November 10, 2005

Dear Mr. Nelson:

Thank you for your supportive note regarding our status in the new world of Ontario healthcare.

Your comments concerning the high-profile wait-time strategy reflect the realities of this government's initiative to "improve accessibility". While we all agree that shorter wait times are ideal, they are complex entities that even our government does not fully understand.

From the perspective of cardiac services, Thunder Bay is now publicly accountable for cardiac cath wait times which are only published to reflect the mean number of days waiting. The government has dropped the previous, more appropriate standard, which measured our ability to care for patients of various urgency rankings within the validated acceptable timeframes for each category. Excellent service for emergent and urgent patients is not apparent to Dr. Hudson's group if our elective wait times are longer than some other facilities. The "bar" has been moved, but not to better serve all patients in the system. And you are correct: most of our patients cannot jump the queue. Likewise, we have not received any referrals from the GTA.

This brings us back to the issue of how and where our government sites resources and programs. I think we would all agree that drastically low wait times (eg- angioplasty, cardiac surgery) reflect excess capacity in a system .... not necessarily excellent resource management. We know our patients wait longer and suffer more complications during their waits, but the government is not reporting by regions, only by providing facilities. This essentially hides the true access issues experienced by our northwestern patients. Our most significant access issues are not apparent on any "Wait Time" web sites.

I found your note refreshing and encouraging for our staff in the wake of the Balanced Budget process and Wait Time initiative. I agree; TBRHSC staff have pushed to the outer limits and that we've reached the point where we cannot do more with less. This comment also applies to our senior managers and board members, under direct pressure to "fix" complex issues without the correction of many root causes.

Thanks for putting the (floating) benchmarks aside ...sometimes we all need to hear that!

Sincerely,

Arlene Thomson
Manager, Cardiac Catheterization Lab
Thunder Bay Regional Health Sciences Centre