…or you could just get rid of the queues

Queue 2012-12-11

I hate it when someone cuts ahead of me in line.  But I’ve done it.  Have you?

While campaigning earlier this year,  Alison Redford, Premier of Alberta, made a promise that if her Conservatives won the provincial election, a public inquiry would be held into allegations of physician intimidation, political interference and queue-jumping within the Alberta health system.

Queue jumping is when people get preferential access to services not based on need but on who they are or who they know.  In Alberta, it was alleged that politicians were asking health authority employees to facilitate preferential access to publicly funded healthcare services for prominent people such as healthcare leaders, prominent business people and philanthropists.

A $10-million public inquiry is currently underway in Alberta.  So far, a senior VP and former CEO of Alberta Health Services have both testified that even though they wrote or signed a memo back in 2009 instructing their employees not to facilitate jumping of the queue, they do not recall that queue jumping was happening in Alberta.  They just wanted to make sure that everyone knew that it shouldn’t.

Maybe the health officials testifying in Alberta don’t remember any specific examples. But I know queue jumping happens where I practice medicine. It’s not as blatant as an NHL team getting the flu shot in advance of the public.  It’s more subtle.

There aren’t many perks in health care. Trust me, it’s not nearly as glamorous as Grey’s Anatomy would have you believe. But preferential access to healthcare occurs at unknown frequency for many who work within the system.

It’s not uncommon for me to overhear a nurse or unit clerk ask a doctor about a personal or family member’s health problem.  Often the doctor will make an offer to see what they can do to expedite an assessment or treatment.

In 1998, 80% of physicians and 53% of administrators in Ontario reported  they had helped a patient access cardiac care more quickly  based on who they were rather than their clinical need. Doctors reported that the patients most likely to get preferential treatment were public figures, politicians, and people with personal ties to physicians.

Queue jumping based on who you are or who you know is ethically wrong.  You should get access to care when you need it and when you request it.  Your access to care (along with the safety and quality of care) should not vary based on your personal characteristics or situation.  And when someone cuts in line, everyone else on a waiting list needs to wait that much longer. Our public health system needs to treat everyone as equals.

We know this is not yet true but we are working in Saskatchewan to make things more equal than they currently are. Our approach here is to get rid of the queue.  Not manage the queue but work with our physicians and healthcare providers to reduce then eliminate the queue.

The Saskatchewan Surgical Initiative  includes the commitment we’ve made to the public that by March 31, 2014, all patients will have to option to receive necessary surgery within three months. Our healthcare system has also set equally bold and transformative targets that will reduce the time for all patients to be seen by a specialist or to have diagnostic tests completed, and to cut the waits in half for all patients that need to be seen in an emergency room. This will be hard work that will change the care experience for both patients and providers.  The benefits for both the patients and the system are enumerable. It’s also the right thing to do.

I’ve already experienced the benefits of some of the changes introduced in our province.  A few weeks ago I took my daughter to our local emergency room when she broke her arm.  Saskatoon Health Region’s Department of Emergency Medicine is steadily improving the service they provide by reorganizing the way they do their work.  A parallel registration and triage system has dramatically reduced the waits at the start of your visit. Even though it was very busy when we arrived, the new system was working just great – no line, no wait!  There’s no temptation to help someone jump a queue when there is no queue.

Most of you out there work in healthcare: have you ever cut in line? Have you ever been asked to help someone access care more quickly?

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