Public involvement in the priority setting activities of a wait time management initiative: a qualitative case study

Abstract

BackgroundAs no health system can afford to provide all possible services and treatments for the people it serves, each system must set priorities. Priority setting decision makers are increasingly involving the public in policy making. This study focuses on public engagement in a key priority setting context that plagues every health system around the world: wait list management. The purpose of this study is to describe and evaluate priority setting for the Ontario Wait Time Strategy, with special attention to public engagement.MethodsThis study was conducted at the Ontario Wait Time Strategy in Ontario, Canada which is part of a Federal-Territorial-Provincial initiative to improve access and reduce wait times in five areas: cancer, cardiac, sight restoration, joint replacements, and diagnostic imaging. There were two sources of data: (1) over 25 documents (e.g. strategic planning reports, public updates), and (2) 28 one-on-one interviews with informants (e.g. OWTS participants, MOHLTC representatives, clinicians, patient advocates). Analysis used a modified thematic technique in three phases: open coding, axial coding, and evaluation.ResultsThe Ontario Wait Time Strategy partially meets the four conditions of 'accountability for reasonableness'. The public was not directly involved in the priority setting activities of the Ontario Wait Time Strategy. Study participants identified both benefits (supporting the initiative, experts of the lived experience, a publicly funded system and sustainability of the healthcare system) and concerns (personal biases, lack of interest to be involved, time constraints, and level of technicality) for public involvement in the Ontario Wait Time Strategy. Additionally, the participants identified concern for the consequences (sustainability, cannibalism, and a class system) resulting from the Ontario Wait Times Strategy.ConclusionWe described and evaluated a wait time management initiative (the Ontario Wait Time Strategy) with special attention to public engagement, and provided a concrete plan to operationalize a strategy for improving public involvement in this, and other, wait time initiatives.

Consumer participation and organizational development in health care: a systematic review

“…Six hundred and twenty studies were excluded from further analysis, because they reported OD projects with consumer participation in other areas than Health Care. Th e remaining 25 studies consisted of 20 studies on OD projects with consumer participation in various areas of Health Care [15,[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] and fi ve systematic reviews of 135 [16], 131 [17], 38 [37], 5 [38], and 143 [39] studies, re- spectively. Table 1 describes the study characteristics such as number of participants/projects, type of consumer participation, study design, use of a control group, and area of Health Care of these 25 studies.…”

The surgical waiting time initiative: A review of the Nigerian situation

“…This is especially true in the fields of cancer, joint replacement surgeries (arthroplasties), sight restoration, cardiac problems and diagnostic imaging among others (Bruni et al ., 2007) 44. Briggs et al ., (2011)45 reviewed the effect of active management of surgical waiting lists in a urological service in Australia, which resulted in a significant reduction in the surgical waiting times for semi-urgent and non-urgent patients from 248-180 days in the 10-month period of the review.…”

Canadians’ Views about Health System Performance

“…Previously we conducted a qualitative case study to describe and evaluate the priority setting activities of the OWTS, with particular attention to public engagement [22]. This previous study was guided by an explicit conceptual framework -'accountability for reasonableness' [23] is a conceptual framework for legitimate and fair priority setting.…”

“…An interview guide was developed based on previous research [22,[29][30][31] and was revised during data collection in order to pursue emerging findings. For example, participants unexpectedly discussed distrust with the OWTS information.…”