Factors that impact the sustainability of wait time management strategies for total
joint replacement surgeries in canadian provinces
In response to federal government requirements regarding wait times for elective hip and knee surgery, hospitals have adopted wait list management strategies, with variable success. This research examined organizational and systemic factors that made it possible to keep wait times within federally established limits of 6-12 months. We used a model based on Parsons’ model. Four dimensions were used to analyze the following factors: governance, culture, resources, and tools. Three cases studies were done: Case 1 was able to meet the requirements for six months but unable to sustain this level; Case 2 was able to maintain compliance with requirements for > 18 months; and Case 3 was never able to meet the requirements. Documents were collected and interviews conducted with people involved in the strategies. In all, eight interviews were conducted at each site and all documents related to each strategy were collected. The results indicated that the one hospital that was able to maintain compliance with the wait time requirements had specific characteristics: an exclusive mandate to do only hip and knee replacement surgery; motivated staff who were not distracted by other concerns; and a strong team spirit. The two other cases had to contend with a medical culture that was less homogeneous and they were less focused on meeting targets and had resources that were dispersed as well as unclear inter-organizational policies. In the end, the hospital factory model is appealing in the context of superspecialized surgery. However, because patients are selected for simple surgeries, with little risk of complications, it cannot be promoted as a sustainable model of excellence.
Canada Strategies Wait Times Sustainability Factors Canada Hip Knee Surgeries