What To Do With The Queue? Improving Wait Times PDF

Image Cred: NY Times 2012 What To Do With The Queue? Improving Wait Times NOVEMBER 12, 2024 What to do with the Queue? “People with cancer may be treated with various combinations of surgery, radiation therapy, and chemotherapy. Radiotherapy cannot be administered in every hospital...

Image Cred: NY Times 2012 What To Do With The Queue? Improving Wait Times NOVEMBER 12, 2024 What to do with the Queue? “People with cancer may be treated with various combinations of surgery, radiation therapy, and chemotherapy. Radiotherapy cannot be administered in every hospital; it requires equipment and skilled technical staff. One such specialized hospital, the Princess Margaret Hospital (PMH) in Toronto, found itself faced with a growing wait list problem in its radiotherapy department. What should it do? This case addresses several policy issues, including: queuing theory, wait lists and how to manage them, human resources planning, payment mechanisms and incentives, and the ethics of rationing.” (Deber and Mah, 2014) Agenda Framing wait times Ethics and ethical decision making when managing the queue Queue Theory Throughput ECFAA and the WTIS Cancer Care Ontario, Targets, Priorities and Wait Times intervals DARCs and DARTs vs system issues in waiting Related/Support readings in Chapter 1 3.6.3 Resource Allocation/Rationing 6.2 Payment Mechanisms and Incentives 6.3.2 Sickness Care Subsectors 8.4 Health Human Resources 8.4.1 Projecting Supply and Demand Learning Objectives To identify how framing can help to select different policy outcomes related to wait times To summarize the different components of queue theory and how we can modify them to improve wait times To define throughput To understand the role of legislation in the way the wait times issue is framed To understand the difference between Wait 1 and Wait 2 To explain the role of Cancer Care Ontario (CCO) in wait times management in Ontario To define the different wait time priorities used by CCO To differentiate between DARCs and DARCs Summary of the Issue PMH had huge backlogs in both 1991 and 1999, so bad patients had to be referred elsewhere Shortages of radiation therapists, oncologists and physicists  only 20 per cent of patients were being treated within 4- week period recommended by CARO Almost half were waiting longer than 8 weeks. Cancer Care Ontario, established at this time to coordinate wait times management for cancer treatment Framing (Problem Identification) Distribution: Send patients to other centres where demand is not so great HHR Issues: Address shortages Improve pay Extend length of time imaging machines were running Management and Oversight: Establish oversight body to address wait times Key ideas in the CCO Approach to Wait Times Management Queue: A line or sequence of patients waiting to be treated Identifying Appropriate Wait Times Measuring Wait times appropriately – e.g. two intervals established Key ideas in Queue Theory Customers Input Source Queue Discipline Service Mechanism Ethics Policy Theory and Ethics in Queuing Consensus policy – costs/benefits, technical issues Virtue ethics Utilitarian (happy: unhappy) Ethics of Care as a goal, sometimes hard to achieve Personalism (access, common good, performance) Principilism Queue Theory : Proportion of available resources : Rate at which patients arrive s : The number of health = /(s* ) care professionals in the system : Rate at which patients are treated 𝞺 must be