Access to Care Plan 2019–2023
Timely access to high-quality care is a priority for Ontario patients. Ontarians want to know that high-quality care will be available when and where they need it. The first Access to Care Plan provides a road map for how CCO, the Ministry of Health and Long-Term Care, health system partners and, in time, Ontario Health will work together to continue to improve the access, performance, quality and efficiency of health services.
Ontario Health is a single agency that will, in time, take on CCO’s work as part of Ontario Health’s larger mandate to oversee healthcare delivery in Ontario, improve clinical guidance and support providers to ensure better quality care for patients.
The goal of this plan is to continue to improve people’s health and their experiences in the healthcare system.
This plan will help us evolve our work to measure and report on health system performance and to identify opportunities for improvement and innovation. In providing high-quality information to our partners and the public, we will enable better decisions and better outcomes for the health system and – most importantly – the people of Ontario.”
Vice-President, Planning and Regional Programs/Analytics and Information, Cancer Care Ontario/CCO
Reducing wait times for healthcare services is only part of the story. Ensuring high quality of that care is equally important. This system plan provides a framework to improve the access, quality and efficiency of healthcare services for our patients across Ontario.”
Dr. Jonathan Irish
Provincial Head, Surgical Oncology Program, CCO
Navigating the healthcare system can be stressful for patients and caregivers. Our work with patient and family advisors helped us learn what is important to Ontarians. People want to understand how long they may have to wait and what to expect during their care. This plan will guide our work with partners to reduce wait times and provide meaningful information to the public to improve their care experience.”
Director, Access to Care, CCO
Goals & Strategic Objectives
Be informed and guided by patients and caregivers to deliver meaningful results
The more people’s experiences with the healthcare system are understood, the more meaningful improvements can be supported.
When people are able to anticipate when they will receive the service they need, they:
- feel more in control of their care
- can make better-informed decisions with their healthcare professionals
- may feel more at ease because they know their wait time is appropriate for their condition
We[*] will work together with patients and their caregivers to understand how timely access to healthcare services affects their experience of care and quality of life
We will collaborate with healthcare professionals and system partners to increase awareness and understanding of wait times. This will help patients and healthcare professionals have the information they need to improve the patient experience.
- Establish a Patient and Family Advisory Council for Access to Care
- Collaborate with the Ministry of Health and Long-Term Care and system partners to develop a wait times awareness educational campaign for patients and providers
Learn, adopt and apply best practices
A safe healthcare system is one in which people receive the same high-quality care wherever the services are delivered.
Consistent, reliable data provides an accurate picture of how the healthcare system is performing. This helps system planners develop policies and programs to improve access to reliable, high-quality care across Ontario.
We[*] will work with our partners to make sure information about wait times continues to be collected in the same way across the province.
With the Ministry of Health and Long-Term Care, we will continue to build upon existing knowledge to establish and support provincial standards and best practices.
- Lead the development and dissemination of provincial wait time data collection standards for Ontario
- Support provincial standardization and appropriateness measures to improve quality of patient care
Promote equity through expansion of wait times performance measurement
People should have the same access to health services no matter who they are, where they live or what resources they have. Yet some Ontarians face significant barriers to:
- reducing their risk of poor health
- receiving early diagnosis
- accessing and using healthcare services
A health equity approach understands and addresses the special requirements of unique populations.
We[*] will collaborate with our partners to measure wait times for marginalized populations. This information will help develop strategies to reduce barriers and improve access to quality services.
- Expand wait times performance measurement in targeted service areas
- Advise on issues, in partnership with the Indigenous Cancer Care Unit, related to improving access to services for First Nations, Inuit, Métis, and urban Indigenous peoples in Canada
Develop new capabilities and establish partnerships to advance health system performance
Ontarians deserve timely and efficient access to high-quality health services regardless of where they live.
We[*] will develop new partnerships and ways of gathering wait times information. Data collection will be expanded to other areas of the health system. This information will provide a more complete view of the total time people wait throughout their care journey and where the health system could be more efficient.
- Acquire new data holdings from third parties and regional providers to advance Access to Care’s work
- Leverage new analytic capabilities to inform decision-making and evaluate health system performance
- Explore new opportunities to offer support to the Ministry of Health and Long-Term Care and regions to improve access to services
Provide evidence-based recommendations to health system stakeholders
The foundation of a high-quality healthcare system is built upon reliable facts and key information.
People need timely, accurate information about their health to make choices about their care. System planners need evidence to make informed decisions about how and where to distribute services.
We[*] will continue to collaborate with our system partners and the Ministry of Health and Long-Term Care to make reliable, meaningful and relevant wait times information available to the public.
This evidence will help people make decisions about where and when to access services. It will also support the ministry and regional partners in system planning and policy development.
- Use evidence to inform system planning and policy development in collaboration with the Ministry of Health and Long-Term Care and regional partners
- Make all wait times performance data public in partnership with the ministry, Health Quality Ontario and, in time, Ontario Health
- Leverage CCO data holdings, in partnership with system stakeholders, to evaluate clinical evidence and system performance related to access to services
Deliver sustainable performance improvement
Waiting for health services can be stressful. Timely access to care allows people to make better decisions and care plans with their healthcare professionals.
Ontario has made improvements in access to services and reduced wait times in many areas. However, more needs to be done to keep pace with the rising demand.
We[*] will improve our ability to gather and report wait times data. With this information, the Ministry of Health and Long-Term Care will be advised on areas needing improvement.
- Inform and advise the Ministry of Health and Long-Term Care where performance results in service areas do not meet established targets
- Transform data collection capabilities for wait times performance measurement and reporting
“I’ve had cancer twice, and both times the care was great. But there was a big difference in communication. The timelines were about the same, but I was a lot less stressed when I was kept well informed about who would do what and when.”
Lauri P. is a retired banking executive. She was treated for clear cell ovarian cancer in 2013 and stage 1 kidney cancer in 2017.
Accessing Care in Ontario
Why Ontario needs this plan
The demand for healthcare services is rising. This is largely because:
- Our population is growing: In 2017, Ontario was home to more than 14 million people. By 2041, our population is projected to grow to 20 million.[*]
- Our population is aging: Seniors ages 65 and older now represent about 17% of Ontario’s population. This is expected to rise to more than 24% by 2041.[*] Older people are more likely than younger people to need healthcare services, such as cancer treatment, joint surgery and long-term care.
- New and emerging health services and technologies are being adopted, which can impact Ontarians’ access to health services.
Emergency department wait times
Overall, the length of time patients spend in emergency departments in Ontario and the time to see a physician have improved over the past decade, despite a growing number of people seeking care in emergency departments.
A key challenge in emergency department medicine continues to be the length of time people wait when they need to be admitted to hospital. As of December 2018, 9 out of 10 patients will wait up to 34 hours before being admitted to a hospital bed.[*] This continues to be an area of focus for improvement.
Working with health sector partners, CCO has improved access to healthcare services and reduced wait times in many areas. The following are examples of provincial wait times in key clinical areas and notes on where continued work is needed.
Electronic Canadian Triage and Acuity Scale
Every patient in Ontario is triaged when they go to an emergency department for care. Emergency department nurses have a critical role to triage each patient to determine who needs immediate care and who can safely wait to see a physician.
The Canadian Triage and Acuity Scale (CTAS) is a set of guidelines that helps nurses quickly assess the patients’ conditions.
In 2017, CCO launched an electronic version of the CTAS guidelines, known as eCTAS. eCTAS ensures the guidelines are used consistently in all emergency departments across Ontario to improve patient safety and quality of care. When hospitals started using eCTAS, triage consistency improved for approximately 1 in 5 patients.[*] By 2019, eCTAS will be launched in over 100 hospitals, triaging 4,800,000 patients per year.
Diagnostic imaging (MRI & CT) wait times and efficiencies
More than 2 million magnetic resonance imaging (MRI) and computed tomography (CT) scans are ordered for patients in Ontario each year.[*] People often experience long waits due to an increase in demand for these services which can exceed existing provincial capacity.
- 38% of people waiting for an MRI received their scan within a target wait time, compared to 52% in 2013/2014.
- 77% of people waiting for a CT received their scan within a target wait time, compared to 78% in 2013/2014[*]
CCO is helping hospitals keep pace with the growing demand for diagnostic imaging by finding ways to use their scanners more efficiently.
Diagnostic efficiency data has helped hospitals improve their productivity by scanning more people per hour and using the scanners more hours of each day. This work has resulted in an overall increase of 22,000 MRI scans per year across Ontario over a four-year period (2014 to 2018).[*]
Wait times for cancer consultations and surgeries
Wait times to see a surgeon specialist for an initial consult and cancer surgery continue to be key areas of focus to improve access.
Over the past decade, there has been an increase in the percentage of patients who need a referral to a surgeon and may need surgery as part of their care. Surgical wait time targets[*] and standards help doctors determine how quickly a patient needs to be seen and treated.
In 2018, 89% of all patients who were referred to a cancer surgeon specialist and required cancer surgery were treated within the target wait time.[*] However, access to some forms of cancer surgery continues to be a challenge for some patients and requires improvement.
For example, only 74% of all patients with prostate cancer who were referred to a surgeon specialist were treated within the target wait time. Similarly, 81% of all patients who required prostate cancer surgery were treated within the target wait time.[*]
Wait times for hip and knee surgeries
The demand for hip and knee replacement surgeries continues to grow along with Ontario’s aging population. Since April 2016, the demand for hip and knee replacement surgery increased 11% and 12% respectively.[*]
8,420 people were waiting for hip replacement surgery and 18,240 people were waiting for knee replacement surgery as of December 2018.[*]
- 94% of all people referred to an orthopedic surgeon for a hip replacement consult were seen within the target wait time.
- Only 80% of all people who required hip replacement surgery had surgery completed within the target wait time.[*]
- 91% of all people referred to an orthopedic surgeon for a knee replacement consult were seen within the target wait time.
- Only 75% of all people who required knee replacement surgery had surgery completed within the target wait time.[*]
A key challenge for hip and knee surgeries is in the area of people who need urgent access to services due to a high probability of disease progression. Of these cases, only 60% of hip replacement surgeries and 37% of knee replacement surgeries meet target wait times.[*]
Alternate level of care
Alternate level of care (ALC) is the designation given by a physician or designate to a patient who is occupying a bed in a hospital but does not need the intensity of resources or services provided in that setting.
Bottlenecks happen when patients who do not need the services provided within a hospital setting occupy hospital beds. This affects how patients are cared for and move through the healthcare system.
As of November 2018, patients who were designated alternate level of care occupied more than 16% of beds in Ontario hospitals.[*] The largest proportion of these patients were waiting for long-term care (43%), followed by supervised and assisted living (13%), and home and community support (10%).[*]
The Access to Care Plan will guide the way we[*] will work with our partners to reduce wait times and make sure high-quality healthcare services are available to Ontarians when needed.
“There is a silver tsunami hitting our system. As the Baby Boomers get older, the demand for scans is only going to grow. We need to make maximum use of the CT and MRI machines. Perhaps add another shift, rather than having the scanners gather dust from 3 p.m. to 8 a.m.”
Kathy S. is a retired college professor in northern Ontario. A diagnosis of breast cancer in 2003 was followed by surgery, chemotherapy, radiation and 10 years of hormone therapy. She now has suspected heart damage and is waiting to have diagnostic tests booked.
For more information
Putting the Ontario Access to Care Plan into Action
We[*] will work closely with numerous partners to meet the goals of the Access to Care Plan and improve the performance of the health system.
This work involves partnerships with more than 100 hospitals, independent health facilities and surgeon offices. Working together, we collect near-real-time data for wait times performance reporting.
Health Quality Ontario has been a key partner. Each month, CCO collects information about wait times for surgery, diagnostic imaging and emergency departments. Health Quality Ontario publicly shares this information on its website.
“Health Quality Ontario relies on Access to Care for reliable, timely, high-quality data about wait times and other performance indicators. Working together, we publicly report on wait times in Ontario on the Health Quality Ontario website to provide necessary information to the public, healthcare providers and policy-makers – showing where Ontario is performing well and where improvements are needed to address gaps in care and outcomes.”
Interim President and CEO, Health Quality Ontario
Many other partners help develop the programs, policies and projects that support the Access to Care Plan. These partners include provincial agencies, healthcare organizations and healthcare professionals.
Working with the government
The Ministry of Health and Long-Term Care helps bring the Access to Care Plan to life.
The ministry reviews and assesses the plan, and provides funding that allows us to measure, report and analyze wait time information.
This work informs the ministry about health system performance in relation to access to services.
Working with experts
We[*] work closely with clinical and healthcare leaders in the fields of diagnostic imaging, surgery, emergency care and alternate level of care.
Their experiences, expertise and advice ensure this system plan will continue to drive sustainable and continuous improvement for Ontarians’ access to health services in the future.
Partnering with patient and family advisors
Thank you to the patient and family advisors who participated in the development of this system plan. Their personal stories and experiences helped to create a plan designed to address the needs and values of all Ontarians as they navigate the healthcare system.
Input from patient and family advisors will continue to guide work with the ministry as policies, programs and practices are developed to meet the goals of this plan.
For more information
Accountability and Measurement
We[*] are accountable to the Ministry of Health and Long-Term Care, health system partners and the people of Ontario for meeting the commitments outlined in this plan.
Annual business plans submitted to the ministry, and detailed internal operating plans, set out how we will work with our partners to develop and put in place projects and programs to support the plan’s goals and strategic objectives.
There are a robust measurement plan and performance indicators to measure progress.
Progress will be reported in several ways:
- Annual report
- Quarterly and special program reports
- Quarterly reports on our accountability and funding agreements
All of this information is used to adjust planning and respond to changes.
“There is plenty of high-quality evidence showing I did not need radiological evaluation for overt metastases as the risks significantly outweighed any benefit. However, how does this help me as a patient? Does avoiding the anxiety, cost and potential long-term harm these scans entail outweigh knowing that my scans were normal?”
Natalie M. is a family physician. Following breast surgery for lymph node positive breast cancer in 2015, she received chemotherapy and radiotherapy and has since been on endocrine therapy.
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About This Plan
The Access to Care Plan will guide the measurement, analysis and reports used to understand how the health system is performing. This information helps:
- the Ministry of Health and Long-Term Care make informed decisions about programs and funding
- healthcare organizations make the best use of resources
- people make better-informed decisions about their health
The plan focuses on 5 priority areas:
- Emergency department wait times
- Electronic Canadian Triage & Acuity Scale (eCTAS)
- Diagnostic imaging wait times and efficiencies
- Surgical wait times and efficiencies
- Alternate level of care wait times
This work will apply best practices, promote equity, be informed and guided by patients and caregivers, and deliver sustainable performance improvement for Ontarians.
The goals and strategic objectives in the plan will help to:
- Identify priorities to guide our work at all levels
- Focus our efforts where they are most needed
- Bring together many partners within our complex health system
Developing the Plan
CCO began by reviewing the performance of Ontario’s healthcare system in current areas of focus and by reviewing the progress made since Access to Care was established at CCO in 2005.
CCO consulted with staff across the organization, clinical leaders, patient and family advisors, health system partners and the Ministry of Health and Long-Term Care. Their insight and expertise are much appreciated.
Opportunities were identified to sustain, improve and advance our work in emerging areas where access is a known issue and will require focus in the coming years.
“Wait-time reporting should be more patient-centred. It should capture my cumulative experience, from when my family physician first refers me to a specialist, through all the diagnostic tests, further consultations and finally to my surgery. That’s the time my body is waiting for help.”
Susan R. was a psychologist for 35 years before closing her private practice due to her limited mobility because of extended wait times. She has had 36 surgeries, including 8 spinal surgeries and 2 hip replacements. She is happy to report that she enjoys walking again.