An Achilles' heel of Canadian Medicare is long waits for elective services. The Western
Canada Waiting List (WCWL) project is a collaboration of 20 partner organizations committed to
addressing this issue and influencing the way waiting lists are structured and managed. The focus of the
WCWL project has been to develop and refine practical tools for prioritizing patients on scheduled
Scoring tools for priority setting were developed through extensive clinical input and highly iterative
exchange by clinical panels constituted in five clinical areas: cataract surgery; general surgery
procedures; hip and knee replacement; magnetic resonance imaging (MRI) scanning, and children's mental
health. Several stages of empirical work were conducted to formulate and refine criteria and to assess
and improve their reliability and validity. To assess the acceptability and usability of the
priority-setting tools and to identify issues pertaining to implementation, key personnel in the seven
regional health authorities (RHAs) participated in structured interviews. Public opinion focus groups
were conducted in the seven western cities.
Point-count scoring systems were constructed in each of the clinical areas. Participating clinicians
confirmed that the tools offered face validity and that the scoring systems appeared practical for
implementation and use in clinical settings. Reliability was strongest for the general surgery and hip
and knee criteria, and weakest for the diagnostic MRI criteria. Public opinion focus groups endorsed
wholeheartedly the application of point-count priority measures. Regional health authorities were
generally supportive, though cautiously optimistic towards implementation.
While the WCWL project has not 'solved' the problem of waiting lists and times, having a standardized,
reliable means of assigning priority for services is an important step towards improved management in
Canada and elsewhere.
A full description of the development and testing of the five tools can be found in
the paper Waiting for scheduled services in Canada: development of priority-setting scoring systems T. W.
Noseworthy, J. J. McGurran, D. C. Hadorn and the Steering Committee of the Western Canada Waiting List
Project Journal of Evaluation in Clinical Practice Volume 9 Issue 1 February 2003