D'Souza D P, Martin D K, Purdy L, Bezjak A, Singer P A
Department of Radiation Oncology, Hamilton Regional Cancer Centre, McMaster University, Canada.
BMC Health Serv Res. 2001;1:3. doi: 10.1186/1472-6963-1-3. Epub 2001 Apr 17.
Why waiting lists arise and how to address them remains unclear, and an improved understanding of these waiting list "dynamics" could lead to better management. The purpose of this study is to understand how the current shortage in radiation therapy in Ontario developed; the implications of prolonged waits; who is held accountable for managing such delays; and short, intermediate, and long-term solutions.
A case study of the radiation therapy shortage in 1998-99 at Princess Margaret Hospital, Toronto, Ontario, Canada. Relevant documents were collected; semi-structured, face-to-face interviews with ten administrators, health care workers, and patients were conducted, audio-taped and transcribed; and relevant meetings were observed.
The radiation therapy shortage arose from a complex interplay of factors including: rising cancer incidence rates; broadening indications for radiation therapy; human resources management issues; government funding decisions; and responsiveness to previous planning recommendations. Implications of delays include poorer cancer control rates; patient suffering; and strained doctor-patient relationships. An incompatible relationship exists between moral responsibility, borne by government, and legal liability, borne by physicians. Short-term solutions include re-referral to centers with available resources; long-term solutions include training and recruiting health care workers, improving workload standards, increasing compensation, and making changes to the funding formula.
Human resource planning plays a critical role in the causes and solutions of waiting lists. Waiting lists have harsh implications for patients. Accountability relationships require realignment.
等候名单为何出现以及如何应对尚不清楚，更好地理解这些等候名单的“动态变化”可能会带来更好的管理。本研究的目的是了解安大略省目前放疗短缺的情况是如何形成的；长时间等待的影响；谁应对管理此类延误负责；以及短期、中期和长期的解决方案。
对加拿大安大略省多伦多市玛格丽特公主医院1998 - 1999年放疗短缺情况进行案例研究。收集相关文件；对十名管理人员、医护人员和患者进行半结构化面对面访谈，进行录音并转录；观察相关会议。
放疗短缺是由多种因素复杂相互作用导致的，包括：癌症发病率上升；放疗适应症扩大；人力资源管理问题；政府资金决策；以及对先前规划建议的响应情况。延误的影响包括较差的癌症控制率；患者痛苦；以及医患关系紧张。政府承担的道德责任与医生承担的法律责任之间存在不相容关系。短期解决方案包括将患者重新转诊至有可用资源的中心；长期解决方案包括培训和招募医护人员、改善工作量标准、增加薪酬以及改变资金分配方案。
人力资源规划在等候名单的成因及解决方案中起着关键作用。等候名单对患者有严重影响。问责关系需要重新调整。
