Operationalizing wait lists: Strategies and experiences in three hospital outpatient physiotherapy departments in Montreal

ABSTRACT

In Canada, limited resources and increasing demand place pressure on the public healthcare system, something that is likely to increase. In this context, wait lists in outpatient physiotherapy departments (OPD) will get longer, system inefficiencies will arise, and frustrations and ethical concerns will be experienced by patients and staff. To better understand the perceptions of OPD staff regarding priority setting, treatment frequency, treatment duration, and wait list management strategies, we conducted an Interpretive Description study involving semi-structured interviews in three OPDs in Montreal. Participants discussed factors that influenced their decision making about who was prioritized to receive care, strategies that were used to respond to an imbalance between needs and resources in the OPDs and procedures to manage wait lists to help improve access to care. While clinical needs are central in approaches to prioritization, other non-clinical factors relating to the patient, the physiotherapist, and the institution also influence decisions. We examine these findings through the lens of complexity theory, providing insight into opportunities and obstacles for the implementation of management strategies in OPDs. These strategies will need to be carefully evaluated in order to create evidence-based guidelines for wait list management in other settings.

KEYWORDS:

• Resource allocation
• priority setting
• wait list management
• treatment frequency
• treatment duration
• physiotherapy
• complexity theory
• Canada

Acknowledgments

The authors wish to thank Erin Douglas, Catherine Olivier, Anne Hudon, Emilie Bishop, Katherine Tousignant, and Tatiana Orozco for their involvement as research assistants. The authors also thank the research participants and the physiotherapy departments involved in this study. Maude Laliberté holds a doctoral fellowship from the Fonds de recherche du Québec-Santé (FRQ-S). Matthew Hunt is supported by a Research Scholar award from the FRQ-S.

Conflict of interest

The authors declare that they have no conflict of interest in relation to this study.

Additional information

Funding

Financial support for this work was also received from the Canadian Institutes of Health Research (CIHR-grant number EOG-120255) and Edith Strauss Foundation.