The province has received the final report of the Wait Times Reduction Task Force, a document that combined with the recommendations and findings of the Peachey report, the EMS system review and other relevant studies of Manitoba’s health system, will be used as the foundation for clinically informed transformation of Manitoba’s health-care system, Health, Seniors and Active Living Minister Kelvin Goertzen announced today.
“Manitobans have for too long experienced uncertainty and delay in accessing health-care services across the province,” said Goertzen. “Change is necessary if we are going to improve the services available to Manitobans, but that change must be rooted in clinical planning and evidence-based practices. This report includes recommendations that will build upon the work already underway by clinical leaders and will inform a provincial plan to improve access to emergency, surgical and diagnostic care in our province.”
The report includes observations made at more than 100 consultations held with both members of the public and health system staff. These meetings, as well as online surveys for both public and staff input, looked at the current state of emergency departments, surgery and diagnostic testing across Manitoba. The resulting recommendations for improvement across all three categories will further guide the transformation of Manitoba’s health-care system, added Goertzen.
Wayne Elhard, chair of the task force, noted the review began with a close look at the current system in order to identify specific processes in need of improvement.
“Changes must be made in these key areas to ensure better patient care and the long-term sustainability of Manitoba’s health-care system,” said Elhard. “This report outlines a number of opportunities to strengthen the system and ensure quality care is available to people across the province, but it is important to recognize that no single initiative will solve all of the problems identified. Changes in one area will always affect another part of the system so a collaborative approach is recommended.”
The report emphasizes the interdependencies of emergency departments (EDs) and emergency medical services (EMS) as well as between EDs and timely access to primary care or family doctors. It found that small EDs with frequent suspensions or closures are essentially serving as primary care sites where staff may feel ill-equipped to deal with emergency situations requiring specialized skills.
“Staff at sites that do not deal with high volumes of a particular type of serious health concern like cardiac or significant traumatic injuries, may feel limited in their ability to maintain the specialized skills necessary to provide appropriate treatment,” said Dr. John Ross, co-chair of the Emergency Department Wait Times Reduction Committee. “The goal in rural areas should be the provision of accessible, timely primary care as well as consistent, reliable and ready access to emergency services.”
The report does not recommend specific changes to rural health facilities, but concludes it is not reasonable for rural residents to memorize the hours of EDs that are not open 24-7 or are subject to inconsistent service. Nearly every site and many health-care providers consulted mentioned the need for a provincial on-call consultation service. The report states such a resource would allow rural health-care practitioners to consult with dedicated emergency physicians via phone on treatment options as well as the need and urgency of transfer to another site.
The Manitoba government has previously committed to exploring the feasibility of such a service, known as a Provincial Emergency Consultation Service (PECS).
The report also analyzed the waits and delays for hip and knee replacements, cataract surgery and magnetic resonance imaging (MRI) and makes recommendations on ways to reduce wait times and improve access. Recommendations focus on better education for providers on the appropriate ordering of tests, implementing standardized referral processes, increasing capacity, making use of distance communications options such as Telehealth for follow-up appointments, and undertaking analysis to determine the best options for future investments.
“Our findings demonstrate the need for more robust clinical planning and governance for many services,” said Dr. Jack McPherson, co-chair of the Priority Procedures Wait Times Reduction Committee. “Standards of practice and performance measures should be strengthened, innovation amongst providers should be encouraged and the public should be engaged in the planning process to ensure that all changes are made with patient needs as a central motivation.”
The minister noted the findings of the review will support clinical planning work already underway or to be launched in the new year. This includes the development of a provincial clinical and preventive services plan, the ongoing review of rural health authority proposals by Shared Health, the implementation of recommendations made in the 2013 EMS system review, and the government’s continued work toward paramedic self-regulation.
“As stronger connections between rural and northern health facilities are established with major sites in Winnipeg, and hospital and emergency services are consolidated, there must be clearly demonstrated clinical planning and ongoing comprehensive evaluation,” said Goertzen. “The report makes a number of recommendations which will inform the planning of the Winnipeg Regional Health Authority as it continues to work on the makeup and timing of next steps. We expect the region will work closely with clinical leaders at Shared Health to ensure alignment with broader clinical planning.”
The minister emphasized the government’s commitment to ongoing health transformation – appropriately planned, clinically informed and consistently monitored – and confirmed that further changes will be made within a plan that ensures provincial resources and services are organized to provide the best possible patient care and access.
“The findings of this report are in many ways consistent with the recommendations of the large volume of work that is informing our efforts to create a more integrated provincial planning process,” said Dr. Brock Wright, CEO of Shared Health. “Patients are – and will remain – at the centre of our development of a clinical and preventive services plan for Manitoba. Clinical planning of acute care services, including the WRHA’s plans for clinical consolidation, are an important piece of broader efforts to improve services for Manitobans and establish consistent standards of care across the province.”
Other key findings of the review include the need to:
- address ongoing challenges related to physician burnout, recruitment and retention and ED suspensions;
- expand Telehealth opportunities for rural and northern patients as a means to reduce inter-facility transfers by offering appropriate services to Manitobans closer to home;
- improve co-ordination of land and air emergency medical services (EMS);
- implement rapid assessment zones, a dedicated space where patients are quickly assessed pending tests and/or reassessment;
- develop more proactive mental health-care services to reduce reliance on emergency departments;
- implement protocols to allow paramedics to bypass local facilities for conditions such as trauma, acute stroke or obstetrical emergencies requiring specialized care at larger, urban sites;
- develop and use diagnostic testing protocols in all regions;
- develop a provincial central intake process for certain services to improve access, reduce wait times and analyze the true capacity of the system by using existing resources and people more efficiently.
The report also notes that good data, improved transparency, stronger communications and increased patient involvement are key to making significant changes to the system.