Ontario Wait Time Strategy What Now? Breakfast with the Chiefs February 21, 2007

1. Ontario Wait Time Strategy What Now? Breakfast with the Chiefs February 21, 2007 Alan R. Hudson, OC, FRCSC

2. “In less than two and a half years enormous progress has been made in developing and implementing a wait time information and management system in Ontario.” “I am therefore, persuaded that measures are in place to deal with all the concerns that were raised by the AG in his report.” Senator Michael Kirby

3. “Speak SLOWLY, stop mumbling and don’t burp!” Joann Trypuc “If you tell the “cataract bus” story once more, I will kill you!” Vince Rice “We had a late cancellation at Breakfast with the Chiefs – we can’t find anyone, will you do it?” Anton Hart “If you want to live to see another day, don’t think, do exactly what I tell you.” Vincy Perri

4. 90% of Cataract Surgeries Completed Within trendline

5. Cataract Surgery Wait Times

6. Cataract Prices Have Come Down

7. Cataracts/Ophthalmology • Capacity Building – Volumes • Guarantee • Hospital Price • Physician Price • Lens Price • Anaesthesia Price • Vendor Issues • Kensington – Paediatrics • Ethics • Benchmarks/Targets

9. Progress to Date

10. Cardiac • Reorganization CCN, Ministry and LHINs – DHC Regional Offices • Reporting Expansion • Service Ratio Variability • Physician Discretion Cost Causation • IT Integration • Results • Chronic Disease Management • ED • Imaging/Medical/Surgical Systems • HR -- Surgeons

11. 90% of Cancer Surgeries Completed Within trendline

12. Regional Trend - 90% completed within

13. Regional Trend - 90% completed within

14. Cancer Surgery • Independent Oversight • Performance Culture – Boards and CEO Searches • Four Wait Times • A Culture of Quality Measurement • Demand Control – Patient Education • Democratization of Knowledge/ – The Role of the Physician • LHIN System Development • ICU • Drugs/Radiotherapy • Shift Away from Global Funding

15. Pay for Performance – Growth in the Variable Funding Portion Today 2010

16. 90% of Hip Replacement Surgeries Completed Within trendline targetline

17. 90% of Knee Replacement Surgeries Completed Within trendline targetline

18. Hip and Knee/Orthopaedics • Systems – Design, Bottlenecks, Patient Satisfaction, Cost and Efficiency • Surgeon Specific Wait Times • Facts Versus Opinions • Waiting for the Specialist • Non-MD Health Care Providers • Entitlement • Fractured Femur – Spine • Scopes • Trauma • Primary Care

19. Current State (Oct/Nov 2006 data) % cases completed within target Note: Priority 4 targets used in absence of priority-level data. Source: Interim wait times database, Wait Times Information Office

20. MRI/CT • Appropriateness • Machines Static/Mobile -- Replacement • LHIN Equity Issues • Public/Private • In and Out Patients • Split Website • Catalyst for Physician Change • Expert Panels – Gaming • Volume Quality Relationship • Interests and Data

21. Wait Times Challenge Demand -- Capacity -- Supply

22. www.ontariowaittimes.com