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	About WCWL A Summary

Overview
Introduction
Activities
Final Reports
Key Findings
Implications
WCWL_2
Communication

The work of the Western Canada Waiting List Project can be conveniently categorized as WCWL_1 or WCWL_2. Funded through Health Canada's Health Transition Fund, WCWL_1 began in 1999 and ended in 2001 with the development of wait list management tools in five clinical areas. With funding from Health Canada and the four Western Canadian Provinces, the second phase of work, WCWL_2, began in 2002 and is expected to be completed late in 2004.

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In recent years, there has been increasing media coverage of the length of time patients wait for access to medical services, and waiting lists are often assumed to be indicative of general inadequacy in the Canadian health care system. In 1998 Health Canada reported that, with rare exceptions, waiting lists are non-standardized, capriciously organized, and poorly monitored. As a result, most waiting lists were, at best, misleading sources of data on access to care, and at worst instruments of misinformation. When waiting list data are carefully and accurately compiled, and routinely monitored, the public clearly benefits.

The Western Canada Waiting List Project (WCWL) was developed with a mission to improve the fairness of the health care system so that Canadians' access to appropriate and effective medical services is prioritized on the basis of need and potential to benefit. Specifically, it sought to develop physician-scored, valid, reliable, practical, and clinically transparent measures of patients' priority for selected wait-listed services. This approach could be extended to other procedures and interventions where waiting and access is problematic.

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WCWL is a collaborative undertaking by medical associations, ministries of health, regional health authorities, and health research centres. Five areas of investigation (children's mental health, cataract surgery, general surgery, hip/knee replacement surgery, and MRI scanning) were chosen to permit a comprehensive evaluation of waiting list issues across a broad case-mix. Each tool was developed by a clinical panel consisting of family physicians, medical specialists, health administrators, and researchers relevant to each field. The draft tools were tested in clinical practice. Additional activities included: 1) an assessment of the potential for implementation of the WCWL priority tools in seven Western Canada regional health authorities, and 2) an assessment of public opinion regarding the tools and their potential for implementation.

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A Final Report entitled, From Chaos to Order - Making Sense of Waiting Lists in Canada, was published in March 2001. A companion volume of Appendices was released at the same time.

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	Priority-criteria tools for the five clinical specialty areas were successfully developed, and were able to discriminate between differing levels of patient urgency and ability to benefit. Extensive consultation and testing found the tools to be valid and practical.
	The results indicate that clinicians, administrators, and the public accept that better management of waiting lists is possible and appropriate, and that the work of WCWL has provided some of the essential elements.

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	The partnership of medical associations, ministries of health, research centres, and regional health authorities unanimously endorsed the project's work, and remains committed to taking the next steps.
	WCWL has made significant progress in the development of valid, reliable, practical, and clinically transparent measures for prioritizing patients in five clinical specialty areas. It has also carried out additional work to assess the environmental impact and public acceptance of these tools and processes.
	Recommended next steps include implementing and evaluating the tools in real-world settings; developing acceptable waiting times; considering implementation options, change management strategies, and information system requirements; expanding the scope of the tools within and across specialties; and collaborating in the development of standard measures and definitions for waiting times.

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Work on the objectives of WCWL_2 began in April 2002; these include implementation and evaluation of the waitlist management tools, development of standardized maximum acceptable waiting times linked to WCWL tool scores, and adaptation of the WCWL tools for use by primary care providers. Financial support for these projects is provided by Health Canada, Manitoba Health, Saskatchewan Health, Alberta Health & Wellness, and the British Columbia Ministry of Health Services.

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