Table 6 Checklist of factors that influence WTMS implementation[66], as applied in an orthopedic program

High level coordinating, reporting monitoring structures

• Advisory Committee established, including VP of Acute Care, Directors, and Provincial Wait Time Manager, monthly meetings

• Regular reporting of progress to Regional Surgical Services Leadership Team and Acute Care Directors Committee

• Quarterly updates provided to CEO, Board of Trustees and Ministry of Health

• Indicator added to organizational Strategic Plan and Scorecard for three-year cycle (April 2011-2013)

Stakeholder engagement

• Numerous meetings and presentations to internal staff, including nurses, doctors, allied health and support staff

• Presentation to Minister of Health

• Briefing note/budget submitted

• Regular meetings with Vice President

• Meeting with past President of NL Medical Association

• Presentations to Community Medical Advisory Committee

• Department of Health Sponsor / meetings with Wait Time Management Coordinator

Strong management and clinical leadership

• Project Steering Committee established

• Direct reporting to Vice President

• Director & Clinical Chief of Surgery - Project Sponsors

• Project Lead hired to support project

Dedicated and stable decision making and management structures

• Advisory Committee established

• Project Team

• Director & Clinical Chief members of Advisory Committee

Consultation with frontline actors

• Presentation to Orthopedic Education Days and Surgical Rounds

• Weekly meetings with frontline stakeholders to establish algorithm for new referral practice, including clerical staff, allied health disciplines and managers

• Monthly consultation and in-servicing to relevant program staff along the continuum

• Standard Referral Working Group

• Inpatient Working Group

• Orthopedic Charge Nurses, clinical staff participating in site visits

• Established formal orientation package for assessment by clinic staff

• Assessment clinic education day organized to facilitate clinical skills upgrading and clinical practice review

• Cross-site / multi-program working group

• Meetings with surgeons’ secretaries

Physician involvement

• Presented at Surgical Teaching Rounds

• Meeting with each surgeon individually

• Physician sponsors/ champions identified

• Developed a broad based communication strategy targeting multiple mediums to facilitate physician engagement and communicate planning including:

 ✓ Visits to urban and rural family physician clinics

 ✓ Family Physicians invited to participate in developing algorithm for changes to referral practices prior to development of referral tool

 ✓ Anesthetists / surgeons working group

 ✓ Teleconferences / site visit for anesthetist

• Surgeon Champion appointed to establish strong leadership and obtain buy-in for Central Intake Process

• Provincial Medical Association engagement: collaboration with the Communications team to communicate central intake information tools and updates to physicians via web-based media and provincial newsletters to membership

Funding levels and earmarked resources

• Budget request for Project Team 2011/2012 - approved

• Department of Health funding for Project Lead

• Health Canada funding obtained

Appropriate levels of dedicated staffing

• Increased staffing to facilitate enhanced clinical capacity for assessment clinic and to establish formal interdisciplinary case management

• Funding secured for two-year pilot with dedicated staff

• Project Lead - funded for additional year

• Clerical Position allocated for data collection

Flexible, adequate capacity

• Orthopedic clinic space renovation: increased space for increased clinic capacity by nine half-day slots

• Evaluation of existing clinical booking practice to redistribute patient ratios, improve efficiency, and increase capacity

• Additional orthopedic operating room capacity assigned (34% increase including dedicated trauma time)

• Additional inpatient bed capacity

Individual and unit/team incentives

• Adult Orthopedic Team - CEO Award for Team Excellence

• ‘Improving Access’ poster presentation selected for Taming of the Queue, 2012 – Ottawa.

• Key performance indicators collected and shared with team to support improvement

Central Registries (the collection and standardization of data)

• Wait Time 1 defined

• Data fields incorporated into standardized referral tool to collect Wait Time 1

• Central Intake Registry established

• Orthopedic Wait List Data Value Stream Map Session: Full day event organized for all stakeholders

Standards and guidelines

• Development of algorithms, pathways for central intake process

• Evaluation Framework developed

• Guidelines for completion of standardized referral tool

• Definitions for Wait 1 and Wait 2

Information Management Systems

• Represented on working group

• Meetings with IMT representative ongoing

• Site Visit (Holland Clinic, Toronto) for demonstration of

• Central Intake Booking System

Training and support

• Site visits to Edmonton, Halifax, Toronto, and Vancouver

• Participation in National Best Practice Initiative – Bone and Joint Canada: representation from all allied health disciplines, surgeons and medical staff.

• Best Practice Toolkit introduced: Bone and Joint Canada coordinators invited to participate in multisite education event