WCWL - Evaluation Plan

While implementation of the tools is clearly the jurisdiction of the health regions and provinces, WCWL partners have assisted the providers in designing and carrying out the evaluation described here. Evaluation is embedded within the implementation plans.

There are three stages to the implementation and evaluation process:

	Stage 1 - Pre-implementation assessment of the preparedness for evaluation
	Stage 2 - Scoring of patients without prioritization
	Stage 3 - Full implementation and scoring of patients with prioritization

Before proceeding, a full evaluation protocol is developed for each application and is submitted to the appropriate academic and hospital ethics review boards for assessment.

The purpose of this stage is to document essential baseline information describing how the current system works for comparison with full-scale implementation, and to set the groundwork and initiate planning for evaluation activities of Stages 2 and 3.

In Stage 1 we identify the factors that should be monitored in Stages 2 and 3 to inform decisions by regional health authorities about proceeding with implementation. This includes clarifying the factors that are critical to understanding the impact and feasibility of implementing the tools. The final element of this stage is to determine the evaluation logistics by addressing the following questions:

	How extensive should the monitoring and evaluation be?
	What data sources are available?
	How will the evaluation proceed in the region in concert with implementation?

A checklist of items to be included in a Stage 1 evaluation has been developed. Once this stage is complete, the local authority would proceed to the next.

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The purpose of this Stage is to generate practical and timely evidence that will inform the health authority's decision to progress to future stages of implementation. Stage 2 will provide baseline data to allow regions to monitor whether the tool works effectively to prioritize patients in their setting (Stage 3).

In addition, stage 2 provides new data and the opportunity to assess the validity and reliability of the tool in a real-world setting. The item weighting can be re-examined. Input from patients, where feasible, can be obtained and baseline data is generated for the before/after design that will address WCWL research questions:

	Do patients with lower point-scores have longer wait times with implementation?
	Do patients with higher point-scores have shorter wait times with implementation?
	Fully implemented, is this system better than not scoring and prioritizing?

In Stage 2, the appropriate specialist scores the patients using the WCWL tool in the course of an assessment for surgery, admission to a specific program, etc. The date of the assessment is recorded as are the responses to the WCWL prioritization tool items, and the patient is followed to their intervention. The date of intervention is recorded, allowing the measurement of actual patient waiting time associated with an urgency score or range of scores.

In Stage 2, the health authority can evaluate implementation logistics, 'buy-in' by participants, acceptability of the tool, and critical success factors (e.g. compatibility with existing information systems and management practices.

At the conclusion of Stage 2, evidence is available allowing the authority to determine whether to, and how best to, move forward with full implementation (Stage 3) or use of the tools to manage wait lists.

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