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Long wait times for scheduled surgery are a major problem in Canadian health systems. We sought to determine the extent to which single-entry referral models (next available consultation), team-based care models (next available surgery regardless of consulting surgeon), or both could affect wait times for consultations and surgery. We performed a discrete-event simulation study of wait times for consultations and surgeries for knee and hip joint replacement in Ontario’s 5 postal regions using prospectively collected data on surgical wait times. We simulated the effects of coordinated referral models on the wait time for consultation (wait 1) and surgery (wait 2). Coordinated models led to larger reductions in high-outlier wait times (as reflected by the 90th percentile and the percentage of patients exceeding wait-time targets) than on median wait times when compared with the status quo. Single-entry referral models largely influenced wait 1, and team-based models of care affected only wait 2. Fully integrated models incorporating both single-entry referral and team-based care largely prevented patients from exceeding both wait-1 and wait-2 targets; the percentage of patients exceeding wait-1 targets in these models was 0% in all regions, and the percentage exceeding wait-2 targets was 0% except for Ontario West (2.0%, from 35.7% at baseline), East (1.1%, from 22.7% at baseline), and North (1.0%, from 25.1% at baseline). Coordinated referral and practice models improve access to scheduled surgery in Canadian health systems. Implementation of these models could largely eliminate prolonged wait times for joint replacement surgery in Ontario.

Background: Long wait times for scheduled surgery are a major problem in Canadian health systems. We sought to determine the extent to which single-entry referral models (next available consultation), team-based care models (next available surgery regardless of consulting surgeon), or both could affect wait times for consultations and surgery. Methods: We performed a discreteevent simulation study of wait times for consultations and surgeries for knee and hip joint replacement in Ontario's 5 postal regions using prospectively collected data on surgical wait times. We simulated the effects of coordinated referral models on the wait time for consultation (wait 1) and surgery (wait 2). Results: Coordinated models led to larger reductions in high-outlier wait times (as reflected by the 90th percentile and the percentage of patients exceeding wait-time targets) than on median wait times when compared with the status quo. Single-entry referral models largely influenced wait 1, and team-based models of care affected only wait 2. Fully integrated models incorporating both single-entry referral and team-based care largely prevented patients from exceeding both wait-1 and wait-2 targets; the percentage of patients exceeding wait-1 targets in these models was 0% in all regions, and the percentage exceeding wait-2 targets was 0% except for Ontario West (2.0%, from 35.7% at baseline), East (1.1%, from 22.7% at baseline), and North (1.0%, from 25.1% at baseline). Interpretation: Coordinated referral and practice models improve access to scheduled surgery in Canadian health systems. Implementation of these models could largely eliminate prolonged wait times for joint replacement surgery in Ontario.

Interpretation: Coordinated referral and practice models improve access to scheduled surgery in Canadian health systems. Implementation of these models could largely eliminate prolonged wait times for joint replacement surgery in Ontario.

M thodes : Nous avons analys les r seaux d'aiguillage des patients et patientes entre les m decins traitants et les sp cialistes en chirurgie pour des interventions courantes planifi es de 2016 2019 partir de banques de donn es administratives ontariennes. Nous avons d crit l'appariement m decin traitant-sp cialiste en chirurgie l'aide de mesures descriptives et d'une repr sentation graphique des r seaux d'aiguillage.

M thodes : Nous avons analys les r seaux d'aiguillage des patients et patientes entre les m decins traitants et les sp cialistes en chirurgie pour des interventions courantes planifi es de 2016 2019 partir de banques de donn es administratives ontariennes. Nous avons d crit l'appariement m decin traitant-sp cialiste en chirurgie l'aide de mesures descriptives et d'une repr sentation graphique des r seaux d'aiguillage.

Little is known about the existing structure and function of referral networks in the prevalent referral system for specialized surgical care in Canada, which is based on direct physician referral to specialists in a largely unmanaged referral marketplace. Our objective was to describe and analyze the referral networks of referring physicians and surgeons for common surgical procedures in Ontario, to better understand potential barriers to single-entry models. We analyzed referral networks for patients between referring physicians and surgeons for 9 common scheduled surgical procedures from 2016 to 2019 using administrative data sources in Ontario. We described the connectedness of referring physician-surgeon pairs using descriptive measures and graphical social network analysis. The median number of surgeons connected to a referring physician for patients having a particular surgical procedure ranged from 1 (interquartile range [IQR] 1-3) for spine surgery to 3 (IQR 1-4) for knee arthroplasty and 3 (IQR 2-5) for noncancer uterine procedures. Referral network structure varied according to the procedure studied. Spine surgery was highly clustered with a small number of larger groups; gallbladder, inguinal hernia, and noncancer uterine surgery were highly distributed with many small groups within the referral network. Breast cancer surgery occurred in a largely distributed network, but with a skewed distribution reflecting a few small groups with large numbers of patients. Improving surgical wait times by coordinating surgical referrals will require approaches that address the structure of existing referral networks. Most physicians refer their patients to a very small number of surgeons, suggesting that referring physicians largely do not individualize referrals to multiple different surgeons based on specific patient characteristics.

Over the past decade much of the leadership literature addressed the skills required for effective Chief Executive Officers (CEOs) within the Business Sector as a result of the corporate scandals that occurred in the United States. The literature introduced the construct of Authentic Leadership as a means for CEOs to build enduring organizations, keep their employees motivated and inspired, and ultimately fostering organizational commitment. Within the past eight years more of the literature on leadership within the Healthcare Sector had recognized that Authentic Leadership had the ability to impact organizational performance and sustainability when the CEO had insight into their performance, their strengths and weaknesses, and were focused on their organization’s strategy, structure and culture. Thus, this qualitative study was designed to examine 14 healthcare CEO’s self-perceived level of Authentic Leadership and its alignment with their followers’ perception. The study was conducted in Ontario, Canada. The researcher used the Authentic Leadership Questionnaire (ALQ), one on one interviews with each CEO and a minimum of five of their followers. In addition, each CEO was required to complete a self-study on leadership to determine whether or not the CEO’s perception of the value of Authentic Leadership changed after the self-study. The researcher found that all of the CEOs were true to self, led with integrity, conducted themselves morally and ethically and recognized the impact of their leadership upon their team’s and their organization. This study provided the 14 CEOs with new learning regarding the value of Authentic Leadership and its impact on organizational performance.