Saskatchewan's decade-old promise on 90-day surgery times has failed and will fail again

This Opinion piece is by Steven Lewis, a health policy consultant formerly based in Saskatchewan.

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The only things certain in life are death, taxes and Saskatchewan not achieving a 90-day maximum surgical wait time by the target date of 2030. 

It doesn't take an oracle to reach this conclusion. Hindsight will do.  

In 2010, the Saskatchewan Party government promised a 90-day maximum wait by 2014. It spent hundreds of millions of dollars to increase capacity and improve backlogs. It created the Saskatchewan Surgical Initiative to turn the system into a juggernaut bent on fast service that would leave no patients behind. 

Prospects looked good for a time. By April 2015, 90 per cent of non-emergency surgeries got done within 96 days. Still, 10 per cent (8,000 or so a year) waited longer, some a lot longer. Only a year later, 10 per cent waited at least 142 days. A year after that, 189. By February 2020, the last pre-pandemic month, 237. Those numbers don't include the often months-long wait to see the surgeon. 

Here's the weird part. In every year from 2005 to 2020, 50 per cent of patients waited no more than 50 days for non-emergency surgery, and in some years no more than 30 days. It's basically a lottery where the lucky winners get served within five to eight weeks, while one in 20 might wait more than a year. 

This is chaotic, unnerving and unfair. 

Access is a fundamental principle of the Canada Health Act. The core value of medicare is to treat everyone equally on the basis of need. 

We can't assume the system is starved of capacity: the provincial population has grown by 17 per cent since 2007 while the number of doctors has grown by 51 per cent. More than 200,000 MRI or CT scans are done in the province every year. Most are timely. But thousands wait, and wait, and wait some more.

What actually needs to be done

If they were truly accountable for eliminating the unconscionably long waits, managers and doctors would eliminate them. Here's what they would do.

• Allocate the next surgical slot to the next patient on a provincewide, accurate, real-time waitlist, regardless of who the surgeon is. If that means giving Surgeon B some of Surgeon A's operating room time, so be it. Patients' needs must come first and fairness is paramount. No exceptions.

• Monitor all patients for any changes in condition that would warrant fast-tracking. It's not up to patients to self-diagnose. Nor is it fair to reward squeaky wheels while ignoring the plight of patients unaware of added risks or unable to advocate for themselves.  

• Automatically flag every case approaching the 90-day mark and do something about it. Call the patient. Explore all the options. Figure out why patient X has waited 15 months while thousands hardly wait at all. If the system can't be empathetic, it should at least be curious. 

• Quit rewarding long wait times. You read that right. Some surgeons have large referral networks of family physicians and build up big waitlists. The longer the list, the more operating room time they get, and – surprise! – they also make more money. In theory patients can choose a surgeon or a location with a shorter wait time, but many don't know about this option. They shouldn't have to — patients aren't shoppers in a flea market.

• Cull unnecessary surgery. Adding a lot of capacity in a hurry — as the province did following 2010 — creates an incentive to use it. Most surgery is undeniably warranted, but some isn't. Research has revealed overuse of dozens of tests, drugs, procedures and low-value care unlikely to benefit patients (some will cause harm). Arthrosocopic knee surgery for the treatment of degenerative knee arthritis is one example. Surgical volumes have risen steadily over the years. Residents of some regions get more surgery per capita for no apparent reason. The cultural assumption is that you can never have enough health care. That's like saying you can never get enough calories. 

Time-honoured tactics still won't work

There is a dark side to the surgical wait time issue. 

Patients who wait and suffer interminably become victims, and some of their heartbreaking stories make the news. That creates the impression that health care is underfunded, or the public system is a colossal failure, or we need private pay options so that people with money don't have to get stuck in an interminable queue. 

The long waits become ammunition for those who want even more money dumped into an already expensive system, and others who want to see the universal public system scrapped.

The time-honoured fix is to spend more money and do little else. It is as doomed now as it was in 2010. 

The real solution is to redesign the system and make it accountable for succeeding. Government and health-care leaders must focus relentlessly on the root causes of wait times, and fight the policy and organizational battles to overcome them.

Money can't do the work of wisdom, courage, expertise and discipline.

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