Editorial: Ontario's Wait Time Information System: Learning from Success
The expression goes that we should learn from our mistakes. Well, here is an opportunity for us to learn from our success.
The development and implementation of information technology (IT) for use in healthcare is a challenging pursuit. Projects that fail, particularly if they are funded by government, can be intensely criticized by the Auditor General, opposition parties and/or the news media. When there is a major IT success (and there are many), they receive little praise or recognition. The result? The public and political leaders believe incorrectly that failure of government IT projects is almost inevitable.
This Special Issue of Healthcare Quarterly is entirely devoted to breaking this vicious circle by celebrating a major government-funded health IT success - Ontario's Wait Time Information System (WTIS). The WTIS is no minor success. In just four months a strategy was created. In less than two years the system was developed, deployed and put into use in hospitals throughout Ontario. As of March 2009, 86 hospitals are using the system. Data captured from more than 3,300 doctors is being used to calculate and publicly report on wait times involving more than 2.2 million surgical procedures and MRI/CT scans. And it doesn't end there. The WTIS is expanding to include more of the continuum of care, notably the wait times of alternate level of care patients who have received their hospital care and are waiting to be discharged to another, more appropriate, setting.
The goals for developing the WTIS have been met and wait times in Ontario are down significantly. Moreover, the WTIS is enabling hospitals and doctors to focus on their accountability and on improving their performance.
So what can we learn from this very successful endeavour? The answer to this question is covered from a variety of perspectives in the excellent articles included in this Special Issue. I was pleased to be asked to review these articles and write this editorial, as it helped crystallize in my mind what really makes IT projects successful. Before you read them, let me summarize what the authors believe are a few of the key ingredients that helped the WTIS achieve its remarkable goals:
- Appointing a talented leader (in this case Sarah Kramer) as the single point of accountability for the IT development and implementation;
- Capitalizing on existing public pressure, government priority and provider interest in achieving the system's primary goal (in this case reduced wait times);
- Using an outside agency (Cancer Care Ontario) that had the expertise and ability to secure the necessary health IT staff, vendors and private sector consultants to get the work done quickly and effectively;
- Building upon experiences of other jurisdictions such as the Saskatchewan wait times project and the wait times work of the Ontario Cardiac Care Network of Ontario;
- Engaging volunteers, clinician leaders, researchers and management leaders as role models on expert panels;
- Building momentum through transparency, and accountability through public reporting;
- Using a highly orchestrated communications program to minimize misinterpretation or misinformation (i.e., "a single source of truth");
- Identifying the value proposition for all participants (in this case the value of additional funding to increase provider capacity and shorten patient wait times);
- Creating a sense of urgency due to the Minister's public commitment to demonstrate results before the October 2007 election;
- Maintaining a narrow scope of deliverables through beta testing in five hospitals so that the project would not succumb to scope creep;
- Reporting early successes (quick wins) to help gain support from resistant stakeholders;
- Committing to a "no surprises" approach to project management so, if some aspect steered off course, correction occurred immediately with effective issue escalation and management;
- Making room for local hospital solutions because of hospitals' diverse sets of skills and needs.
That sums up some of the key learnings that are evident for the successful implementation of Ontario's WTIS. I hope you will enjoy reading the articles that follow as much as I did. Most importantly, I hope all readers learn from this tremendous story of health system success.
About the Author
President and CEO
Ontario Hospital Association
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