{ echo "Merry Christmas!" }
else
{ echo "Happy Holidays!" }
//but we prefer: "Merry Christmas!" :)
Warmest wishes from ThinkOR.org
an exchange corner for the OR professionals, an OR information source for the general public
In practice, IT always needs an "end state" to the requirements of a project in order to start the development and testing process. However, in O.R. there is never a true "end state", since O.R. is constantly changing to find the optimal model. By nature, this is a cause of conflict and frustration between O.R. and IT.Am I being silly or is this a prime candidate for the well-known agile development by iteration? Wait, isn't Google doing this constantly with their beta release of products?
We cannot overemphasize the value of this type of spreadsheet demonstration in selling the potential of an OR model.Interestingly enough their experience differs from my own. I tried to convince an utlrasound department supervisor that if average-45-minute appointments of uncertain lengths are booked every 45 minutes, her technologists would reliably work overtime. To do this I built a simple spreadsheet simulation, but it was totally lost on her. This is not meant as a knock against this approach, but rather to emphasize the importance of manager familiarity with spreadsheets. My ultrasound supervisor as a senior medical radiation technologist thinks differently from a rising Canadian Colonel.
Beginning with the worst example I saw in my research, we look at the Nova Scotia Department of Health Website. Waiting times are reported by authority and by facility, important data for individuals seeking to balance transportation with access. However, it's how the wait times are measured that worries me the most. Waiting time is defined as the number of calendar days from the day the request arrives to the next available day with three open appointments. I have found that this is the traditional manner in which department supervisors like to define waiting lists, but at a management level it's embarrassingly simplistic. At the time of writing, the wait time at Dartmouth General Hospital for a CT scan is 86 days. I guarantee you that not every patient is waiting 86 days for an appointment. Not even close. Neither is the average 86 days, nor is the median 86 days. The question of urgency requires that we discuss our level of access for varying urgencies. Additionally, there's the fact that 3 available appointments 86 days from now says nothing about what day my schedule and the hospital's schedule will allow for an appointment. If there's that much wrong with this measurement method, then why do they do it? The simple fact is that it is very easy to implement. In healthcare where good data can be oh so lacking, this system of measuring "waiting lists" is cheap and easy to implement. No patient data is required, one needs simply to call up the area supervisor or a booking clerk and ask for the information. So hats off to Nova Scotia for doing something rather than nothing, which indeed is better than some of the provinces, but there's much work to be done.
Next, we'll look at the Manitoba Health Wait Time Information website. Again we have data reported by health authority and facility. Here we see the "Estimated Maximum Wait Time" as measured in weeks. The site says, "Diagnostic wait times are reported as estimated maximum wait times rather than averages or medians. In most cases patients typically wait much less than the reported wait time; very few patients may wait longer." If this is true, and it is, then this is pretty useless information, isn't it? Indeed I am reconsidering my accusation of Nova Scotia being the worst of the lot. If this information represents something like the 90th or 95th percentile then I apologize because, as I discuss later, this is a decent figure to report. However, it is not explicitly described as such.
Heading west to Alberta, we visit the Alberta Waitlist Registry. Here we can essentially see the waiting time distribution of most patients scanned in MRI or CT accross the province in the last 90 days. The site reports the "median" (50th) and "majority" (90th) percentiles of waiting time. It then follows to report the % of patients served in <3>18 months. What is lacking in this data is two key elements. For one, both day patients and in patients are included in this data. This means that both the patient waiting for months to get an MRI on their knee and the patient waiting for hours to get one on their head are treated as equal. Patients admitted to the hospital and outpatients experience waiting times on time scales of different orders of magintude and should not be considered together. The percentage of patients seen in less than 3 weeks must therefore include many inpatients and thus overstates their true level of service. The other key element is the notion of priority. Once again, for an individual in the population looking for information about how long they might wait or for a manager/politician looking to quantify what the level-of-care consequences are of current access levels, this data isn't very useful because it lacks priority. If urgent patients are being served at the median waiting time, this shows significant problems in the system, but without data reported by urgency, we can only guess that this is being done well. As someone who has seen it from the inside, I would NOT be confident that it is.
Now I return to what westerners would rather not admit is the heart of Canada, Ontario and the Ontario Ministry of Health and Long-Term Care website. This site measures wait times in terms of the time between request and completion. It reports the 90th percentile wait times in days by facility and provincially and calls it the "point at which 9 out of 10 patients have had their exam." The data excludes inpatients and urgent outpatients scanned the same-day, addressing a critical issue I had with the Alberta data. Priorities are lacking, but with a little digging you can find the province's targets by priority, so there is, perhaps, hope. Reporting the 90th percentile seems like a good practice to me. With the funky distributions we seen when measuring waiting times, averages are certainly of no use. Additionally the median isn't of great interest because this is not an indication what any one individual's experience will be. This leaves the 90th percentile which expresses what might be called a "reasonable worst case scenario".
Finally I turn to the organization whose explicit business is communicating complex issues with the public, the Canadian Broadcasting Corporation. Their CBC News Interactive Map from November 2006 assigned letter grades from A-F converted from %ages of the population that were treated within benchmark. Who knows if this is glossing over the lack of priority data or if it includes the %age that met the benchmark for each priority, but it's a start. Letter grades given were: BC N/A, AB D, SK N/A, MN F, ON C, QC N/A, NB N/A, NS N/A, PEI F, NF N/A. So with over half not reporting, there wasn't much they could do.
How could analysis and Operations Research help us foresee trends and make intelligent and informed political decisions? Philip Sharp, the president of Resources for the Future, former Congressman from Indiana, US House of Representatives, attempts to answer this question in the Doing Good with Good OR series of plenaries. The humble but frank former congressman speaks to the scientific crowd about the importance of rigorous analysis for important political issues. Furthermore, Sharp elaborates on the institutional connections and the ability to communicate complex issues simply as the crucial factors to make the analysis matter.
