While generally restricted to a few selective procedures, these guarantees represent a rapid evolution from benchmarks to what are expected to be enforceable standards. Communicate these accountabilities to all involved, including patients. Portugal, the United Kingdom, and Italy). This reality is unlikely to go away regardless of wait-time benchmarks. While there has been an encouraging effort to reduce the length of time a patient has to wait for care, there has been less focus on addressing the real and potential concerns associated with the accountability and liability issues associated with managing wait times. Establish high-level accountabilities that set common parameters for regional authorities and institutions. Specialty medical societies and others must be cautious in contributing to the establishment of wait-times benchmarks that could be construed by the courts as a rigid standard. This creates a real dilemma for physicians. In law, physicians owe a duty of care to their patients and they may be held accountable and liable for damages suffered by their patients as a result of a failure to fulfill their duty of care. If Canadians are to trust health-care delivery, they need to trust the indicators used to measure the performance of the health-care delivery system. Success will not however be based on the actions of one or two of these groups but rather on each taking the necessary actions, both within their own domains and collectively with others. The Ministry of Social Affairs and Health (Ministere des Solidarites et de la Sante) administrates public healthcare in France, with primary and secondary care services delivered by the various different healthcare providers. Physicians are trained, oriented and, within a legal context, liable to provide a clearly delineated standard of care to individual patients. Given the trend to cross-jurisdictional comparisons, these methodological inconsistencies are coming under increasing attention. Ongoing research to support benchmarking and operational improvements; Adoption of management practices and innovations in health systems; Accelerated implementation of information technology solutions; Cultural change amongst health professions; Development of regional surge capacity; and. While the paper highlights accountability and liability concerns that should be addressed, its goal is to contribute to the generation of appropriate solutions. Notwithstanding this important role in care delivery, physicians do not ultimately make many of the decisions that impact on service accessibility. For example, patients rightfully expect their physician will act on their behalf to gain timely access to the care needed. Should the clinical condition of your patient necessitate an earlier appointment or should the scheduled appointment exceed the wait-time benchmark, attempt to negotiate an earlier appointment. Be aware of any legislation and/or institutional requirements with respect to the management of wait times. Establishing wait-time benchmarks for all diagnostic, therapeutic and surgical services; Developing and implementing wait list management tools; A duty of care arises if there is a doctor-patient relationship. If, at the time of the referral, the wait time exceeds the benchmarks, consider: - Declining the new consultation and recommending referral elsewhere, and. The final report of the WTA in August 20057 emphasized that wait-time benchmarks were to be considered "health system performance goals" and included the following statement: Despite this distinction, such goals do, for the first time in Canada, provide a benchmark against which performance may be assessed. This gives rise to a potential situation in which a physician might be held accountable for not advocating strongly enough for a patient faced with overly long wait times. If true progress is to be made in reducing medico-legal risk, a broad range of actions is required. Physicians and other health-care providers are familiar with these regulations and how they impact care delivery. The Wait Time Alliance (a coalition of several stakeholder groups facilitated by the Canadian Medical Association) defines benchmarks as "health system performance goals that reflect a broad consensus on medically reasonable wait times for health services delivered to patients."6. Notwithstanding the challenges associated with the establishment and reporting of benchmarks, their adoption has served to provide a measure of system performance. On one hand, improved access should lead to better results as patients receive care in a more timely manner. Wait-times guarantees involve a commitment, on the part of governments, to deliver treatment within a publicly declared wait-time period. The Association maintains that, while Canadians benefit from wait-time initiatives that hold the potential to provide greater access to care, governments, institutions, health-care professionals and others have a collective responsibility to work together to address these accountability and liability issues. The following eight proposed actions are all deemed to be readily achievable by governments, regulatory authorities and other policy makers, and each of these is likely to have a tangible and positive impact: The CMPA believes that regional and local health-care authorities and institutions, such as hospitals and clinics, should undertake the following actions to address wait times related to accountability and liability issues: The medical profession (specialty societies, national and provincial/territorial associations and others) can contribute to improved accountability and liability through the following realizable actions: For physicians whose wait times may be exceeding the recommended benchmarks, it is important to recognize the courts, in consideration of the specific facts of the case, may determine the physician owes a duty of care from the moment his/her office accepts a referral, irrespective of whether the patient has been seen by the physician. Avoid the cannibalization effect wherein wait-time targets for one clinical procedure jeopardize access to others. Monitor the impact of wait times on patient safety and be prepared to adjust accordingly. Reversing these effects requires both immediate action and a long-term commitment. Since the likelihood of targets being interpreted by the courts and others as de facto standards is real, the importance of setting realistic targets cannot be over-emphasized. Individuals should therefore be held accountable if they have not followed procedures prescribed to govern their profession or to access the resources necessary to enable them to deliver upon their accountabilities. Accordingly, the CMPA is committed to working with all parties to put in place workable solutions to the accountability and liability issues. When viewed individually, the majority of these recommendations are generally very sound and, if implemented, would make a useful contribution to reducing wait times. The health care system in France is made up of a fully-integrated network of public hospitals, private hospitals, doctors and other medical service providers. Within a legal environment that is yet to be fully charted, specialty societies and others should exercise prudence when contributing to establishing benchmarks. Average Wait Time to See a Doctor in France Pediatrician or radiologist – three weeks Dentist – one month (average 17 days) Gynecologist – six weeks (average 32 days) Cardiologist – 50 days Dermatologist – two months Ophthalmologist – 80 days It is a universal service providing health care for every citizen, irrespective of wealth, age or social status. This is the second-longest wait ever recorded by the Fraser Institute, which has been measuring wait times across Canada since 1993 when patients waited just 9.3 weeks. Some important participants in the discussion, in particular the College of Family Physicians of Canada, have expressed the view that the determination of wait times should also take into account the time between the patient's first visit with his or her family physician and when required, subsequent visits with consultants, as well as the time it takes for a patient who does not have a family physician to find one.1 Regardless of the definition chosen, the CMPA is of the view that a common, clearly communicated definition is required and such a definition should form the basis for all measurement activities.
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