Today I spoke about the Wait Times Benchmark project at the annual meeting of the Ordre des orthophonistes et audiologistes du Québec. I am very grateful to Philippe Fournier (past president of the Quebec Association of Speech Language Pathologists and Audiologists) for arranging for us to present on this topic and I hope that he is successful in motivating Quebec speech-language pathologists and audiologists to get involved in this project. Today I will continue with the promised series of blog posts on wait time recommendations to mark this occasion. Philippe and I talked about three topics in our presentation today (definition of a benchmark, approaches to developing a wait times benchmark and how to achieve recommended wait times). In this blog I will cover the question of what a benchmark is and what it is not in the context of wait times recommendations. This is the second in the series of blog posts.

1. Introduction to the Wait Times Benchmarks Project
2. What is a Benchmark?

In literal terms a benchmark  is a “point of reference” against which similar things can be compared or measured. With this definition in mind it can be seen why the development of benchmarks was an essential first step in the drive to improve access to speech, language, swallowing and hearing services across Canada. It would be quite impossible to evaluate the efficacy of strategies for improving wait times without first identifying benchmarks for reasonable wait times that apply in a consistent fashion across geographical boundaries, sectorial jurisdictions and diagnostic groupings. It is not expected that recommending a benchmark wait time will by itself result in improvements in wait times for services. However, by providing a clear target and a means of measuring progress toward achievement of that target the benchmarks will be an important strategy for ensuring fair and reasonable wait times for services across Canada. We can expect that progress toward a benchmark for a given diagnostic grouping will be gradual and most likely uneven across different service providers. Nonetheless, repeated measurement of incremental change toward achievement of a common benchmark will have an impact that would not be observed with every jurisdiction measuring wait times according to criteria that are adjusted for each specific time and place.

Over the next 9 blogs we will expand upon the nature and role of the benchmarks in some depth. It may be useful to begin by reflecting on what a benchmark is not however. First it is important to understand that a benchmark is not a regulation. Some countries do have legally enforceable wait times guarantees for some health care services. A benchmark is not a guarantee however – it is merely a tool for measuring achievement of a goal. It might be desirable to have legally enforceable wait times guarantees for some services but obviously SAC and the Pan Canadian Alliance cannot enact such regulations and it would be up to patient groups to lobby their governments to implement any such measures. Second, a benchmark wait time recommendation is not a standard of care or a practice guideline. It is recognized that there may be variations in the application based on the needs of individual patients and the unique circumstances of the service provider. However, the standard reference allows for measurement of improvements in wait times overall and comparisons among jurisdictions in the rate of improvement toward the achievement of the recommended wait times. Finally, the benchmarks are not static: although the principles underlying the development of the benchmarks should be stable the recommended wait times themselves could be adjusted to reflect new information as it comes available in the future.

In the next blog post, approaches to developing wait times benchmarks will be discussed and the process adopted by the Pan Canadian Alliance of Speech- Language Pathology and Audiology Organizations will be outlined. The blog posts to come will expand upon the basic underlying principal, taken from the Health Council of Canada “which it defines a benchmark simply as a recommended maximum wait time” with the added explanation that “maximum means that the wait time is not associated with an increased incidence of negative outcomes.”

Upcoming Posts

3. Approaches to Developing Wait Times Benchmarks
4. Evidence Based but not Evidence Bound
5. Use of Benchmarks by Clinicians and Policy Makers
6. Potential Advantages of Having Wait Times Benchmarks
7. Potential Disadvantages of Having Wait Times Benchmarks
8. Strategies for Achieving Wait Times Benchmarks
9. Factors that Impact on the Achievement of Wait Times Benchmarks
10. Role of the Pan Canadian Alliance and SAC in the Achievement of Wait Times Benchmarks