Share says:


      When you consider the codes in ICD- 9 ( 14,000+) and ICD -10 ( 60,000 +) it appears that the Classification of Diseases, Functioning, and Disability will open more doors than simply data
      mining ( Carepaths should flourish in co-morbid states ).

      Couple this with new ways of distributing funds inside an all-encompassing funding structure for health … and watch the silos fall.

      The burning question is what will the service structure actually look like at the “blending” of the parts is then” distributed as service”?

      • Merrilee Fullerton says:

        Could you clarify your comment in simple terms? I don’t understand your point.

  • Sharon Wilton, Project Share says:

    Chris ….

    This is a very encouraging article in the sense that it shows an exciting connection directly with the husband ( albeit possibly just for datamining ) where you anticipated the need to respond.

    The “herald plaque” of the true dilemma in seeking input from the husband is this statement you made:

    ‘“All of the doctors and staff were great”, he repeatedly told me, almost as if he were trying to protect those of us who work on the front line from critique, “but the system let her down.”

    This patient is deep into “learned helplessness” when a very uncaring, disconnected, flawed ?system cannot see that it’s entire fragmented structure has created an exciting prosperous event for the professional provider of service …and… the Stockholm Syndrome in the people they are to paid to rescue.

    This person you interviewed wanted to discuss how he had been unable to rescue his wife ( not the quality of your work ). It was not about you … or her…. it was now about him ( and how he could not overcome the obstacles to rescue her). I hope you referred him to a grief counsellor ….or is that silo too separated from yours?

    Imagine yourself introducing the finest threading into the myocardium to leave that “stent” where that one small event restores the operations of multiple systems (depending upon that small foreign object letting the blood flow again.)..

    In healthcare….. freedom to flow requires the introduction of something equally small ,but dramatic in effect, to enable existing systems to work again at optimal levels.

    Just as the stent is a foreign body that requires backup protection while the body gradually accepts it’s presence and covers it with appropriate tissue …so… the healthcare “delivery” needs an opening and that very small opening is needed inside two sites ( an dit needs to be protected until it is accepted by the host. The sites where it is needed are:

    1.the “myocardium” of the “healthcare provider” who has lost touch with the person /client/ patient/ neighbor/ citizen / that his entire profession ( and all systems within it ) were created to serve.

    Perception of patient value … is the stent…. and empathy is not the answer. Humility is.[ and the faithful consumption if humble pie for several months IS as “ equivalent “as the reason for taking Plavix :)

    2. the carotid artery

    A re”think” to transform this situation may only happen when the payor has to affect the circulation of $ to the Provider where “scarcity” becomes the controller (versus supervision )… and disabler. ( Web 4.0 is coming)

    Transition points are easily overcome by inserting a navigator or a scout role ( a paraclete) not just a coordinator…….but who wants to do that? It has to be something that makes existing systems respond quickly and perform their connections properly and it has to be inserted in the right places.

    Be bold …be brave…….let’s talk about a proper P3 construct as that stent… that incorporates ALL persons through the IN door. :)


Chris Simpson


Chris Simpson is the Canadian Medical Association President elect nominee, the Chair of the Wait Time Alliance and Chief of Cardiology at Queens University.

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